A 42-year-old woman in Malappuram, Kerala, was admitted to a private hospital with severe symptoms resembling encephalitis. Just days later, her worst fears were confirmed — she had contracted the Nipah virus. On Thursday, the National Institute of Virology (NIV) in Pune officially verified the infection, thrusting Kerala once again into the national spotlight as it battles another outbreak of this deadly zoonotic disease.

As Health Minister Veena George heads to Malappuram to monitor the containment strategies, public health concerns are intensifying, especially given the virus’s history in the state and the high fatality rate associated with it. Here’s everything you need to know about the Nipah virus, how it spreads, and why it’s resurfacing now.

Kerala is no stranger to the Nipah virus. Since 2018, the state has witnessed five outbreaks, leading to 22 confirmed deaths. The first outbreak in 2018 was particularly catastrophic — 17 of the 18 infected individuals died, leaving public health systems scrambling for solutions. Further cases occurred in 2019, 2021, and 2023, most commonly between May and September, the region’s monsoon season, which is also marked by a surge in respiratory infections and influenza-like illnesses.

These seasonal overlaps make early diagnosis challenging, as Nipah symptoms often mimic more common illnesses. In 2023 alone, Malappuram reported two deaths linked to the virus. Of all the confirmed infections since 2018, only six individuals have survived, underscoring the virus’s high mortality rate and the need for rapid medical intervention.

How the Virus Is Contracted?

Nipah virus is a zoonotic pathogen, meaning it spreads from animals to humans. Scientific investigations from previous outbreaks, including a joint field survey by the National Institute of Virology (NIV) and the National Institute of High Security Animal Diseases (NIHSAD), found a clear link between fruit bats (commonly known as flying foxes) and human infections.

The virus strain detected in Kerala is closely related to the Bangladeshi strain, notorious for its person-to-person transmission and high mortality, estimated by experts to be up to 90% in some cases. In the 2023 outbreak, antibodies were found in fruit bats from Pandikkad village, strongly pointing to them as the source of the infection.

The consumption of contaminated fruits or exposure to bat saliva and urine on fruits is believed to be one of the primary routes of transmission in initial cases.

What is Nipah Virus?

First identified in Malaysia in 1998, Nipah virus gets its name from the village of Sungai Nipah, where the initial outbreak occurred. The virus belongs to the Henipavirus genus and has since been recognized as one of the world’s most dangerous pathogens due to its pandemic potential and high case fatality rate — estimated to range between 40% and 75%, depending on the outbreak response and healthcare access.

Early symptoms are often non-specific and include:

• Headache
• Muscle pain
• Vomiting
• Sore throat

As the disease progresses, some patients experience acute respiratory distress, neurological complications like encephalitis, seizures, and altered mental states, which may rapidly lead to coma or death.

Is the Virus Contagious and Airborne?

Yes, Nipah virus is both contagious and airborne. It spreads primarily through respiratory droplets, bodily fluids such as saliva, urine, feces, and blood, and via direct contact with infected individuals or animals.

Healthcare providers and family members caring for infected patients are particularly at risk. This is why strict infection control measures, including personal protective equipment (PPE) and isolation protocols, are crucial to preventing person-to-person spread.

Why Prevention Is Critical?

Currently, there is no specific antiviral treatment or licensed vaccine available for Nipah virus. Medical care is supportive and symptomatic, focusing on:

Hydration and rest

Medications for fever and pain (e.g., acetaminophen, ibuprofen)

Treatment for nausea, seizures, and respiratory distress

Use of inhalers or nebulizers in case of breathing difficulties

Experimental therapies, such as monoclonal antibody treatments, are under research but not yet widely accessible. Given the lack of curative options, early detection and containment remain the most effective ways to manage an outbreak.

Containment Measures Followed in Kerala

Since the first outbreak, Kerala’s public health system has developed a robust protocol to respond to Nipah cases. Isolation wards, contact tracing, and real-time epidemiological surveillance are quickly deployed. The state has also worked closely with central agencies like NIV and WHO to bolster its diagnostic and response capabilities.

With this latest case in Malappuram, authorities are already mobilizing rapid response teams to trace contacts, disinfect the patient’s surroundings, and educate the public about symptoms and preventive measures.

Although most outbreaks have been localized to South and Southeast Asia, Nipah virus is considered a global threat. The World Health Organization (WHO) includes it on the list of priority diseases for research and development, due to its potential to cause widespread epidemics and the lack of available countermeasures.

The U.S. Centers for Disease Control and Prevention (CDC) also closely monitors Nipah virus, emphasizing the importance of global health surveillance systems. As climate change, deforestation, and wildlife trade continue to increase human-animal interactions, the risk of zoonotic spillovers like Nipah is on the rise.

The emergence of a new Nipah case in Kerala is a critical reminder of the interconnectedness of human and animal health. While the virus is not currently spreading globally, the high fatality rate, airborne nature, and lack of treatment options make it essential to remain vigilant.

For residents in affected areas and globally the best approach is a combination of early reporting, awareness about transmission, and adherence to public health guidelines.

Food Standards Australia New Zealand is urging people to not consume two peanut butter products by Coles. These two varieties are Coles Smooth peanut butter and Coles Crunchy peanut butter, which have been found to contain mycotoxin and aflatoxin. Coles has also recalled these two products. The question is raised for products with the batch marked best before February 5, 2027.

Coles' recalling means that people can return these products for a full refund.

The toxins found in these products are said to increase the risk of liver cancer. An alert has been issued, which reads: “Coles Online customers can receive a refund or credit by contacting Coles Online Customer Care on 1800 455 400. Any consumers concerned about their health should seek medical advice.”

What Are These Toxins, How Does It Impact Our Health?

Mycotoxins

As per the World Health Organization (WHO), mycotoxins are toxic substances produced naturally by certain types of mould (fungi). These moulds can grow on a wide variety of foods—such as grains, dried fruits, nuts, and spices—especially in warm, damp, and humid environments. The contamination can occur either before harvest or after, during storage or even on the food itself. Alarmingly, most mycotoxins are highly stable and can survive food processing methods.

There are hundreds of known mycotoxins, but a few pose significant health risks to both humans and animals. These include aflatoxins, ochratoxin A, patulin, fumonisins, zearalenone, and nivalenol/deoxynivalenol. Mycotoxins enter the food chain when crops are infected with mould. People can be exposed either by consuming contaminated food directly or indirectly—most commonly through animal products like milk, when livestock are fed mould-contaminated feed.

Where Are They Found?

Mycotoxins can contaminate food before harvest (in the field) or afterward during storage and processing. Since most mycotoxins are chemically stable, they can survive food manufacturing and cooking processes, making them hard to eliminate completely.

Mycotoxins can pose serious health risks to both humans and animals. Their effects can range from sudden poisoning to long-term health issues such as:

• Suppressed immune response
• Liver damage
• Increased cancer risk

Livestock can also be exposed through contaminated feed, and humans may indirectly consume these toxins through animal products like milk.

Common Mycotoxins to Watch For

Though hundreds of mycotoxins have been identified, a few are especially harmful and frequently found in food:

• Aflatoxins (among the most toxic, produced by Aspergillus moulds found in soil and stored grains)
• Ochratoxin A
• Patulin
• Fumonisins
• Zearalenone
• Nivalenol/Deoxynivalenol (DON)

What Are Aflatoxins?

As per the National Cancer Institute, US, aflatoxins are a group of toxic compounds produced by specific types of fungi, primarily Aspergillus flavus and Aspergillus parasiticus. These fungi thrive in warm, humid climates and commonly infect crops like maize (corn), peanuts, cottonseed, and various tree nuts. Contamination can occur at multiple stages—while the crops are growing in the field, during harvest, or later in storage.

The National Cancer Institute also notes that exposure to aflatoxins is associated with an increased risk of liver cancer.

Another 2013 study published in World Journal of Gastroenterology notes that while Hepatocellular carcinoma (HCC) is one of the leading causes of cancer deaths worldwide, it is caused by aflatoxin. The study notes that aflatoxin is a food contaminant produced by the fungi Aspergillus flavus and Aspergillus parasiticus, is a known human carcinogen that has been shown to be a causative agent in the pathogenesis of HCC. In fact, Aflatoxin B1 has been classified by the WHO as a “group A” carcinogen because of it’s proven contribution to the pathogenesis of HCC.

In 2001, Uzbekistan was far from a model of public health. The country was grappling with high hepatitis B infection rates and a fragmented healthcare system, few would have predicted that it would one day be celebrated for near elimination of the disease in children.

Yet today, reports Gavi, The Vaccine Alliance, the country stands among just nine in the World Health Organization (WHO) European region to meet hepatitis B control targets. A recent nationwide survey revealed that only 0.2% of Uzbek children carry the hepatitis B surface antigen (HBsAg)—well below WHO’s 0.5% threshold.

What is Hepatitis B and Why It’s Dangerous

Hepatitis B is a viral infection that affects the liver. While some infections are brief and symptom-free, others can become chronic, quietly progressing over years to cause liver failure or cancer. The risk of chronic infection is especially high in infants whose immune systems are still developing.

Fortunately, the hepatitis B vaccine is highly effective, offering 98–100% protection after a full three-dose series. WHO recommends that all infants receive the first dose within 24 hours of birth, followed by two or more doses at spaced intervals.

Also Read: National Doctors' Day, July 1, 2025: Theme – "Who Heals the Healer?" Know more about Its History and Significance.

What Are Gavi Countries?

Gavi supports lower-income and transitioning middle-income countries to strengthen immunisation systems and increase vaccine access. Countries that receive support are commonly referred to as “Gavi countries.”

Uzbekistan introduced universal hepatitis B vaccination in October 2001, supported by US$4.5 million in funding from Gavi, the Vaccine Alliance.

From 2001 to 2008, Uzbekistan provided the hepatitis B birth dose followed by two additional doses.

In 2009, the country upgraded to the pentavalent vaccine—offering protection against hepatitis B, diphtheria, tetanus, pertussis, and Haemophilus influenzae type B—while still delivering a standalone birth dose. Gavi extended further funding of US$32 million for the next decade.

Also Read: Healers, But Human Too: The Quiet Burdens Our Doctors Carry

Vaccination coverage has remained impressively high—above 95% since 2002. However, until recently, the real-world impact of the programme on hepatitis B infection rates had not been comprehensively measured.

Proof of Progress In Uzbekistan’s Healthcare

In 2022, a team led by Dr Nino Khetsuriani from the U.S. Centers for Disease Control and Prevention (CDC), along with local researchers, conducted a nationwide survey.

They tested blood samples from 3,753 children in grades one to three and reviewed their immunisation records. Their findings, published in Vaccine, showed that just 0.2% of the children tested positive for HBsAg—proof of the vaccine’s long-term effectiveness.

With consistently high coverage, experts expect the burden of hepatitis B in Uzbekistan to decline further as vaccinated children grow into adulthood, replacing older, unvaccinated cohorts.

Uzbekistan graduated from Gavi’s financial support in 2022. Today, its national immunization programme is fully self-funded and regarded as one of the most efficient in the region.

“Uzbekistan stands as a model of excellence in immunization,” said Jan-Christopher Castilhos França, Gavi’s Senior Country Manager for Middle-Income Countries.

On June 30, the U.S. Supreme Court declined to hear a lawsuit filed by Children’s Health Defense (CHD), an anti-vaccine group founded by Robert F. Kennedy Jr., now the Secretary of Health and Human Services under the Trump administration.

The group alleged that its First and Fifth Amendment rights were violated when Meta Platforms—parent company of Facebook and Instagram—restricted its content related to vaccine misinformation during the COVID-19 pandemic.

Without providing comment, the Supreme Court left in place a series of lower court rulings that dismissed CHD’s claims. These rulings found that Meta acted independently and could not be treated as a government actor bound by constitutional free speech protections.

Lawsuit Stemmed From Facebook’s 2022 Removal of CHD’s Page

The legal dispute centered around Facebook’s removal of CHD’s page in 2022, amid efforts to combat vaccine misinformation during the pandemic. CHD claimed Meta’s actions were a result of coordination with the federal government as part of the CDC’s “Vaccinate with Confidence” campaign—an initiative encouraging platforms to promote accurate health information.

The group’s lawsuit was filed under the First and Fifth Amendments and other laws, arguing that Meta effectively carried out government censorship by restricting CHD’s content. However, courts repeatedly found no substantial evidence of collusion between Meta and the federal government.

Lower Courts: Meta Is Not a State Actor

The San Francisco-based 9th U.S. Circuit Court of Appeals, among others, ruled that Meta, as a private company, is not a "state actor" and is therefore free to determine what content appears on its platforms. The court also observed that Meta and the federal government were not always aligned in their objectives or actions.

While the CDC encouraged accurate vaccine messaging, the 9th Circuit noted there was no direct government control or coercion over Meta’s decisions. This distinction was critical in rejecting CHD’s claim that Meta was acting as an agent of the state.

Dissent Raises Concern Over Platform Power

Despite the unanimous rulings, one appeals judge issued a dissent, suggesting that Meta may still warrant First Amendment scrutiny due to the sweeping influence it holds over public discourse. The judge argued that when a platform controls speech at such a vast scale, its role begins to resemble that of a government actor—especially when supported by government policy, even if not outright directed by it.

Part of a Broader Pattern

The rejection follows a similar 2024 Supreme Court ruling, in which justices said Louisiana, Missouri, and other Republican-led states lacked legal standing to sue the Biden administration over alleged censorship of conservative content on social media. These decisions reflect a cautious judicial stance on intervening in disputes over online content moderation, especially in the absence of clear evidence of government overreach.

A Continuing Free Speech Debate in the Digital Age

While Meta has prevailed legally, the case leaves unresolved broader questions about the relationship between government agencies and tech companies—and how far platforms can or should go in moderating content related to public health or politics.

As misinformation continues to be a major concern and social media remains central to public discourse, the debate over where free speech ends and platform responsibility begins is far from over.