A recent case of Zika virus infection in Pune has renewed concerns about India’s preparedness for diagnosing emerging infectious diseases. After experiencing symptoms like fever and rashes, the 46-year-old doctor was hospitalised and diagnosed with Zika virus infection after his samples were sent for testing to the apex virology institute. Subsequent testing of his family members revealed that his 15-year-old daughter was also infected. This is not the first time Zika has been identified in India. Cases have been identified from multiple States in India in the past, with larger outbreaks occurring in Kerala and Uttar Pradesh as recently as 2021.

Zika virus is a mosquito-borne pathogen belonging to the flavivirus family of viruses which also includes dengue. Clinical symptoms of Zika infection in many cases could be mild and indistinguishable from other infectious diseases including dengue. However, for pregnant women, the Zika virus poses a significant risk as it can be transmitted from mother to child, potentially leading to microcephaly in the offspring.

Due to climate change, it is not surprising that multiple dengue outbreaks are making headlines. The same vectors that spread dengue could also spread Zika. However, India’s lack of significant Zika surveillance means we might never fully understand its spread. In March 2023, CDSCO, India’s apex organisation for diagnostic approvals, confirmed that there is no approved diagnostic test for Zika. This limitation hinders our ability to diagnose Zika, relying only on classical symptoms and high clinical suspicion, making it complex as we see a concurrent upsurge in dengue cases across the country. Surveillance by ICMR on Aedes mosquitoes showed Zika virus positivity following human cases, indicating that many cases are likely being missed.

Zika is not an isolated case. A case of avian influenza A/H5N1 was recently reported from Australia in a child who had traveled to India, hinting at more undetected infections. Despite multiple avian influenza outbreaks in India this year affecting poultry, and an ongoing outbreak in Kerala, human testing and surveillance have remained limited. This is partially compounded by the lack of widely available diagnostic tests and over-reliance on a few apex institutes.

Consider the case of the Nipah virus, which has seen multiple outbreaks in Kerala. India has experienced several Nipah virus outbreaks, notably in West Bengal (2001 and 2007) and Kerala (2018, 2021, and 2023). In Kerala, identification of the virus relied heavily on clinical suspicion. Some cases were indeed missed during initial admissions due to the lack of routine testing, largely because the diagnostic facilities are not readily available apart from apex national institutes, adding to the complexity of testing, delays, and consequent loss of valuable time to institute countermeasures. Rapid identification and isolation of cases, contact tracing, and targeted screening of contacts are key to the effective containment of Nipah outbreaks.

For the rapid development of widely available and accessible diagnostics, the primary requirement is the quick availability of whole genome sequences in the public domain from outbreaks apart from an independent, time-bound accreditation process, especially in outbreaks. While many countries grant emergency approvals for diagnostics based on synthetic genomic material, India requires validation on clinical samples, which are not readily accessible. These limitations hamper rapid development. Although there have been multiple publications on Zika and Nipah outbreaks over many years now, the genomes from these outbreaks are still not rapidly released in public repositories. For example, the Nipah virus genome from the 2023 outbreak in Kerala was only released last month. Even with ongoing avian influenza outbreaks in multiple States, we do not yet have the whole genome sequences available in GISAID, the primary repository for influenza sequences, hampering our understanding of the disease and spread and more importantly, our ability to rapidly develop and deploy diagnostics.

During the COVID-19 pandemic, India swiftly expanded its testing infrastructure by rapidly decentralising and leveraging the existing network of hospitals, medical colleges, and private laboratories nationwide and tapping into the industry with a systematic approach for approvals of diagnostic tests making diagnostics widely available and accessible. The experience gained from the COVID-19 pandemic can be a stepping stone for improving testing capacities for other emerging diseases.

By decentralising testing facilities particularly at the district and sub-district levels, developing accessible and affordable diagnostic tests for Zika, Nipah, avian influenza, and many more emerging infectious diseases, India can ensure a more effective response to future outbreaks. There has never been a better time to swiftly establish a decentralised system for diagnostics, genomic surveillance, and data sharing to enable preparedness and public health response to emerging infectious diseases.

(Bani Jolly is a senior scientist at Karkinos Healthcare, and Vinod Scaria is a senior consultant at Vishwanath Cancer Care Foundation and Adjunct Professor at IIT Kanpur and DY Patil Vidyapeeth)

New Delhi:

The Centre has asked all states to be vigilant for any unusual deaths amongst the domestic birds and poultry, and share the information with the Animal Husbandry Department immediately so that public health action can be initiated as per the national action plan for Avian influenza.

A joint advisory issued on May 25 by the National Centre for Disease Control (NCDC) and Department of Animal Husbandry and Dairying stated that in 2024, four states — Andhra Pradesh (Nellore), Maharashtra (Nagpur), Kerala (Alappuzha, Kottayam, and Pathanamthitta districts), and Jharkhand (Ranchi) — have already reported outbreaks of Avian influenza in poultry.

“Given that Avian Influenza (H5N1) infection is highly pathogenic and has the potential to be transmitted to humans, it is imperative to take all necessary measures to minimize and prevent the spread of this infection,” the joint advisory said.

The Avian Influenza virus (bird flu virus) is normally maintained in circulation in nature among mainly migratory birds and is known to cause outbreaks among domesticated poultry birds probably due to spill over events when migratory birds come in contact with poultry, it said.

The H5N1 is the main Avian influenza virus that has caused multiple outbreaks among poultry globally. Both types of viruses (HPAI and LPAI) may occasionally affect other mammalian species, including humans.

Human infections are primarily acquired through direct contact with infected poultry or contaminated environments, the joint advisory said.

Although there have been sporadic reports in humans and outbreaks among domestic and wild birds, since March 2024, there is a global concern over Avian influenza outbreaks in cattle from multiple states in the US that have resulted in one reported human case of H5N1, the joint advisory stated.

Avian influenza outbreaks from India in poultry have been reported since 2006 and have been jointly investigated by the Animal Husbandry and Health Departments (IDSP, NCDC).

The states and Union Territories have been advised to orient all the health care workers/private practitioners on case definitions, signs and symptoms of Avian influenza.

“Be vigilant for any unusual deaths amongst the domestic birds/poultry in your state, and if observed, please share the information immediately with the Department of Animal Husbandry so that public health action can be initiated as per the national action plan for Avian Influenza,” the joint advisory said.

The states have been advised to strengthen biosecurity measures in all poultry establishments, zoos, poultry markets, etc. after conducting a thorough assessment.

“Comprehensive biosecurity assessments on all poultry farms are recommended. Access to farms should be restricted and stringent hygiene protocols, including the use of disinfectant footbaths and protective clothing, should be enforced. Measures to prevent contact between wild birds and domestic poultry should be implemented,” it stated.

The states have been asked to enhance information, education and communication tools among the general public regarding preventive measures such as minimizing the handling of dead or sick birds with bare hands and without adequate respiratory protection and following food safety measures while consuming products of animal origin.

Besides, they have been asked to be prepared for all preventive measures like stockpiling of an adequate number of antiviral drugs (Oseltamivir), PPE, masks etc.

Isolation wards/beds at dedicated hospitals may be required to handle any suspect case of Avian Influenza if confirmation among birds occurs in your state, the joint advisory stated.

It also called for enhanced surveillance (in wet markets, abattoirs, poultry farm workers etc.) as well as expanded surveillance (in sewage samples, water bodies, crows etc.) for Avian Influenza in collaboration with National Centre for Disease Control (NCDC), Indian Council of Medical Research (ICMR) and Department of Animal husbandry and Dairying (DAHD).

It emphasised on timely sharing of information besides underlined the need for strict compliance with the SARI surveillance guidelines of the Ministry of Health and Family Welfare by all states and its monitoring at senior level.

For the states where there is an active outbreak of Avian Influenza, the joint advisory advised some additional measures.

They have been asked to collect samples from cullers and surveillance workers (considered as ‘at-risk’ groups) on the 5th and 10th days following sanitization operations for H5N1 testing.

The joint advisory has stressed on conducting surveillance for suspected human cases and providing health check-ups for cullers and poultry workers, with a duration of 10 days and stated that recommended measures for chemoprophylaxis, management, and use of personal protective equipment (PPE) should be implemented.

It also advised following the SOPs for collecting and transporting samples from suspected cases to designated laboratories.

“A coordinated response involving experts from veterinary services, health departments, wildlife and forest departments, local authorities and other relevant stakeholders is required in all Avian Influenza outbreaks. Regular meetings should be conducted to share information, assess the situation and adjust strategies accordingly,” the joint advisory said.
 

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)