Attendants wear masks as a precaution against the Nipah virus as they help a patient Wednesday, May 23, 2018, at the Government Medical College hospital in Kozhikode, in the southern Indian state of Kerala.
New Delhi CNN  — 

The Nipah virus outbreak in India’s southern state of Kerala is suspected to have spread to the neighboring state of Karnataka, where two people are being tested for it, a health official told CNN.

A 20-year-old woman and a 75-year-old man in the port city of Mangalore showed symptoms of the virus – which can cause fatal brain inflammation – after traveling to Kerala, where they came into contact with infected patients, said Dr. Rajesh BV, a district surveillance officer in Karnataka.

“We are still waiting for their blood results, but we have seen their condition is improving,” he added.

Eleven people have died in the outbreak, Rajeev Sadanandan, additional chief secretary for Kerala’s Department of Health and Family Welfare, told CNN. Another 14 people are confirmed to have contracted Nipah virus, while 22 are awaiting test results after showing symptoms.

The situation is “under control,” with a Central Expert Team continuously reviewing treatment procedures, infection control practices and the availability of personal protective equipment, Sadanandan said.

“There is no need to panic, and … the situation is under control with the State Government constantly monitoring the situation in a proactive manner,” state health authorities said Thursday in a statement released after a meeting of the National Disaster Management Authority.

Victims’ relatives will get money

Among the dead is a nurse, Lini Puthussery, who was treating patients at Perambra Taluk Hospital in the district of Kozhikode, where the outbreak began, officials have said.

The government of Kerala state announced Wednesday it will compensate her family. In a tweet, the office of Chief Minister Pinarayi Vijayan wrote that 1 million Indian rupees (about $14,600) will be given to each of Puthussery’s two children.

In addition, her husband, Sajeesh, will be offered a government job.

The government also announced it will give 500,000 Indian rupees (about $7,300) to each family that lost a relative to Nipah virus.

Bats found near site of first cases

The outbreak began in mid-May in Kozhikode district and spread to neighboring Malappuram and Wayanad districts, all in the southern state of Kerala.

Indians standing in a queue outside the Government Medical College hospital in Kozhikode wear masks as a precaution against the Nipah virus.

The first cases were reported on May 19 in a family from Kozhikode, after which India’s Ministry of Health and Family Welfare and the World Health Organization, or WHO, were alerted. India’s health ministry deployed a response team to Kerala on Monday.

Fruit bats, which are natural hosts of Nipah virus, were found in an unused well near the family’s house, along with rabbits being bred that had recently died, the WHO said. The bat family, Pteropodidae, can spread severe disease to farm animals including pigs, which can result in substantial economic losses.

People can become infected after contact with infected bats, other animals or other people.

Brain inflammation and coma are possible

Initial symptoms of Nipah virus can include headaches and drowsiness, and patients can slip into a coma within days, according to the US Centers for Disease Control and Prevention, or CDC. Other symptoms may include acute respiratory syndrome – in which the lungs cannot get enough oxygen to the body – and fatal encephalitis, an inflammation of the brain.

In the most severe cases, encephalitis and seizures will progress to coma within 24 to 48 hours.

Between four and 14 days may elapse between a person becoming infected and showing symptoms, though a 45-day incubation period has been previously reported for some patients, according to the WHO.

Scientists estimate the virus has a fatality rate of 40% to 75%, varying by outbreak. There is no vaccine, and treatment is limited to supportive care.

Most people who survive acute encephalitis brought on by Nipah virus make a full recovery, but some patients report long-term neurological conditions. About 20% of patients are left with seizure disorder and personality changes, while a small number relapse, according to the CDC.

Urgent research required, WHO says

Nipah is considered an “emerging” virus because it was discovered relatively recently – during a 1998-1999 outbreak in Malaysia, where almost 300 people were infected and more than 100 died, according to the CDC. More than 1 million pigs were euthanized to halt the spread of the illness. The virus was named after the village of Kampung Sungai Nipah, where pig farmers contracted the disease.

Follow CNN Health on Facebook and Twitter

  • See the latest news and share your comments with CNN Health on Facebook and Twitter.

    Only a few outbreaks have happened since then, including in India and Bangladesh, according to the WHO. More than 600 reported human cases between 1998 and 2015, and many parts of Asia, as well as Australia, Madagascar and Ghana are at risk of outbreaks, the agency said.

    The virus is on the WHO’s list of epidemic threats in need of urgent research and development.

    CNN’s Susan Scutti and Meera Senthilingam contributed to this report.