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Rapid Detection Accelerates India’s Response to Nipah Outbreak

Posted on by Dr. Kayla Laserson, CDC India Country Director
CDC is working internationally to build laboratory capacity so that disease can be identified at their source. Photo: CDC India
CDC is working internationally to build laboratory capacity so that disease can be identified at their source. Photo: CDC India

 

Dr. Kayla Laserson, CDC India Country Director
Dr. Kayla Laserson, CDC India Country Director

On May 17, 2018, almost two weeks after his brother died of febrile illness, a male patient in his mid-twenties visited a hospital in Kerala, India, with a fever. A day later, he was dead — but not before his doctors noticed his symptoms were consistent with encephalitis.Recognizing the potential danger, they immediately sent samples from the patient to the Manipal Centre for Virus Research (MCVR), followed by the National Institute of Virology (NIV) in Pune, where laboratory tests identified the cause of death as Nipah virus.

WHAT IS NIPAH VIRUS?

Nipah virus is an emerging infectious disease of public health importance. There is no cure, and it kills about 75% of people it infects. As of June 6, Nipah virus had claimed 16 lives out of 18 laboratory-confirmed cases in Kerala, a case fatality rate of 88.9 percent.

People can get sick with Nipah virus after direct contact with infected bats, pigs, or people. In humans, the infection typically presents as fever, headache, drowsiness, disorientation, or confusion, but can also include respiratory and neurological symptoms.

Because Nipah virus is deadly and can spread between people, it is critical to detect outbreaks rapidly. This means recognizing and reporting symptoms in patients quickly, and making sure laboratories have the ability to confirm the diagnosis. Thanks to recent efforts to strengthen its public health capabilities through the Global Health Security Agenda (GHSA), India was prepared to do just this.

TRAINING LEADS TO FASTER DETECTION

In August 2017, through partnership under GHSA, CDC provided laboratory training to participants from MCVR and NIV. The training was a part of an ongoing GHSA-funded study on hospital- based surveillance of acute febrile illness, giving laboratorians the skills to successfully investigate causes of these diseases and increased the diagnostic capacity of laboratories. CDC shared technical expertise, specific reagents, and training for diagnosis of dangerous viruses including Nipah virus and Crimean-Congo hemorrhagic fever through next-generation sequencing (NGS) analysis.

Less than one year later, scientists at MCVR used those skills, including NGS, to detect Nipah virus as the pathogen responsible for the outbreak and identified the exact strain of the virus. This early detection, completed for the first time in India rather than at CDC headquarters, paved the way for state and central governments to respond to the Nipah virus infections more quickly than in previous outbreaks.

Additionally, the quick diagnosis likely limited the severity of the outbreak, containing its geographic spread and potentially reducing costs in terms of loss of life and commerce in a state with significant international produce trade. Understanding the exact strain causing the outbreak also allowed doctors to anticipate which symptoms to watch for in potentially infected patients.

“MCVR’s ongoing partnerships with Kerala’s state health services and private sector partners, beginning with pandemic Influenza A/H1N1 in 2009, as well as its work under GHSA with international partners like CDC on detection of emerging pathogens, were crucial in detecting the Nipah virus infection so quickly,” said Dr. Arunkumar Govindakarnavar, who serves as the head of MCVR.

IMPACTS OF A COORDINATED OUTBREAK RESPONSE

The ability to diagnose dangerous pathogens like Nipah virus is one critical part of India’s faster, smarter response capabilities, where partners now work hand-in-hand to contain deadly outbreaks at the source.

India’s commitment to GHSA and enhanced detection and response represent a significant gain in the world’s ability to address disease threats. With a population of 1.3 billion people, progress in India’s health security leads to a safer and more secure world.

75% of people affected with Nipah virus die-THERE IS NO CURE. Nipah virus has killed 17 of the 19 confirmed cases as of June 2018.

Posted on by Dr. Kayla Laserson, CDC India Country Director

Zambia: A regional leader in NPHI development and emergency management

Dr. Victor Mukonka, Director of the Zambia National Public Health Institute

The Zambia National Public Health Institute (ZNPHI) is young but is already emerging as a leader for public health in Southern Africa. We are proud of our growth over the past four years and the increasing role we have assumed in the region. As ZNPHI  Southern Africa’s first regional workshop on public health emergency management Read More >

Posted on by Dr. Victor Mukonka, Director of the Zambia National Public Health Institute

CDC works with countries to identify children infected with hepatitis B virus and generate the evidence for hepatitis B vaccine birth dose introduction

Anna Minta training the survey team

Around the world, approximately 257 million people are infected with hepatitis B virus (HBV), and about 700,000 die every year as result of the long-term, chronic health threats from HBV, including liver disease and cancer. But, such suffering can be prevented with a vaccine! More tragic still, newborn babies infected at birth by their mothers, Read More >

Posted on by Anna Akua Minta, (CDC/CGH/GID)

Community-based Surveys are Informing Local Cessation Smoking Campaigns for Indigenous Australians

Project leader Alyson Wright surveys a community member in Central Australia.

Australia is a global leader in tobacco control, with a continuous comprehensive strategy initiated in the late 1980s that includes advertising restrictions, price increases, plain packaging, and mass media campaigns. However, after three decades, limited progress has occurred with regard to smoking prevalence among Australia’s Aboriginal and Torres Strait Islander population. Cigarette smoking prevalence among Read More >

Posted on by Alyson Wright, National Centre for Epidemiology and Population Health, Australian National UniversityTags , ,

How Senegal is tracking the Silent Killer

How Senegal is tracking the Silent Killer At a packed clinic in the middle of Dakar, Senegal, a busy nurse secures a blood pressure cuff around a patient’s arm. “After I take the blood pressure, I record it here,” the nurse says enthusiastically, showing a patient treatment card to Dr. Monica LaBelle, a CDC Foundation Read More >

Posted on by Bethany Hall, MPH

The Global Polio Eradication Initiative History Project: Documenting the Eradication of Polio

L to R: Oral Historian Hana Crawford, Project Manager Mary Hilpertshauser, Archivist Laura Frizzell

The Global Polio Eradication Initiative (GPEI) is a partnership led by five organizations: the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), and the Bill & Melinda Gates Foundation. The goal of GPEI is to eradicate polio worldwide. Based at the David Read More >

Posted on by Oral Historian Hana Crawford, Project Manager Mary Hilpertshauser, Archivist Laura FrizzellTags , , , ,

Tetanus: Eliminating the Forgotten, Deadly Disease

FETP Resident Pheobe Hilda Alitubeera searching for tetanus cases in health facility registers.

As a clinician, seeing a patient with a preventable disease like tetanus is heartbreaking. The most common signs are painful spasms of the muscles of the jaw (lockjaw) and spine. But, in the worst cases, tetanus impairs breathing, and without medical intervention, nearly 100% of patients die. Tetanus rarely occurs in the U.S. because we’ve Read More >

Posted on by Dr. Rebecca Casey, EIS Officer, Global Immunization DivisionTags , , , ,

Preventing Cervical Cancer in Cambodia: Evaluating the HPV Vaccination Demonstration Project

A nine-year old girl and her grandmother being interviewed in Svay Rieng province about her knowledge on HPV vaccine

Cervical cancer claims the lives of a quarter of a million women every year with almost nine out of ten deaths occurring in developing countries.   Cervical cancer is caused by human papillomavirus (HPV), a virus that can cause cancers in the mouth, throat, and reproductive tract, as well as genital warts. Safe and effective vaccines Read More >

Posted on by Julie Garon, MPH - Vaccine Introduction Team, GIDTags , , ,

Proud to Protect Burkinabè from Meningitis

A child lines up to get her routine MACV vaccination in Burkina Faso in 2017. © Evelyn Hockstein/CDC Foundation

Isaïe Medah, MD, MSc, is a physician and director general of public health in Burkina Faso. Previously he was director of the country’s routine immunization program from 2015–2017 and director of disease control from 2011–2015. Proud to Protect Burkinabè from Meningitis By Isaïe Medah, MD, MSc In a remote village of Burkina Faso, a woman Read More >

Posted on by By Isaïe Medah, MD, MScTags , , , , ,

Message from Hank Tomlinson, PhD, Acting Director of CDC’s Division of Global HIV & TB.

CDC's innovative efforts to find, cure, and prevent TB are creating a safer America and a safer world.

“We are at a key moment in the global fight against tuberculosis. Tremendous progress has been made and, yet, this preventable, curable infection still claims more lives than any other infectious disease or epidemic. As leaders come together on World TB Day and again at the United Nations High Level Meeting on TB in September, Read More >

Posted on by Dr. Hank Tomlinson
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