Shweta Sharma

Samaan Lateefin Mumbai

Two cases of Nipah virus, a rare, bat-borne pathogen, have been confirmed in an Indian hospital, prompting a nationwide alert as well as local quarantine and surveillance measures.

The cases, both in nurses working at the private Narayana Multispeciality Hospital in Barasat,  West Bengal, 16 miles from the capital city Kolkata, have raised fears that the disease, which inspired the Hollywood film  Contagion, could be spreading undetected.

&ldquo Two nurses at a private hospital are infected with Nipah virus, and one of them is in critical condition,&rdquo Mr Narayan Swaroop Nigam, Principal Secretary, Health and Family Welfare Department, West Bengal, told The Telegraph.

The pair were on duty together between December 28 and 30. Between December 31 and January 2, they developed high fevers and respiratory distress and were admitted to the hospital&rsquo s intensive care unit on January 4 after their conditions worsened.

Initial investigations suggest that both nurses, one of whom is in a coma, caught the virus while treating a patient with severe respiratory symptoms who later died before testing could be carried out, sources at the hospital said.

&ldquo The most likely source of infection is a patient who had been admitted to the same hospital previously. That individual is being treated as the suspected index case, and investigations are ongoing,&rdquo said a senior health official involved in West Bengal&rsquo s Nipah surveillance efforts.

The outbreak prompted the health authorities to impose quarantine and emergency surveillance  and contact tracing measures in the area.

So far 180 people have been tested and 20 high risk contacts quarantined.

&ldquo All of them are asymptomatic and tested negative. We will again test them before their 21-day quarantine ends,&rdquo Mr Nigam said.

 

India&rsquo s Ministry of Health and Family Welfare issued a nationwide alert, urging states to strengthen surveillance, detection, and preventive measures to reduce risk and prevent any further spread.

India has faced sporadic outbreaks of Nipah in recent years. The virus lives in bats and can be passed to humans through contaminated food or by contact with the bodily fluids of infected animals. It can also jump from bats to pigs, opening up another route for onward transmission to people, where it spreads from person to person through droplets and saliva.

The virus  has a fatality rate of up to 75 per cent  and causes a range of symptoms, beginning with a fever, vomiting and fatigue before developing into respiratory issues and swelling of the brain. Neurological issues like encephalitis can appear months or years after an initial infection

In response to the new cases, several Indian states have directed their health authorities to strengthen surveillance for Acute Encephalitis Syndrome (AES), a broad term for brain inflammation that can be caused by Nipah infection.

&ldquo Persons admitted with AES, particularly those with travel or contact history linked to West Bengal, should be closely monitored and evaluated for possible Nipah virus infection,&rdquo reads one advisory issued by the authorities in Tamil Nadu, a state in southern India.

&ldquo Government and private hospitals must be alerted about the Nipah virus situation and directed to promptly notify all AES cases,&rdquo it said.

The focus on examining cases of AES will help stop undiagnosed Nipah infections from flying under the radar, said Ali Althaf, a senior health official at Government Medical College, Thiruvananthapuram in Kerala, who has done extensive work on the Nipah virus.

&ldquo There were over 100 cases of AES, a key indicator for diseases like Nipah, reported last year in Kerala, and if we subjected all of them to diagnostic testing, it&rsquo s plausible that we&rsquo d uncover a greater number of Nipah infections,&rdquo he told The Telegraph.

Misidentifying Nipah infections as AES or as other respiratory illnesses has serious consequences, particularly for healthcare providers, he added.

&ldquo We have repeatedly seen human-to-human transmission occurring within hospital settings,&rdquo he said. &ldquo When cases are not recognised early, healthcare workers are placed at the highest risk of exposure to this often fatal virus.&rdquo

The senior health official involved in West Bengal&rsquo s Nipah surveillance efforts denied the initial case had been misdiagnosed, but conceded the case had probably been missed.

&ldquo I wouldn&rsquo t describe it as misdiagnosis. It&rsquo s more accurate to say a missed diagnosis,&rdquo he said.

He added: &ldquo We are expanding the criteria for testing so clinicians know when to suspect Nipah and when to order broader panels. This is not only about Nipah, several emerging and re-emerging infections, including respiratory diseases, can present with AES-like syndromes. The state is therefore expanding case definitions and lab testing protocols.&rdquo