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Case Reports
. 2022 Feb 17:10:818545.
doi: 10.3389/fpubh.2022.818545. eCollection 2022.

Nipah Virus Outbreak in Kerala State, India Amidst of COVID-19 Pandemic

Pragya D Yadav  1 , Rima R Sahay  1 , Anukumar Balakrishnan  2 , Sreelekshmy Mohandas  1 , Chandni Radhakrishnan  3 , Mangesh D Gokhale  1 , R Balasubramanian  2 , Priya Abraham  1 , Nivedita Gupta  4 , A P Sugunan  2 , Rajan Khobragade  5 , Kalpana George  6 , Anita Shete  1 , Savita Patil  1 , Ullas Padinjaremattathil Thankappan  1 , Hitesh Dighe  1 , Jijo Koshy  2 , Vivek Vijay  2 , R Gayathri  3 , P Jayesh Kumar  3 , Asma Rahim  7 , A Naveen  8 , Sarala Nair  9 , V R Rajendran  10 , V Jayasree  11 , Triparna Majumdar  1 , Rajlaxmi Jain  1 , Prasanth Viswanathan  6 , Deepak Y Patil  1 , Abhinendra Kumar  1 , Dimpal A Nyayanit  1 , Prasad Sarkale  1 , Ashwini Waghmare  1 , Shrikant Baradkar  1 , Pranita Gawande  1 , Poonam Bodke  1 , Kaumudi Kalele  1 , Jyoti Yemul  1 , Sachin Dhaigude  1 , Manjunath Holepannawar  1 , Sanjay Gopale  1 , Ganesh Chopade  1 , Shilpa Ray  1 , Priyanka Waghmare  1 , Jitendra Narayan  4 , Basavaraj Mathapati  1 , Manoj Kadam  1 , Abhimanyu Kumar  1 , Annasaheb Suryawanshi  1 , Beena Philomina Jose  6 , Saritha Sivadas  6 , N P Akash  6 , T V Vimisha  6 , K V Keerthi  6
Affiliations
Case Reports

Nipah Virus Outbreak in Kerala State, India Amidst of COVID-19 Pandemic

Pragya D Yadav et al. Front Public Health. .

Abstract

We report here a Nipah virus (NiV) outbreak in Kozhikode district of Kerala state, India, which had caused fatal encephalitis in a 12-year-old boy and the outbreak response, which led to the successful containment of the disease and the related investigations. Quantitative real-time reverse transcription (RT)-PCR, ELISA-based antibody detection, and whole genome sequencing (WGS) were performed to confirm the NiV infection. Contacts of the index case were traced and isolated based on risk categorization. Bats from the areas near the epicenter of the outbreak were sampled for throat swabs, rectal swabs, and blood samples for NiV screening by real-time RT-PCR and anti-NiV bat immunoglobulin G (IgG) ELISA. A plaque reduction neutralization test was performed for the detection of neutralizing antibodies. Nipah viral RNA could be detected from blood, bronchial wash, endotracheal (ET) secretion, and cerebrospinal fluid (CSF) and anti-NiV immunoglobulin M (IgM) antibodies from the serum sample of the index case. Rapid establishment of an onsite NiV diagnostic facility and contact tracing helped in quick containment of the outbreak. NiV sequences retrieved from the clinical specimen of the index case formed a sub-cluster with the earlier reported Nipah I genotype sequences from India with more than 95% similarity. Anti-NiV IgG positivity could be detected in 21% of Pteropus medius (P. medius) and 37.73% of Rousettus leschenaultia (R. leschenaultia). Neutralizing antibodies against NiV could be detected in P. medius. Stringent surveillance and awareness campaigns need to be implemented in the area to reduce human-bat interactions and minimize spillover events, which can lead to sporadic outbreaks of NiV.

Keywords: Kerala; Nipah virus (NiV); Pteropus medius; bats; seropositivity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer PB declared a shared affiliation with several of the authors, PY, RS, AB, SM, MG, RB, PA, NG, APS, ASh, SP, UT, HD, JK, VV, TM, RJ, DP, AbhinK, DN, PS, AW, SB, PG, PB, KK, JY, SD, MH, SG, GC, SR, PW, JN, BM, MK, AbhimK, and ASu, to the handling editor at the time of review.

Figures

Figure 1
Figure 1
The map shows the Nipah virus outbreak location in India and in the inset, the location of the index case house (red icon), and the four bat sampling sites (blue icon).
Figure 2
Figure 2
Contact tracing and probable transmission dynamics in the Nipah virus outbreak in Kozhikode district, Kerala state, India, 2021.
Figure 3
Figure 3
Neighbor Joining tree of Nipah virus full genome obtained from the samples of the index case in Kerala outbreak 2021.
See this image and copyright information in PMC

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