NIPAH VIRUS (NIV)

Mentor:
Rakesh kr. Tiwary
Dr. Surya B. Parajuli
Roll : 24
Dr. parth Guragain
Department of Community Medicine,
MBBS 3rd year
Birat Medical College

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OUTLINE OF PRESENTATION
• Organism
• History
• Epidemiology
• Transmission
• Disease in Humans
• Prevention and Control
• Actions to Take

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WHAT IS NIPAH VIRUS (NIV)

• Nipah virus (NiV)

• family Paramyxoviridae,
• genus Henipa virus.

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ORIGIN OF NAME

• Sungai Nipah, a village in the

Malaysian Peninsula where pig
farmers became ill with
encephalitis.

• flying foxes of the genus Pteropus

are identified as the reservoir for NiV

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HISTORY
• NiV was initially isolated and identified in 1999
during an outbreak of
encephalitis and
respiratory illness
among pig farmers and people with
close contact with
pigs in Malaysia and Singapore.

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RESERVOIR
• Flying foxes (fruit bats)
• Carry the virus
• Are not affected
• Virus found in
• Urine
• Partially eaten fruit (saliva?)
• No known secondary host

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OUT BREAK OF NIPAH VIRUS

In the 1999 outbreak, Nipah virus caused a
INFECTION 1999
relatively mild disease in pigs, but nearly 300
human cases with over 100 deaths were
reported.
• In order to stop the outbreak, more than a
million pigs were euthanized, causing
tremendous trade loss for Malaysia.
• Since this outbreak, no subsequent cases (in
neither swine nor human) have been reported
in either Malaysia or Singapore

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• 1998-1999: Malaysia
• 265 persons hospitalized; 105 deaths
• Primarily adult males with swine contact
• Disease in swine
• Severe respiratory disease
• Transmitted by movement of infected pigs
• 1.1 million pigs culled
• Great economic loss
• Surveillance and testing
• 1999: Singapore
• 22 seropositive persons (1.5%)
• All were male abattoir workers
• 12 symptomatic
• Encephalitis, pneumonia, or both
• 10 asymptomatic

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OUT BREAK IN BANGLADESH

AND SILIGURI
• In 2001, NiV was again identified as the causative agent in an outbreak of human
disease occurring in Bangladesh.
• Genetic sequencing confirmed this virus as Nipah virus, but a strain different from the
one identified in 1999.
• In the same year, another outbreak was identified retrospectively in Siliguri,

• 2004: Bangladesh
• 34 cases; 26 deaths
• Transmission
• Close contact
• Exposure to common source

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• 2005: Bangladesh
• 44 cases; 12 deaths
• Contaminated palm
fruit juice

• 2007: Bangladesh
• 7 cases; 3 deaths
• Person-to-person
transmission

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2018 INDIA
• The recent outbreak in Kerala is thought to have
been caused by dead bats found in a well of a
family's home in the village of Changaroth. The
infection reportedly spread among family members
and was passed on to others who had been in
contact with the family.
• It correlates well with the season when young bats
leave the nest to fly (April- June with a peak in May)!
• The Nipah virus has already claimed 17 lives in the
Indian state of Kerala, including a 31 year-old nurse
who was treating the infected.
• Some 40 people have been quarantined in a bid to
halt its spread. But the world is watching, nervously.

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6TH JUNE 2018

• Kerala Chief Minister Pinarayi Vijayan said on Monday the spread of the
Nipah virus was slowing although people should still remain alert.

He said: "There is no alarming situation now.

• The spread of the virus has been controlled.
• But people should remain alert.”

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TRANSMISSION

• Pigs in Malaysia • Person-to-person

• Direct contact
• Contact with body fluids
• Aerosolization of respiratory or
urinary secretions
• Vertical transmission across the
placenta?
• Semen and iatrogenic spread?
• Not reported in Malaysia
• Likely in Bangladesh and India
• Nosocomial infections
• Bat-to-person
• Not reported in Malaysia
• Common in Bangladesh and India
• Contaminated fruit, unpasteurized
date palm juice

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ZOONOTIC TRANSMISSION CYCLES OF NIPAH VIRUS

• Pteropus species fruit bats are the

natural reservoir of Nipah virus.
• In Malaysia (left), Nipah virus was
transmitted from bats roosting in fruit
trees on pig farms to pigs; subsequently,
pigs transmitted Nipah virus to people in
close contact with the pigs.
• In Bangladesh (right), Nipah virus is
thought to be transmitted via the
consumption of raw date palm sap

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THEORIES OF SPREAD OF NIPAH VIRUS

• As a result of deforestation programmes,

many of the Malaysian farms first
affected had fruit trees close to where
the pigs were housed which attracted
the bats and ultimately increased the
exposure of the pigs to bat excretions
containing the virus.

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 SPREAD BY NOSOCOMIAL ROUTE 20

• India with reports of person-to-person

transmission in hospital settings
(nosocomial transmission).
• Unlike the Malaysian NiV outbreak,
outbreaks occur almost annually in
Bangladesh and have been
reported several times in India.

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 COUNTRIES WITH REPORTED OUTBREAK OF AT 21

RISK BASED ON SEROLOGICAL EVIDENCE OR

MOLECULAR DETECTION IN PTEROPUS BATS
•Australia,
• Bangladesh,
• Cambodia,
• China,
• India,
• Indonesia,
• Madagascar,
• PNG Taiwan,
• Thailand

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HOME RANGE OF PTEROPUS BATS

• Bhutan, Brunei,
• China, India,
• Indonesia, Laos,
• Madagascar, Myanmar,
• Nepal, Philippines,
• PNG, Singapore,
• Taiwan, Thailand,
• Vietnam

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PATHOGENESIS OF NIPAH

• However NiV presents itself in a

varied set of symptoms
depending on the infected
species.
• In general the main mode of
dissemination with each host,
regardless of species, is by
inducing syncytial cell formation
• These large multinucleated cells
then spread rapidly through the
vascular tissue of the infected
host.

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HUMAN ILLNESS
• Incubation period: 4 to 20 days
• Fever and headache
• Encephalitis
• Dizziness, drowsiness, vomiting
• Seizures
• Progresses to coma in 24-48 hours
• Respiratory difficulty
• Relapsing neurologic symptoms

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HUMAN ILLNESS
• Complications (Malaysian outbreak)
• Septicemia (24%)
• GI bleeding (5%)
• Renal impairment (4%)
• Asymptomatic
• Relapse or late-onset encephalitis
• Residual neurological deficits
• Treatment: Supportive, ribavirin

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LONG TERM SEQUELAE

• Long-term sequelae following Nipah virus infection have been noted,

including persistent convulsions and personality changes.
• •Latent infections with subsequent reactivation of Nipah virus and death
have also been reported months and even years after exposure.

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SAMPLING
• Before collecting or sending any samples, the proper authorities should be
contacted

• Samples should only be sent under secure conditions and to authorized

laboratories to prevent the spread of the disease

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ENCEPHALITIS IN THE PAST

• Many of the original human cases

of the Nipah Virus disease were
provisionally diagnosed as
Japanese encephalitis (JE) before
the isolation and identification of
the newly discovered Nipah Virus

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DIAGNOSIS
• Differentials for swine
• Classical swine fever,
• PRRS,
• pseudorabies,
• swine enzootic pneumonia,
• porcine pleuropneumonia
• Diagnostic tests
• ELISA
• Immunohistochemistry
• PCR
• Virus isolation

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DIAGNOSIS WITH REAL TIME PCR

• Laboratory diagnosis of a patient with a clinical

history of NiV can be made during the acute
and convalescent phases of the disease by
using a combination of tests.
• Virus isolation attempts and real time
polymerase chain reaction (RT-PCR) from
throat and nasal swabs, cerebrospinal fluid,
urine, and blood should be performed in the
early stages of disease.

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DETECTION BY ELISA METHODOLOGY

• Antibody detection by ELISA (IgG

and IgM) can be used later on.
• In fatal cases,
immunohistochemistry on tissues
collected during autopsy may be
the only way to confirm a diagnosis

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UNIVERSAL PRECAUTIONS A PRIORITY

TO PREVENT NIAPH VIRAL SPREAD

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CASE DEFINITION
• Suspected (clinical) Nipah case: Patient coming from the community
affected by an outbreak and has: fever with acute onset of altered mental
status or seizure and/or fever with headache and/or fever with acute onset
of cough with shortness of breath.
• Probable Nipah case: Suspect cases, and/or who died before complete
diagnostic specimens could be collected.
• Confirmed Nipah case
Suspected/probable cases who have been confirmed by tests from the
laboratory, i.e. IgM antibody (ELISA test) against NiV in serum or CSF, or RT-PCR
for NiV RNA from respiratory secretions (throat swabs), urine or cerebrospinal
fluid, or Actual virus isolation from respiratory secretions, urine or cerebrospinal
fluid or other tissue specimens.
(The tests are currently being done at National Institute of Virology, Pune)

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UNDERTRIALS WITH ANTIVIRAL DRUG

Ribavirin
ribavarin may alleviate
the symptoms of
nausea, vomiting, and
convulsions.

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PREVENTING NIPAH VIRUS INFECTION

• Avoiding exposure to sick pigs

and bats in endemic areas and
• Not drinking raw date
• Keep fruit bats away from pigs
• Do not drink unpasteurized fruit
juices
• Wash, peel, and/or cook all fruit
thoroughly before eating

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SUBUNIT VACCINE ON TRAIL

• A subunit vaccine, using the Hendra G protein, produces cross-protective

antibodies against HENV and NIPV has been recently used in Australia to
protect horses against Hendra virus. This vaccine offers great potential for
henipa virus protection in humans as well
• ALVAC Canarypox vectored Nipah F and G vaccine appears to be a
promising vaccine for swine and has potential as a vaccine for humans

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MEASURES TO BE FOLLOWED IN OUTBREAKS

• After culling, the burial sites are disinfected with chlorinated lime.
• It is also recommended to use sodium hypochlorite (bleach) to
disinfect the contaminated areas and equipment.
• Other important control measures have been a ban on transporting
pigs within the countries affected,
• a temporary ban on pig production in the regions affected, as well as
improvement of biosecurity practices

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SCIENTIFIC VIEWS/ STUDIES

HOW THE NIPAH SPREAD IN THE HOSPITALS

• Nipah patients frequently

contaminated hospital surfaces near
them with detectable NiV RNA,
posing a risk for fomite borne Nipah
transmission. The most commonly
contaminated surfaces were the bed
sheets and the towels used by
caregivers for patient care

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RECENT ACTIVITIES IN KERELA

• To prevent infection, people in affected areas
should In Kerala, authorities are currently on high
alert and have set up medical camps to control
the situation and prevent a further spreading of
the virus.
• They are also educating the public and giving
specific instructions about general infection
control practices, avoiding exposure and
contact with sick people, as well as domestic
animals also avoid consuming raw date palm sap
or other raw fruits.

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NIPAH AS A
BIOLOGICAL WEAPON
• CDC Category C Bioterrorism Agent
• Emerging pathogen
• Potentially high morbidity
and mortality
• Major health impact
• Aerosolization potential
• Economic impact
• Social disruption (fear, panic)

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REFERENCES
1. Heymann, D. L. (2015). Control of Communicable Diseases Manual, 20th
Edition. Nipah and Hendra Viral Diseases. American Public Health Association.
2015: 428-431.
2. Centers for Disease Control and Prevention. Nipah Virus.
www.cdc.gov/vhf/nipah/.
3. World Health Organization. www.who.int/csr/disease/nipah/en/.
4. Uptodate
5.https://www.ncbi.nlm.nih.gov/pubmed/26981928#
6.https://www.ncbi.nlm.nih.gov/pubmed/10482278#
7.National Guideline for Management, Prevention and Controlof Nipah Virus
Infection including Encephalitis-Bangaldesh

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