This document summarizes Nipah virus outbreaks, including the first in Malaysia and Singapore in 1998-1999 among pig farmers, with a case fatality rate of 30%. It discusses subsequent outbreaks in India in 2001 and 2007 through contact with bat fluids and in Kerala in 2018 through contact with infected fruit bats or their body fluids, with case fatality rates of 70% and 89.7% respectively. It provides details on the incubation period, symptoms, lab confirmation, case definitions, management including ribavirin therapy, and prevention efforts like those taken in Kerala to control transmission and prevent future outbreaks.

1. NIPAH
OUTBREAK
DR ANANDU S

2. INTRODUCTION
 Emerging zoonotic disease
 Caused by NIPAH VIRUS (NiV){Family
paramyxoviridae}
 FIRST OUTBREAK:1998-1999 among pig
farmers in Malayasia and Singapore.CFR-
30%
 next reported in Bangladesh(meherpur)-raw
date palm sap

3. OUTBREAK IN INDIA
 2001 and 2007 in Siliguri and Nadia districts
of West Bengal
 Infection was through direct contact with bat
fluids
 CFR -70%

4. OUTBREAK IN KERALA
 In Malapuram and Kozhikode districts of
Kerala on may ,2018.
 CFR -89.7%
 Cause –contact with body fluids and
secretions from infected fruit bats(pteropidae
family)
 Transmission –from bats to humans and
humans to humans

5.  Incubation period -4 to 14 days
 Symptoms –first is high grade fever with
features of encephalitis leading to confusion
,disorientation and drowsiness and even
coma within in 24 -48 hrs.most cases have
signs of neurological ,respiratory and
pulmonary system.
 Lab confirmation-RT PCR;throat
swabs,csf,urine and blood .Igm and IGg
antibody to confirm recovery.Also
immunohsitochemistry on tissues collected.

6. CASE DEFENITION
 SUSPECT-fever with altered mental status or
seizure
-fever with head ache
-fever with cough or shortness of
breath
 PROBABLE-resides in the same village of the
confirmed and died before specimen
collection.
 CONFIRMED – Nipah virus RNA identified by
PCR or isolation of the virus from the
secretions.

7. MANAGEMENT
 Plenty of oral fluids and electrolytes balance
 Parentral or NT tube feeding
 Paracetamol can be given but aspirin is
contraindicated.
 Maitain saturation
 If significant cardiac dysfunction Vasopressors
along with noradrenalin can be given.
 Steroids can also be used.

8.  RIBAVAIRIN THERAPY
 ADULTS: 2000 mg loading (10 tabs of 200
mg)
 Day 1-4: 5 tabs of 200 mg each 4 times.
 Day 5-10:200 mg 3 tab-3 tab-2 tab -2 tab.
 Children -30 mg/kg loading
 Day 1-4 : 15 mg/kg 4 times
 Day 5 to 10: 7.5 mg/kg 4 times.

9. Kerala model
 By taking stringent containment and preventive
measures like acute fever and acute encephalitis
surveillance,lead by NCDC AND GOVT.WHO
provided technical support.
 Field workers were ropped in cordinated by
docrors of phc /chc.
 Mass media and public awareness
 Intergovernmental cordination under special task
force.

10.  Future outbreak prevention:breaking the
transmission chain.
 Bats pigs humans
raw palm sap

14. THANK YOU