While we are grappling with the ongoing outbreak of Nipah, a rare and deadly virus, we get the doctors to talk about it who faced and detected the presence of Nipah for the first time.They tell us how it all unfolded.

 

 

 

 

 

 

 

Mohammed Salih was wheeled in to the emergency ward of Baby Memorial Hospital in Kozhikode, Kerala, on May 17 about 2.30 am. Dr Anoop Kumar AS, chief for critical care medicine at Baby Memorial Hospital, says his colleagues examined the patient and referred him to the ICU, suspecting a case of viral encephalitis. When Dr Anoop checked on Salih, the patient was highly unstable and his condition deteriorating fast. The clinical symptoms he exhibited were not in tune with viral encephalitis cases. And in spite of having a sophisticated ICU, they could not maintain the patient’s vitals.

Dr Chellenton Jayakrishnan, a neurologist, was the first to suspect Nipah virus could be responsible for the symptoms. Dr G Arun Kumar, head of the virology department at Manipal University, broke the mystery behind the fatal infection within 48 hours of extracting samples from the patient.

Salih’s father, who had been undergoing treatment at the same hospital, died on the morning of May 24. Since May 5, this is the fourth death in the family after brothers Sabith and Salih and their aunt Mariyam died of the infection. Now, Dr Anoop’s colleagues, Dr Ajith K Gopal and Dr Ganga Prasad are at the risk of a possible infection as they were not wearing the personal protection equipment (PPE) while examining Salih.

The key doctors involved in Salih’s case share their encounter with the Nipah virus.

 

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Dr Anoop Kumar AS, Chief for Critical Care Medicine, Baby Memorial Hospital

 

Contrary to the common symptoms of fever, Salih had high blood pressure and was sweating excessively. His heart rate was too high and we soon suspected that it was not a common infection. We then took his family history and learnt his brother had died after exhibiting similar symptoms about two weeks ago. Another two family members were suffering from fever. We immediately summoned the rest of them and got them admitted. My friend and colleague Dr Jayakrishnan, who examined the patient, also suggested this was a rare viral infection. I then called up my friend Dr Arun Kumar from the Virology department of Manipal University and sought his help. So a team from Manipal came down to our hospital and collected samples the same night.

The next day, Arun called up to say the samples tested negative for all other possible viruses and said an unusual and a fatal virus has been detected. He alerted us about the potency of the virus and cautioned us to be extremely alert. The information was passed on to the state health department and soon all things fell into place. Government issued the treatment and prevention protocol to contain the spread of the virus.

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Dr Chellenton Jayakrishnan, Consultant Neurologist, Baby Memorial Hospital

Salih was showing obvious symptoms of a viral encephalitis and I had worn the PPE while examining Salih, as standard protocol demands. However, his symptoms were not exactly like that of any known viral infection. He was having high blood pressure, which is not seen in patients in a comatose state, and areflexia, which is the absence of reflex, suggesting nerve damage. We had to rule out chances of rabies as we learnt the patient's brother had died of similar symptoms earlier, and that two more family members were suffering from fever. The only other possibility was Nipah virus infection, which was recorded to have similar symptoms.

When the samples were tested, Dr Arun unofficially confirmed it to be Nipah. We had never come across the Nipah infection in our medical life, though there were cases reported in two places in West Bengal. With no anti-viral therapy available against this virus, what we are giving is a supportive treatment. The source of the infection is still under investigation. However, early detection has helped us contain the spread of the disease to a great extent.

 

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Dr G Arun Kumar, Head of Virus Research Institute, Manipal University

 

On the afternoon of May 17, Dr Anoop called me and informed me about the situation. In India, the common viruses that cause encephalitis are Herpes Simplex, Japanese encephalitis, and Western Eye encephalitis. But these viruses cannot infect more than one in a family. When we got the samples, we immediately ruled out the common infections and soon we isolated the rare and dangerous Nipah virus. We at the institute were familiar with the Nipah virus as we had a training in Nipah virus detection in August.

The head of Center for Disease Control and Prevention, Atlanta, USA, had conducted the training programme at our institute. I immediately called the health department and Dr Anoop, telling them that the samples contained a rare and dangerous virus that could spread fast and asked them to take protection. We then contacted the National Institute of Virology, Pune, and sent the samples for re-confirmation. We detected the virus within 10 hours and that helped in containing the infection.

The million-dollar question is what’s the source of the virus.

Only one patient contracted the infection from the environment and the others were infected through him. So there is no need for any panic as the disease is not there in the community. We have stopped the spread and only those who would have picked up the infection early are left. The virus spreads only through body fluids and not through the air. The droplet spread could be stopped if a one-metre distance from the patient is maintained. The virus does not spread during incubation and only a sick patient could spread it. Bats are the natural hosts of the virus but we need to have a detailed investigation to establish the source. Our 34-member team at the institute is now comparing the Nipah infection in Kozhikode with similar outbreaks in Malaysia, Bangladesh, and India.

K Praveen Kumar is a freelance reporter and a member of 101Reporters a pan-India network of grassroots reporters.