Why Kerala has to send Nipah virus samples to other states for testing

A look at why samples have to be sent out of state for confirmation, and why each state does not have its own lab to do the same.

Health Nipah Virus

Kerala is a state which has one of the highest developed medical science indices in the country. Given this, several people have wondered why the samples from suspected cases of Nipah are being sent to the National Institute of Virology in Pune and the Manipal Centre for Virus Research (MCVR) in Karnataka for confirmation. The state does not have its own facilities for the same. TNM sought to understand why.

Dr Anbumani N, Professor in the Department of Microbiology at Sri Ramachandra Hospital, Chennai, explains that there are different levels of biosafety in laboratories and as per their classification, they are authorised to handle specific organisms. "The Center for Disease Control (CDC) has classified labs into four biosafety levels (BSL). Based on the organisms typically worked with in these labs, there have to be certain precautionary measures in place. For example, a BSL 1 lab usually has a very basic set-up and there is minimal potential risk to the individuals themselves because the organisms they work with aren’t very harmful," she said. “BSL 4 labs, on the other hand, have an extremely strict set of precautions to follow,” she added. “The microbes that scientists study in BSL 4 labs are extremely harmful, hence the rigorous protocols.”

According to the CDC website, a BSL 4 lab is authorised to work with fatal pathogens such as Ebola, which means that stringent safety measures must be in place. The guidelines by the CDC clearly state that the lab must be located ‘in a separate building or in an isolated and restricted zone of the building.’ Furthermore, those going into the lab are required to change clothing before entering and must shower and decontaminate all materials before leaving. The entrance and exit doors must be on different sides and have to be automated.

“Nipah is a highly contagious virus which falls under the level 4 category. Level 4 labs work with rare microbes and there are extreme personal protective measures in place which the lab staff have to undertake while handling the samples. The equipment used in these labs are also quite advanced, and security is top notch. Given this, it doesn’t make sense for every state to have a level 4 lab, since the organisms which fall under this classification are exceptionally rare. For instance, even the current outbreak of Nipah is the first of its kind reported in Kerala,” says a medical officer from Kozhikode district.

She further added that Manipal and Pune are the only two top level (BSL 3 and 4) labs in the country, which is why samples are being sent there for confirmation.

“It all comes down to funding,” says Dr Anbumani, “if every state had the financial means to set-up such a lab, it would definitely be an added advantage to the public health sector.”

The institute in Pune is part of the Indian Council of Medical Research (ICMR) and just like the MCVR is funded by the central government.

Dr Sreejith, a Public Health expert and Central Working Committee Member of the Indian Medical Association, also echoed her opinion, “As per my understanding, the national policy is that a few different states share such a lab. Kerala is predominantly affiliated to the Manipal lab. Once the samples reach the lab, there isn’t much delay in obtaining the results. However, from a virology point of view, it would definitely be an advantage to have our own lab facilities to not just diagnose diseases, but also to study and research them.”

He further added that such facilities would be useful not only during times of crises, but would also be the best way to understand each state’s epidemiology better.

“There are a lot of hidden diseases and every year a number of deaths occur where the cause remains undetermined. Many of them have some underlying viral origin which could possibly be going unnoticed. Having such a facility would allow for us to not just study known viruses, but also unknown ones and better understand viral behavior, genetics, susceptibility and so on,” he added.

Kerala already has the Rajiv Gandhi Centre for Biotechnology which Dr Sreejith feels would make it easier to establish such a facility in the state: “We need to have such labs nationwide and Kerala should not be an exception. The advantage in Kerala is that there is already the Rajiv Gandhi Centre for Biotechnology and I fail to understand why the expertise of the same cannot be used for infection control. It’s high time that we expand on that front and collaborate with Rajiv Gandhi Centre for better surveillance and disease prevention.”

The private secretary to Kerala Health Minister K K Shailaja told TNM that there are plans in motion to establish such an institution within the next year. She further added that the state has invested 15 crores to set up a high tech virology institute in Thiruvananthapuram, the first stage of which will be inaugurated in 15 months.