Kyasanur Forest Disease: A ticking health bomb in the Western Ghats

Primates such as Hanuman langurs (in the photo) and bonnet macaques are amplifying hosts of the KFD virus spread through ticks. The virus undergoes amplification within their bodies, leading to symptomatic infection similar to that in humans. Photo by Abhishek N. Chinnappa/Mongabay.

Aralagodu residents recount fear and stigma

“Lockdown struck our village a year prior to Covid-19,” recalls Chandrakala Ganapathi, a senior citizen of Aralagodu, a village in Sagara taluk, reflecting on the chaos that followed an outbreak of monkey fever in her tight-knit village of just 86 families (as per the 2011 Census). Monkey fever ravaged Aralagodu during the winter months of November and December in 2018, marking one of the most severe outbreaks of KFD in recent memory.

Caught amidst fear and misinformation, the neighbouring villages shunned Aralagodu residents, even prohibiting them from accessing public transportation, as recounted by the villagers. Chandrakala, who, along with her husband Ganapathi, operates a homestay, shares the stark isolation they endured—neither relatives nor neighbours dared to visit during this period. Farm labourers from neighbouring areas refused to work in Aralagodu, and some of their own workers fell gravely ill with KFD. Desperate, some residents shuttered their homes and sought refuge in nearby villages. Another resident Shivaraj, who spearheaded relief efforts within the village, says that there was an overwhelming influx of patients at the local public health centre (PHC), where four ambulances stood on standby.

Despite its annual cyclic nature, the monkey fever continues to instill fear and perpetuate social stigma, reminiscent of the initial stages of COVID-19 pandemic. Journalists, researchers, or anyone seeking information in the recent outbreak regions of Uttara Kannada and Chikkamagaluru districts are met with hostility and rejection.

During the 2019 outbreak, people believed that the disease was transmitted from human to human. In a 2020 paper addressing social stigma during infectious disease outbreaks, the authors say that stigmatisation and discrimination of individuals can also become barriers to accessing health care and adopting healthy behaviours.

Aralagodu resident Shivaraj spearheaded relief efforts within the village during a major KFD outbreak in 2018-2019. Photo by Abhishek N. Chinnappa/Mongabay.
Aralagodu resident Shivaraj spearheaded relief efforts within the village during a major KFD outbreak in 2018-2019. Photo by Abhishek N. Chinnappa/Mongabay.

Vaccine withdrawal leaves residents baffled

Residents of KFD hotspots have other concerns, too. This year, Chandrakala didn’t receive the usual WhatsApp message from the PHC nurse, Pushpa S., reminding her about the preventive vaccination shots. Additionally, the distribution of Dimethyl phthalate (DMP) oil, which was previously freely provided by the PHC to prevent tick bites, has also ceased. Some individuals, like plantation worker and KFD survivor Somavathi Mahaveera, received the oil in a brand new bottle without any accompanying explanation.

“The vaccine abruptly stopped early last year. We were anticipating booster doses, but there has been no supply so far,” remarks a perplexed Pushpa. In fact, the department of health and family affairs stopped the manufacturing and distribution of the KFD vaccine, arguably the only defence against the virus, in October 2022, citing potency issues.

Public Health Centre nurse Pusha at the health facility in Aralagodu, Karnaaka. Photo by Abhishek N. Chinnappa.
Public Health Centre nurse Pushpa at the health facility in Aralagodu, Karnataka. Photo by Abhishek N. Chinnappa/Mongabay.

A study conducted between 2005 and 2010 by the National Institute of Epidemiology, a sister agency of the National Institute of Virology (NIV) under the ICMR, discusses the effectiveness of the vaccine and confirms the loss of potency. The study attributes this decrease in efficacy to potential genetic drifts and variations in newer strains of the virus, as opposed to the strain used for vaccine development in the 1950s. While Harshavardhan assures that a new vaccine is currently in development at the Indian Immunologicals Ltd in Hyderabad and is expected to be available next year, there is unofficial consensus in scientific circles that its completion may require additional time.

At least three other vaccines made abroad have shown effectiveness against the virus. One is commercially available and the other two are awaiting clinical trials.

A bottle of Dimethyl phthalate (DMP) oil used as a tick repellent. In the absence of a vaccine, avoiding tick bites is the only way to prevent KFD infection. Photo by Abhishek N. Chinnappa/Mongabay.

Impractical preventive measures

In the absence of a vaccine, authorities are urging communities to adhere to preventive measures, which villagers find impractical. “We cannot stop going to plantations or forests because it is our livelihood,” explains Somavathi. She informs us that the tick-repellent DMP oil, though effective, poses challenges due to excessive sweating during outdoor labour activities.

The first one to be infected in Aralagodu in late 2018, Padmavathi, spent over Rs 100,000 in treatment. She couldn’t access the government’s free medical care for the KFD-infected as she got infected before the outbreak became apparent. Padmavathi mentions that fatigue has overwhelmed both her and her husband post-infection, making farming difficult. Extreme fatigue is a post-infection condition observed. Additionally, patients experience hair loss, and for women, an infection during menstruation can be fatal.

A 2023 paper that maps the sociodemographic features of the vulnerable population, identifies the poor, landless or smallholders, and households headed by the elderly as particularly susceptible to the disease. Bheerappa tragically lost both his son and wife, who were labourers at arecanut plantations, to the infection within two days of each other. He recounts that his son and wife were reluctant to get the vaccination. Apart from vaccine hesitancy, most village residents also shy away from reporting the case in the early stages for fear of having to visit large private hospitals that provide free medical assistance to the KFD infected at the government’s behest.

Aralagodu resident Bheerappa lost two of his family members to KFD. Photo by Abhishek N. Chinnappa/Mongabay.

Changing symptoms and cure

The incubation period of KFD in humans typically spans two to four days. This illness is marked by a sudden onset of high fever and headache, accompanied by a range of symptoms such as body aches, diarrhoea, muscle pain etc., and haemorrhagic manifestations like gum, nose, or gastrointestinal bleeding. In approximately 10–20% of cases, fever may recur with neurological symptoms such as mental confusion, drowsiness and other related manifestations. Doctors also caution that the viral load plays a critical role in determining the severity of the infection.

Treatment for KFD is currently limited to addressing symptoms. The symptoms, however, are evolving over time. Pushpa says, “Sometimes patients come without the typical headache accompanying fever, which was once considered a hallmark symptom. In some instances, only blood tests confirm KFD.” Unfortunately, by this point, treatment may be initiated too late to effectively combat the infection.

Despite the disease being around for over six decades, KFD’s changing epidemiological profile suggests it to be considered an emerging tropical disease, according to a 2018 study. There is an overwhelming consensus among the general public and experts that the virus strain may be drifting or mutating. “These opinions remain largely hypothetical in the absence of evidence,” says Dr Prashanth N. Srinivas at the Institute of Public Health in Bengaluru who has been studying the disease for a long time.

Darshan highlights the lack of human postmortems since 1992, which could provide valuable insights into histopathological variations resulting from the infection. However, Harshavardhan dismisses the importance of postmortem studies in medical treatment, arguing that since the disease is managed symptomatically, such studies wouldn’t significantly impact medical interventions.

Padmavathi, the first one to be infected in Aralagodu in late 2018, spent over a lakh on treatment and still experiences extreme fatigue. Photo by Abhishek N. Chinnappa.
Padmavathi, the first one to be infected in Aralagodu in late 2018, spent over a lakh on treatment and still experiences extreme fatigue. Photo by Abhishek N. Chinnappa/Mongabay.

Inaccurate, inadequate data poses hurdles 

Missing or faulty data is another serious concern. KFD Janajagruthi Okkoota members accuse the authorities of consistently undercounting cases and conducting inaccurate death audits. The death of 18-year-old Ananya from Hosanagara taluk due to KFD early this year allegedly occurred because the authorities withheld her blood test results. This incident prompted them to send a letter to the prime minister alleging foul play.

Despite 22 reported KFD deaths from Aralagodu alone in 2018-2019, official records indicate zero deaths in 2018 and only 15 deaths in 2019 in Karnataka. Shivaraj highlights that many genuine cases of KFD are rejected based on the victim’s history of alcohol or tobacco use. “The reality is, almost everyone in our village consumes alcohol and smokes tobacco, but not all of them die from KFD,” he points out. He adds that the monetary compensation ranging from Rs. 2 to 2.5 lakh provides significant relief for the victims’ families. The government also offers free medical aid to confirmed KFD cases and inaccurate testing may result in denial of assistance.

Even monkey deaths are often misreported which Darshan says can be detrimental since infected ticks leave a monkey’s dead body when body temperature drops and spread in the nearest forest floor, creating a “hotspot”. “It’s crucial to steer clear of such areas to avoid an infection,” he says.

A man checks for ticks on his cattle. Sixteen tick species—most of them belonging to the genus Haemophysalis—out of 40 species of ticks recorded from KFD affected areas, have been found to be carrying the virus that causes KFD.Photo by Abhishek N. Chinnappa/Mongabay.
A man checks for ticks on his cattle. Sixteen tick species—most of them belonging to the genus Haemophysalis—out of 40 species of ticks recorded from KFD affected areas, have been found to be carrying the virus that causes KFD. Photo by Abhishek N. Chinnappa/Mongabay.

As KFD-affected regions anxiously await the development of an effective vaccine to alleviate the annual threat and anxiety of potential infections, experts stress the importance of additional measures to curb the spread of the virus. Srinivas emphasises the urgent need to halt rapid land use changes in forested areas, alongside the implementation of enhanced surveillance mechanisms and primary prevention strategies.

Darshan points out that while Kyasanur has not reported any positive cases in decades, the absence of sero-surveillance kits hinders his understanding of why. Srinivas advocates for medico-social audits, akin to death audits, to meticulously analyse cases and identify systemic failures. Experts suggest taking a One Health approach, concentrating on multisectoral collaboration between regional institutions involved in public, animal and environmental health domains.

“It is time for a permanent solution to this,” demands Sripal. KFD Janajagruthi Okkoota has put forward a series of demands to the government. “We are advocating for enhanced health surveillance in KFD-affected regions within the Western Ghats.” Their demands encompass the establishment of another diagnostic laboratory and research centre in Shivamogga, as well as improved reporting of cases and death audits.

 

Banner image: A man shows ticks collected near his house in the Malenadu region of Karnataka. Kyasanur Forest Disease is a tick-borne viral illness that has been wreaking havoc for decades across the Western Ghats. Photo by Abhishek N. Chinnappa/Mongabay.

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