10th May 2025 (13 Topics)
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Greater regularity: On the Nipah virus
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Context
A 42-year-old woman in Malappuram district, Kerala, tested positive for the Nipah virus, marking the third reported case in the district within two years. With previous spillovers and outbreaks, this recurrence underscores a growing epidemiological concern in the region.
Epidemiological Trends and Clinical Profiles
- Increasing Frequency of Occurrence: Kerala has recorded two outbreaks involving human-to-human transmission (2018 and 2023) and four spillovers (2019, 2021, and twice in 2024), suggesting a pattern of regular re-emergence.
- Clinical Variation in Presentations: Spillover cases mostly exhibit Acute Encephalitis Syndrome (AES), while outbreak cases involve Acute Respiratory Distress Syndrome (ARDS), which is linked with greater severity and transmissibility.
- Transmission Pathways and Severity Correlation: ARDS patients carry higher viral loads, especially in the throat, combined with cough symptoms, increasing the likelihood of human-to-human transmission, which correlates with fatality rates — 17 deaths out of 18 cases in 2018, and 2 out of 6 in 2023.
Virological Insights and Research Findings
- Genetic Mutation Concerns: The 2018 Nipah virus strain showed minor genetic differences from the Bangladesh strain, capable of causing multisystemic disease in animal models (Syrian hamsters), mimicking human pathology.
- Significance of Viral Load and Sample Type: Regardless of other biological samples, throat swabs consistently test positive in infected individuals, especially those with ARDS, making it a crucial indicator for transmissibility risk.
- Diversity in Viral Behaviour: The Nipah virus demonstrates a broad clinical spectrum and inconsistent transmissibility, necessitating continuous surveillance and genomic mapping to understand its evolving nature.
Policy Imperatives and Surveillance Strategies
- Routine Surveillance of Fruit Bats: As fruit bats are the natural reservoir of Nipah virus, systematic and periodic monitoring of their virology is essential for early warning systems and understanding zoonotic dynamics.
- Urgency for Open Genetic Data Sharing: To enable timely research and global collaboration, genetic sequences of the virus must be deposited in public databases, allowing real-time tracking of mutations.
- Need for Institutionalised Genomic Studies: A robust mechanism involving multi-institutional and interdisciplinary genomic surveillance, especially in high-risk zones like Kerala, is necessary to pre-empt outbreaks and refine policy responses.
Practice Question
Q. With the increasing regularity of Nipah virus spillovers and outbreaks in India, especially in Kerala, critically evaluate the need for genomic surveillance, zoonotic monitoring, and public health preparedness as part of India’s epidemic response strategy.
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