Kerala has decided to invest in research on the ‘One Health’ platform to study primary amoebic meningoencephalitis (PAM), now that the disease, which has a mortality of 97%, has been reported from many districts in the State.
The State reported 19 cases of PAM this year within a space of three months, including a case cluster — a rarity — in Thiruvananthapuram. While five persons lost their lives, early diagnosis and aggressive management saved the lives of others, again an extremely rare feat, considering the fact that global literature has only ever reported 11 survivors across nations.
On Tuesday, August 27, 2024, the State Health department organised a technical workshop on PAM at the Government Medical College Hospital, Thiruvananthapuram, involving experts from the Indian Council of Medical Research (ICMR), Institute of Advanced Virology, AV Medical College, Puducherry, Indian Institute of Science, Bengaluru, and the State Pollution Control Board to discuss various aspects of PAM and the way forward.
Action plan
Health Minister Veena George, who addressed the workshop, later said Kerala would formulate an action plan within a week or two, addressing all aspects of PAM — environmental factors, public awareness creation, scaling up diagnostic aspects, particularly molecular diagnostic techniques to aid early detection of the disease.
The State had decided to invest in PAM research when the PAM cluster was reported. The authorities were able to identify the potential cluster of cases as soon as the first case was detected and while the first case could not be saved, the rest of the patients were on their way to recovery now. However, it was important to understand why PAM cases had suddenly gone up in the State, it was pointed out.
Experts who participated in the workshop appreciated Kerala’s efforts to identify PAM cases early and to treat the patients aggressively. So far, of the 19 cases, four persons have fully recovered, while 10 others are recovering.
Environmental factors
One of the focus areas of the discussion was the environmental biotic and abiotic factors encouraging the abundant growth of amoeba in waterbodies in the State and the topic was led by the State Pollution Control Board and the Environmental Engineering Division.
In the long term, the State will study the environmental factors at play that could have led to the increased concentration of free-living amoeba in waterbodies and the strategies that can be adopted to generate public awareness on preventing the disease and the role of local bodies in keeping the waterbodies clean.
All PAM cases confirmed in Kerala have a history of some kind of contact with water/ unclean water in which amoeba could be present.
Case control study
It was also decided to conduct a case control study to determine why only a few among the scores of people who entered the same waterbody contracted PAM. This study would be undertaken by the National Institute of Epidemiology and the ICMR.
Those who participated in the technical workshop included former Head of Medical Parasitology, PGIMER, Rakesh Sehgal; Professor of Biochemistry, IISc Bengaluru, Utpal S. Tatu; Professor, Dept of Environmental Sciences, Kerala University Salom Gnana Thanga; Member Secretary, SPCB, Sheela Moses; Scientist, ICMR, Anoop Velayudhan, among others.
