Last week, hushed whispers that a person from Qatar with suspected MERS Corona virus (MERS-CoV) infection had been isolated at the Medical College, had the media as well as public health experts on the edge for several hours.
MERS-CoV is a highly infectious pathogen that is airborne and which has been known to cause major outbreaks inside hospitals.
PCR tests
The potential outbreak alert was taken down, once PCR tests confirmed that MERS was not in the picture and that the patient probably had viral pneumonia. It emerged that the alert and the subsequent actions, including isolation of the patient and the infection control measures, were just part of the protocols being following by the Outbreak Monitoring Unit (OMU) at Thiruvananthapuram MCH.
This is epidemic preparedness in Kerala, post-Nipah. In many ways, the Nipah outbreak has been a huge game-changer. The biggest lesson that Nipah management taught the health system was that it was better to err on the side of caution.
“The question was, if Nipah were to hit again, can we pick up the first case? Given the overcrowded environs in our hospitals, we probably cannot,” says R. Aravind, Head of Infectious Diseases at MCH here. All government Medical Colleges have Prevention of Epidemics and Infectious Diseases (PEID) Cells whose main task is disease surveillance. “In the post-Nipah situation, surveillance has to be strengthened so that any potential emerging and unusual infections are picked up at the earliest and controlled. OMUs will be attached to the PEID cells but its main purpose will be to set in motion protocols and infection control processes within the hospital as soon as an alert is raised,” says P.S. Indu, Head of Community Medicine, MCH here.
Patient from Qatar
“Of the emerging infections, about 60% are caused by viruses and two-thirds of these pathogens are zoonotic. We hypothesise that when the animal-to-man spill-over of the pathogen happens, the first victim is likely to be a healthy, immuno competent adult. The OMU will raise a public health alert if a healthy adult is admitted with these five symptoms: acute respiratory distress, encephalitis, acute liver failure, haemorrhagic rash or severe diarrhoea without a diagnosis,” says Dr. Aravind. When the patient from Qatar was admitted at MCH with fever and respiratory issues, it was one of the senior residents who flagged the case as suspected MERS-CoV, as there were ongoing outbreaks in the Middle East.
Unclear
WHO has recorded that MERS-CoV seems to spread easily in healthcare facilities and it is still unclear what drives this transmission. Also, transmission seems to begin before cases are recognised. “We isolated the patient, raised public health alert and put in motion all infection control protocols. These OMU protocols will take Kerala to another level of epidemic preparedness and picking up infections early will become a practice in all MCHs,” Dr. Aravind says.
