Epidemic training helps contain Nipah outbreak

Within 12 hours of being informed about cases of unknown fever and encephalitis-like symptoms in the southern Indian state of Kerala, scientists at India’s National Institute of Virology confirmed Nipah as the pathogen responsible — for the first time without needing to send the sample outside of India.

The U.S. Centers for Disease Control and Prevention (CDC), through a Global Health Security Agenda partnership, trained Indian scientists in August 2017. That helped prepare scientists to rapidly diagnose Nipah, a virus that has no cure or vaccine and a typical fatality rate between 40 and 70 percent.

“This early detection, with a turnaround time of only 12 hours, allowed state and central governments to respond to Nipah more quickly than in previous outbreaks, which likely limited the severity of the outbreak and potentially reduced costs in terms of loss of life and commerce,” said Preetha Rajaraman, the U.S. Department of Health and Human Services’ health attaché to India. Kerala state health officials were applauded for their timely action in coordination with national institutions to identify and contain the virus. During the outbreak, 19 cases of Nipah were confirmed in Kerala, leading to 17 deaths.

Graphic showing Nipah virus transmisson paths (J. Maruszewski/State Dept.)
(J. Maruszewski/State Dept.)

A global alliance

The Nipah outbreak is one example of the various infectious diseases that threaten the world’s second-most populous nation every year.

To counter these threats, the U.S. has worked closely with India, especially through the Global Health Security Agenda, to strengthen epidemic prevention, detection and response. By mid-2018, more than 25,000 Indian citizens had been trained through the partnership in the areas of biosafety and biosecurity, wet-lab processes, and general microbiology.

The Global Health Security Agenda is a multilateral effort launched in 2014. The partnership has grown to more than 64 nations and international organizations working together to strengthen infectious-disease preparedness and prioritize global health security. The U.S. is a member and has invested  $1 billion to build the capacity to prevent, detect and respond to disease outbreaks.

In India, assistance under the partnership focuses on four public-health functions:

  • Increasing real-time surveillance of public-health risks.
  • Improving laboratory systems.
  • Training more health workers in epidemiological capacities.
  • Establishing more emergency operations and strategic health centers with rapid-response teams.

The United States, through the CDC and U.S. Agency for International Development (USAID), has given India approximately $40 million to expand Global Health Security Agenda initiatives.

People wearing health masks surrounding ground well (© AFP/Getty Images)
Officials inspect a well to catch bats in Kerala. (© AFP/Getty Images)

Developing a vaccine

To help fight future threats, the Coalition for Epidemic Preparedness Innovations awarded two U.S.-based pharmaceutical companies — Profectus BioSciences and Emergent BioSolutions — a $25 million grant to apply their expertise and innovative technologies toward the development of a Nipah vaccine.

Profectus and Emergent said in a joint statement that the coalition was anticipating future epidemics and planning so the vaccine would be ready for studies during an outbreak. This “enables companies like ours that have promising vaccine product candidates already in development to accelerate their clinical testing and approval,” the companies said. They noted that infectious disease outbreaks were becoming more of a global concern.

The two companies report that there is currently an animal vaccine demonstrating effectiveness. They are working together to expand that vaccine for human use and estimate that clinical testing will begin in 2019.