Nipah outbreak in Kerala, South India: Ethical challenges in the deployment of healthcare workers.

A highly fatal emerging zoonotic virus, Nipah Virus (NiV), identified as a potential threat to global health security and declared as a candidate for bioterrorism by the World Health Organization (WHO) was first reported in the South Indian district of Kozhikode, Kerala, on May 20, 2018. Following the declaration of an outbreak, emergency control measures, contact tracing, isolation, and barrier nursing were implemented by the state health department. Since no prophylactic drugs or vaccines are available to prevent further transmission, the healthcare teams responded by initiating contact tracing and isolation, the only measures available. There were 2642 contacts that included 40% hospital contacts (185 doctors, 476 nurses, 344 other hospital staff). Quarantine and isolation of healthy persons, especially healthcare workers, involve certain ethical issues. We present an ethical analysis and discussion of contact tracing during the Nipah outbreak in Kerala, based on six principles of public health ethics, namely justice, beneficence and utility, respect for persons, reciprocity and solidarity. Several knowledge gaps and ethical issues that arose should be understood and addressed in future outbreaks. Setting up decision making systems and procedures in advance is the best way to ensure that ethically appropriate decisions will be made during such future outbreaks.