The Virus Diagnostic Lab (VDL) in Shivamogga in Karnataka is a bustle of activity. A van carrying blood samples arrives at the laboratory around noon prompting microbiologists working inside to pause their tests briefly. They collect the vials of blood samples and keep them next to dozens of similar vials that arrived earlier in the morning. It is the first time in months that the laboratory is fully equipped and running tests on blood samples to detect the presence of the Kyasanur Forest Disease (KFD) or monkey fever virus.
"This is the third batch of samples arriving today. We are testing three batches of blood samples every day since the latest outbreak of KFD came to light," says a microbiologist working in the laboratory, even as a vial of blood is closely examined under the sunlight entering through the window. Each batch takes 6-7 hours to be analysed making the scientists at the lab continue working until late into the night.
Since 1957, when the disease was first discovered in Kyasanur forest range, it recurs annually in the forests of the Western Ghats in Shivamogga, taking lives from the communities that live in and around the forest areas. The disease is transmitted to monkeys and humans through infected vectors, which are primarily ticks.
Kyasanur Forest
The VDL was set up in 1959 in Shivamogga as a specialist laboratory to carry out research on the disease. Microbiologists at the facility are working round the clock to fight the spread of the fatal 'monkey fever' infection. This time around, the outbreak of KFD has taken place earlier than expected and has already claimed the lives of six people in Sagar taluk of Shivamogga.
This year, the first case of suspected KFD was reported on November 24, 2018 in Aralagodu village in the district. Hundreds of KFD cases have since emerged from Shivamogga, while cases of monkey deaths have been reported in neighbouring Udupi district.
Officials in the Health and Family Welfare Department in Karnataka admitted that protocol was not followed in conducting vaccination drives in 2018. Dr Ravikumar, Deputy Director of VDL has been suspended following an enquiry. Along with him, the District Health Officer (DHO) of Shivamogga, Venkatesh K has also been suspended.
But the microbiologists at VDL maintain that they are not distracted by the upheavals in the Health Department and reaffirm that they are only focused on containing the spread of the disease. The facility is working along with the National Institute of Virology (NIV) in Pune to test blood samples. "Outbreaks of the disease are usually preceded by reports of deaths of monkeys. But this time around, we first detected five human cases in Aralagodu village in December. There was a shortage of chemicals in the laboratory when the cases emerged. We hastened the process of procuring reagents and we are now fully functional and running tests," says a microbiologist at VDL who did not wish to be named.
The process of vaccinating residents in and around Aralagodu up to a radius of 10km was accelerated following the first sign of the outbreak. "The vaccination process involves two doses given one month apart. It takes two months to build the immunity of the body to fight the virus. We have completed the process of vaccination and we are now vaccinating anyone left out," explains a microbiologist at VDL.
Monkey deaths act as alarm bells for the microbiologists in their efforts to prevent outbreaks of the disease. "Whenever a case of monkey death is reported, we immediately cordon off an area of 50m around the monkey to conduct tests. Ticks move out of the dead monkey and are responsible for the transmission of KFD. We want to stop the infected ticks from spreading," says the microbiologist. The Health Department also provided DMP (dimethyl phthalate) oil to residents in the area to apply on their skin, as it is known to be a tick repellent.
Dr Mangesh Gokhale, a researcher from the National Institute of Virology (NIV), Pune drags a flag on the ground to collect ticks for testing in 2010
But once the virus is detected in a human, the vaccine is rendered useless and the patient can only be treated for the symptoms of fever and dehydration on a case-by-case basis. "Vaccination is key to the whole programme. We must also channelise the reporting pattern for monkey deaths so that common people can reach the Health Department at the earliest," the microbiologist says.
While the disease has a mortality rate of 3-10%, there is a lack of seriousness among residents in the forest areas of Shivamogga in getting themselves vaccinated. "People brush it off as 'monkey fever' and sometimes they take one dose of the vaccination and do not come back for the second dose. We must create awareness about the disease and urge people to take it seriously. Normally, people take their own medications like Paracetamol and only when the condition aggravates, they go to the hospital. So, because of the late admission to the hospital and lack of diagnosis, it leads to complications," says another microbiologist at the facility.
VDL has maintained records of ticks and monkeys found positive for the virus going back to 1959
The disease, which was confined to the forests of Shivamogga for several decades, has now been reported in Kerala, Tamil Nadu, Goa and Maharashtra, along the forests of the Western Ghats since 2013. Health Department officials in Karnataka are now concerned that the latest outbreak in Shivamogga could spread the disease further and are currently conducting surveillance programmes in Shivamogga and its neighbouring districts.
Cases of monkeys carrying the virus have been reported in the coastal districts of Udupi and Uttara Kannada. Six of the seven taluks in Shivamogga have reported cases of KFD, while samples from Dakshina Kannada which were collected this week are yet to be analysed. So far, around 68 cases of KFD have been found since the start of the latest outbreak of the disease. "It is spreading rather than getting contained and with increasing deforestation and human encroachment into forest areas, cases of KFD could increase further," warn the microbiologists working at the facility.
The vaccination given to residents following the emergence of the first case at the end of November 2018 is set to take effect at the end of this month and build the immunity of residents in the affected areas to fight the disease. Health officials remain hopeful that the increased immunity along with surveillance programmes will help them contain the spread of the disease and prevent the loss of more lives.