Kerala's healthcare system has turned deadly Nipah Virus into a completely curable illness

Kerala has set a gold standard in the fight against Nipah Virus. With its latest recovery from the deadly virus, the state has achieved unprecedented success.

While scaling down the case fatality rate from up to 94% to 33% is a remarkable feat, the most notable achievement was bringing back to life a patient placed on a ventilator, which health experts say is a first in the world in Nipah treatment.

Nipah Virus was first detected in Kerala in 2018 and since then the zoonotic illness has remerged thrice: 2019, 2021 and 2023. On each occasion, the state unlocked significant milestones in treating the illness.

“Unlike before, this time was unique,” said Kerala's Health Minister Veena George, because no one other than the contacts of the first patient was infected. “It means, since Nipah was detected on September 11, the health department ensured that no fresh case emerged.”

In the three previous outbreaks in Kerala, three patients recovered after contracting the virus. This time alone, four persons recovered. On the 29th of September, Minister George announced that all four patients had tested negative a second time after a five-day interval and passed fit to return to their homes.

The miracle boy on the ventilator
Of all four patients, the condition of a nine-year-old boy was the most critical. He was the son of Mohammed Ali, a native of Maruthonakara, who died on August 30 and is considered the index case in the latest outbreak.

The boy was admitted to Aster MIMS Hospital in Kozhikode on September 9 along with his brother, mother, maternal uncle and a cousin. The boy and his uncle tested positive for Nipah two days later.

“The boy was very critical from the beginning and was taken to ventilator support as he was losing the memory and developed respiratory issues,” said Dr AS Anoop Kumar, Aster North Kerala Cluster Director and Head of Critical Care (for adults).

An MRI scan revealed that the boys' infection had gotten to the brain stem. “It's hard to make a patient recover from this stage,” said Dr Anoop, who is credited with helping the early detection of the Nipah outbreak in 2018.

“But luckily, the patient was responding to medicines. We still had to control the repeated seizures and reduce cerebral oedema. Then we tackled the respiratory issues,” Dr Anoop told Onmanorama. The process was slow, but the boy gradually gained consciousness and on the sixth day, he was shifted from the ventilator, which Dr Anoop says was a first in the world with regards to Nipah treatment.

Deaths and diagnosis
Two persons died in the latest outbreak: Mohammed Ali of Maruthonkara and Mammilikunni Haris of Mangalad. Ali was the index patient, who died on August 30 while Haris died 12 days later. He had been unwell and died of cardiac arrest soon after arrival at Aster MIMS Hospital.

“Even though the official diagnosis (Haris's death) came later, we took all the precautions. Even though we gave him PCR, no healthcare worker was infected. All other Nipah suspects were also isolated properly from the beginning,” said Dr Anoop.

On recovery mode
Once out of the ventillator, the boy was put through a rehabilitation programme. Eventually, he started talking, taking food orally and began walking.

“It is the success of the teamwork under Dr Sathish Kumar, head of the department of paediatric critical care that brought back the boy from the death point. Every healthcare worker in the team deserves credit,” Dr Anoop said.

According to the World Health Organisation, there are currently no drugs or vaccines specific for Nipah virus infection. “The medicine mainly prescribed for the patient was Ribavirin,” said Dr Anoop. However, monoclonal antibodies, which are administered in patients with a high-risk of exposure at the beginning of the infection, were not given to any of the patients in the recent outbreak.

Health Minister Veena George has said all four returning to their homes Nipah-free, but have been advised to remain in isolation for 14 more days.