Tuesday, May 29, 2018

Was Nipah outbreak expected? WHO had sounded a note of caution in 2015

Was the current Nipah outbreak in Kerala expected? Could it have been prevented? I believe the answer to these questions is perhaps ‘yes’.

The World Health Organization (WHO) had sounded a note of caution in 2015 when it had published a list of top eight emerging pathogens likely to cause severe outbreaks in the near future, and for which few or no medical countermeasures exist.

The diseases included in the list were:

1.    Crimean Congo hemorrhagic fever
2.    Ebola virus disease 
3.    Marburg
4.    Lassa fever
5.    MERS
6.    SARS coronavirus diseases
7.    Nipah
8.    Rift Valley fever

Three other diseases - Chikungunya, severe fever with thrombocytopenia syndrome and Zika - were designated as 'serious', requiring action by WHO to promote R&D as soon as possible.

Other diseases with epidemic potential - such as HIV/AIDS, Tuberculosis, Malaria, Avian influenza and Dengue - were not included in the list because there are major disease control and research networks for these infections, and an existing pipeline for improved interventions.

The WHO revised this list in February this year. According to experts, there is an urgent need for accelerated research and development for the following diseases, given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines

1.    Crimean-Congo hemorrhagic fever (CCHF)
2.    Ebola virus disease and Marburg virus disease
3.    Lassa fever
4.    Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
5.    Nipah and henipaviral diseases
6.    Rift Valley fever (RVF)
7.    Zika
8.    Disease X, which denotes a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.

Nipah is one of the eight diseases in the list compiled by the WHO in 2015. Nipah again figures in the revised list published by WHO this year.

This should have been warning enough for appropriate authorities to be adequately prepared to prevent such outbreaks. There should have been a state of high alert for possible outbreaks of these diseases, which exist in India.

But, there are lessons to be learnt from the Nipah outbreak.

Monitoring systems should be in place preempt any future outbreaks. Disease surveillance should be continual and not episodic. It is also of utmost importance to increase public awareness about these diseases so that they can take due precautions. Otherwise, a small outbreak such as this may well turn into an epidemic. 

With geographical boundaries fast disappearing today, the pathogens get greater opportunity to rapidly travel around the world to different locations where they were previously unknown.

In the coming days, we will be talking about each of these diseases to increase knowledge and awareness about them.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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