A fourth member of the same Indian family has died from the rare Nipah virus, officials said Thursday, as authorities scramble to contain an outbreak that has claimed 11 lives.
V. Moosa, who died Thursday in a hospital in the southwest state of Kerala, had two sons and a sister-in-law succumb to the same deadly infection spread by fruit bats last week.
"He was on ventilator support for a week and died today morning," Kerala state health director Sarita R. L. told AFP of Moosa, 60.
Dead bats were found in a well at their home in Kozhikode district - the epicentre of the viral outbreak that has authorities on high alert.
A nurse who treated one of Moosa's sons also died, leaving a heart-wrenching note for her family.
"Each and every person who was in contact with any suspected patient is being monitored," Sarita said.
Two other confirmed cases of Nipah virus have been detected and the patients are being treated in hospital, she said.
It was unclear whether these patients came into contact with Moosa's family or contracted it elsewhere.
Officials suspect the zoonosis infection outbreak - that causes disease in both animals and humans - spread from the unused well at Moosa's home where the dead bats were found.
Dozens of other suspected patients were being quarantined and many more monitored by health officials in at least four districts in the state.
Two other patients were in isolation in neighbouring Karnataka state after developing symptoms similar to Nipah upon returning from Kerala.
Rajeshwari Devi, a health official in the Karnataka city of Mangalore, told AFP the patients' condition was improving but doctors were awaiting the results of blood tests.
Authorities have issued a travel advisory for half a dozen districts in Kerala and alerts in neighbouring states to try to curb the spread of the deadly virus.
Nipah has killed more than 260 people in Malaysia, Bangladesh and India since 1998 and has a mortality rate of nearly 70 percent, according to the World Health Organization.
In India the disease was first reported in eastern West Bengal state in 2001.
There is no vaccination for the virus which induces flu-like symptoms that lead to an agonising encephalitis and coma.
The WHO has named Nipah as one of the eight priority diseases that could cause a global epidemic, alongside Ebola and Zika.
Dying Indian nurse: "Take care of our children"
The nurse, with two young children and a husband working overseas, scrawled the words in blue pen as she lay dying in an Indian hospital isolation ward, sick with a rare and deadly virus.
"I think I am almost on my way. I may not be able to see you again. Sorry," Lini Puthusheri wrote her husband in a tangle of English and Malayalam, the main language of the south Indian state of Kerala.
"Take care of our children," wrote Puthusheri, who was infected with Nipah virus while caring for sick patients. She signed it "Lots of love."
She died Monday.
At least 10 people have died of Nipah since an outbreak began earlier this month in Kerala, health officials say, and two more people are in critical condition. There is no vaccine for the virus, which can cause raging fevers, convulsions and vomiting, and kills up to 75 percent of people who come down with it. The only treatment is supportive care to keep patients comfortable.
At least eight people who have had contact with the sick are being kept in isolation, in their homes, so their conditions can be monitored, officials say.
Nipah can be spread by fruit bats, pigs and through human-to-human contact. Officials suspect the Kerala outbreak may have begun with bats.
Kerala state health minister K.K. Shylaja told reporters Tuesday that there had been no new cases of Nipah, though it was not immediately clear when the last case was reported.
Puthusheri treated one of the first Nipah patients, Mohammed Sadik, who was admitted with a fever to the hospital in the small town of Perambra.
"She was very much disturbed by the death of Sadik," her husband, Sajeesh, told The Hindu newspaper. "She developed fever a day or two after he passed away."
An accountant who works in Bahrain, he had rushed home Sunday as his wife's condition worsened, but was unable to see her because she was being treated in an isolation ward.
Millions of people from Kerala have sought higher wages by working in Persian Gulf countries, returning home only on vacations.
Fear of the disease has swept Kerala, even as officials insist the situation is under control.
Some ambulance drivers refused to take the nurse's body to be cremated, The Hindu reported.
"A few drivers did not want to carry the body to the crematorium even though we told them that they would not have to touch it," a relative told the newspaper. Eventually, police helped have the body transported.
Nipah was first identified during a late 1990s outbreak in Malaysia. Later outbreaks have occurred in Bangladesh and India.
Five dead, dozens quarantined as virus fears spread in India
A deadly virus carried by fruit bats has killed at least five people in southern India and more than 90 people are in quarantine, a top health official said Tuesday.
Other deaths are suspected to have been caused by Nipah virus and authorities have ordered emergency measures to control the outbreak.
"We can confirm that five people have died from the Nipah virus," Kerala state health surveillance officer K.J. Reena told AFP.
Media reports said 10 people had died, but officials told AFP final tests had not been completed on other suspicious deaths.
Nine people have been admitted to hospital with symptoms resembling the virus, which the World Health Organization says is fatal in 70 percent of cases, Reena added.
One of the nine has tested positive for Nipah.
"We also traced 94 people who had come in contact with the ones who died and they have been quarantined as a precaution," Reena added.
There is no vaccination for Nipah, which has killed more than 260 people in Malaysia, Bangladesh and India in outbreaks since 1998.
The WHO has named Nipah as one of the eight priority diseases that could cause an epidemic, alongside Ebola and Zika.
The virus induces flu-like symptoms that lead to an agonising encephalitis and coma.
Three members of the same family are among the fatalities. Dead bats were found in a well of the family's house in Kozhikode district, previously known as Calicut.
A nursing assistant who died after treating Nipah patients has been hailed as a hero by authorities.
Mother-of-two Lini Puthussery was cremated even before her family members could bid a final goodbye because of fears the virus could spread.
In a final note she scribbled in a hospital isolation unit, Puthussery urged her husband to take care of the children.
"I don't think I will be able to see you again. Sorry. Please take care of our children," she said.
Kerala state Chief Minister Pinarayi Vijayan said that Puthussery's "selfless service will be remembered".
Health authorities across the state were on high alert, setting up medical camps and a control room to tackle the emerging situation.
U.V. Jose, district collector of Kozhikode, said all government and private hospitals were working in close coordination.
"Health staff are visiting individual households giving them specific instructions including about eating fruits from outside and other precautions," he told AFP.
The neighbouring state of Tamil Nadu has stepped up surveillance in border districts fearing the spread of Nipah.
Nipah was first identified in Malaysia in 1998. It spread to Singapore and more than 100 people were killed in both places. On that occasion, pigs were the virus hosts but they are believed to have caught it from bats.
In India the disease was first reported in 2001 and again six years later, with the two outbreaks claiming 50 lives.
Both times the disease was reported in areas of the eastern state of West Bengal bordering Bangladesh.
Bangladesh has borne the brunt of the disease in recent years, with more than 100 people dying of Nipah since a first outbreak was reported in 2001. In 2004, humans became infected with Nipah after eating date palm sap that had been contaminated by fruit bats.