25 May 2018

India: Nipah virus outbreak in Kerala

Confirmed cases of Nipah virus infection(NiV) including fatalities and hospital admissions, have been reported in the southern state of Kerala India: Nipah virus outbreak in Kerala

In May 2018, confirmed cases of Nipah virus infection(NiV) including fatalities and hospital admissions, have been reported in the southern state of Kerala [1, 2]. As of 25 May 2018, the Government of Kerala Directorate of Health Services has reported a total of 36 cases across 6 health districts: 14 confirmed and 22 suspected, including 11 confirmed deaths and one unconfirmed death [2]. Confirmed cases have been reported from Kozhikode and Malappuram districts only.

NiV is an emerging virus that spreads to humans from animals (a zoonosis) and most human infections result from direct contact with sick animals, particularly bats and pigs, or their contaminated environments. NiV can cause a range of illnesses from asymptomatic infection to acute respiratory illness and fatal encephalitis [3]. Treatment is limited to supportive care [4].

Eating or drinking fruit or fruit products (such as raw date palm juice) contaminated with urine/saliva from infected fruit bats is a likely source of infection [3, 4]. Transmission also occurs from direct exposure to infected bats [4]. Limited human to human transmission of NiV has also been reported among family and care givers of NiV patients, including in hospital settings [3, 4].

Advice for travellers

The risk to tourists to southern India is currently very low if standard precautions are taken, but the risk to other UK travellers (such as those visiting friends and family) in Kerala may be higher, depending on activities undertaken.

There is currently no licenced vaccine to protect against NiV [3, 4]. If you are travelling to risk areas, pay careful attention to personal hygiene, and avoid contact with animals, especially bats and pigs, as much as possible. Gloves and other protective clothing should be worn if handling sick animals or their tissues, and during slaughtering and culling procedures [3, 4].

Raw or partially fermented date palm juice should be boiled and all fruit should be thoroughly washed with clean water and peeled before consumption. Close, unprotected physical contact with people with NiV infection should be avoided. Regular hand washing should be carried out after caring for or visiting sick people [3].

Check the Government of Kerala Directorate of Health Services for further travel advisories.

To help ensure a safe and healthy trip, travellers planning to visit in India can check TravelHealthPro India country page for current health advice.

Travellers are also advised to arrange an appointment with their GP, Practice Nurse, Pharmacist or travel clinic for current travel health advice and to ensure they are in-date for all recommended travel and routine UK vaccines.

Advice for health professionals

Healthcare professionals should be aware of the signs and symptoms of NiV and obtain a travel history when assessing patients. Specialist advice must be sought when persons suspected of having NiV are evaluated. Information about diagnostic tests is available from Public Health England (PHE).

PHE’s Imported fever service offers medical professionals managing returned travellers with fever 24-hour, seven days a week telephone access to expert clinical and microbiological advice to support management of febrile patients, infection control and public health interventions.

Health professionals caring for patients with suspected or confirmed NiV infection, or handling specimens from them, should implement standard infection control precautions at all times. As human-to-human transmission, in particular hospital (nosocomial) transmission has been reported; contact and droplet precautions should be used in addition to standard precautions [3].

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