Nipah Virus kills two in Kerala State, India.

Two deaths caused by Nipah Virus have been confirmed in Kerala State, India, in an outbreak in Malappuram and Palakkad districts, that began in April 2025, according to a press release issued by the World Health Organization on 6 August 2025.

The first patient, a woman from Malappuram District presented at a hospital in the same district with fever, cough, and respiratory distress on 25 April 2025. She was admitted to the hospital, and then transferred to an intensive care unit on 2 May after developing acute encephalitis, where she is still being treated. The woman was diagnosed with Nipah Virus on 6 May after samples were sent to Calicut Medical College for testing, with the diagnosis being confirmed by a repeat of the test at the National Institute of Virology in Pune on 8 May.

The second patient, also a woman from Malappuram District first developed symptoms on 25 June, and unsuccessfully sought treatment at several healthcare institutions before being admitted to a multi-speciality hospital, where she died on 1 July. Tests subsequently confirmed she was infected with Nipah Virus.

The third patient, a woman from Palakkad District, developed symptoms on 25 June, and again sought treatment at several healthcare centres before being admitted to a multi-speciality hospital, where she remains in a critical condition on a ventilator. Tests confirmed that she was infected with Nipah Virus, making her the first ever confirmed case in Palakkad District.

The final patient, a man from Palakkad District, developed symptoms on 6 July and immediately sought treatment. He was admitted to a private hospital on 10 July, then transferred to a multi-speciality hospital on 11 July, where he died a day later. He too was confirmed by tests to have Nipah Virus, making him the second case in the district.

Nipah Virus infection, a zoonotic illness, is spread to Humans through contact with infected Animals such as Bats and Pigs. Additionally, direct contact with an infected individual can also lead to transmission, although this route is less common. Those affected by Nipah Virus infection may experience severe symptoms, including acute respiratory infection and fatal encephalitis. The only way to reduce or prevent infection in people is by raising awareness about the risk factors and preventive measures to protect themselves. Case management should focus on providing patients with supportive care measures and intensive support for severe respiratory and neurological complications.

Nipah Virus infection in Humans causes a range of clinical presentations including acute respiratory infection and fatal encephalitis.  The case-fatality rates in outbreaks across Bangladesh, India, Malaysia, and Singapore typically range from 40% to 100%. As of now, there are no available effective therapies or vaccines for this disease.

Electron micrographic image of Nipah Virus. Centers for Disease Control and Prevention.

Nipah Virus was first reported in Kerala State in 2018, since when there have been outbreaks every year. The first ever recorded case of Nipah Virus in India was reported in West Bengal in 2001. To date there have been 28 deaths caused by the Virus in Kerala, although 21 of these were in 2018, when local medical authorities were naïve to the disease. 

In the absence of a vaccine or licensed treatment available for Nipah Virus, the only way to reduce or prevent infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to Nipah Virus infection. Case management should focus on the delivery of supportive care measures to patients. Intensive supportive care is recommended to treat severe respiratory and neurological complications.

In order to reduce Bat-to-Human transmission, freshly collected Date Palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of Bat bites should be discarded. Areas where Bats are known to roost should be avoided. The risk of international transmission via fruit or fruit products (such as raw date palm juice) contaminated with urine or saliva from infected fruit Bats can be prevented by washing them thoroughly and peeling them before consumption.

Natural infection in domestic Animals has been described in farming Pigs, Horses, and domestic and feral Cats. Gloves and other protective clothing should be worn while handling sick Animals or their tissues and during slaughtering and culling procedures. As much as possible, people should avoid being in contact with infected Pigs. In endemic areas, when establishing new Pig farms, consideration should be given to the presence of Fruit Bats in the area and in general, Pig feed and Pig sheds should be protected against Bats when feasible. Samples taken from Animals with suspected Nipah Virus infection should be handled by trained staff working in suitably equipped laboratories.

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Elephant dies after consuming explosives in Kerela State, India.

An Elephant has died after consuming a Pineapple filled with explosives in Kerala State, India. The incident happened on 23 May 2020 in village near the Silent Valley National Park in Palakkad District, when the Animal is believed to have consumed a 'Pig Cracker', a fruit filled with explosives used to deter Wild Pig, which are a serious agricultural pest, something widely used in India and Sri Lanka. The Elephant, a fifteen-year-old female that was pregnant at the time, is reported to have received severe injuries to the mouth and face, and despite attempts by local wildlife officials and vets to provide treatment, died on 27 May while standing in a river near the village, apparently in an attempt to relieve the pain of the injury.

A fifteen-year-old female Elephant that died in a river in Palakkad District, Kerala, on 27 May 2020, several days after eating a Pineapple laced with explosives. AFP.

The incident has prompted widespread outrage in India, with many leading politicians and celebrities calling for those responsible to be brought to justice. The incident is being investigated by the Indian Forest Service, with several people having been arrested and interrogated. This situation has been made more complex by a rumour that the death happened in Malappuram District, to the west of Palakkad, which has a largely Muslim population, something which some politicians appear to be using to fuel sectarian differences across India.

An Indian Elephant injured by explosives hidden within a Pineapple in Kerala State stood in a river near where the incident happened for four days before dying, apparently in an attempt to alleviate the pain of the injury. Mohan Krishnan/Indian Forest Service.

The population of India has risen from 376 million in 1950 to 1339 million today, fuelling an expansion of both urban and agricultural land use into former wilderness areas. The wild Elephant population has declined over the same period, but still stands at about 27 000. Many animals will simply flee such incursions, or, if unable to, are likely to end up in the cooking pots of hungry villagers. Elephants, however, are a somewhat different proposition. They are large animals, not used to being challenged by other animals in their home ranges, and typically live in matriarchal herds of up to a hundred, with herds holding large territories, criss-crossed by Elephant trails. A herd of Elephants encountering a new Human settlement, particularly a poorly defended structure, are unlikely to attempt to go round it, and are quite likely to maximise the damage they cause to show their displeasure. This has resulted in an increasing cycle of Elephant-Human conflict in rural areas of India, with 2361 people killed by Elephants between 2014 and 2019, while in the same period 510 Elephants were killed by people.

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