Nipah virus is an emerging zoonotic virus that causes severe disease in humans with high mortality. It is transmitted to humans from bats or through contaminated foods. The symptoms in humans range from asymptomatic to acute respiratory infection and fatal encephalitis. There are currently no approved vaccines or treatments. Prevention efforts focus on reducing exposure to bats, bats' secretions and sick pigs.

1. NIPAH VIRAL INFECTIONS
update 2019
Dr.T.V.Rao MD
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 1

2. What is NIPAH viral Infections
•Nipah virus infection is
an emerging zoonotic
disease associated with
high mortality rate in
human being which
varies from 40% to
100%. Itpresents with
predominant respiratory
and neurologic features.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 2

3. NIPAH Virus
• Nipah virus belongs to
henipa virus genius of
paramyxovirus family and
closely related to Hendra
virus and Cedar virus. The
virus in an enveloped virus
having negative sense single
stranded non segmented
RNA genome. It is
inactivated by 60 degrees c
for 60 minutes.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 3

4. Transmission
• During the first recognized
outbreak in Malaysia, which
also affected Singapore, most
human infections resulted from
direct contact with sick pigs or
their contaminated tissues.
Transmission is thought to have
occurred via unprotected
exposure to secretions from
the pigs, or unprotected
contact with the tissue of a sick
animal.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 4

5. 05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 5

6. NIPAH Virus Key facts
• Nipah virus infection in humans
causes a range of clinical
presentations, from
asymptomatic infection
(subclinical) to acute respiratory
infection and fatal encephalitis.
• The case fatality rate is
estimated at 40% to 75%. This
rate can vary by outbreak
depending on local capabilities
for epidemiological surveillance
and clinical management.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 6

7. 05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 7

8. How the NIPAH Transmitted
• Nipah virus can be
transmitted to humans
from animals (such as bats
or pigs), or contaminated
foods and can also be
transmitted directly from
human-to-human.
• Fruit bats of the
Pteropodidae family are the
natural host of Nipah virus.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 8

9. 05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 9

10. 05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 10

11. 05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 11

12. Transmission
•In subsequent outbreaks
in Bangladesh and India,
consumption of fruits or
fruit products (such as
raw date palm juice)
contaminated with urine
or saliva from infected
fruit bats was the most
likely source of infection.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 12

13. NIPAH Virus can be decontaminated
with
•It is susceptible to
common soaps,
disinfectants and
lipid solvents like
alcohol, ether and
sodium.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 13

14. Reducing the risk of infection in people
•In the absence of a vaccine,
the only way to reduce or
prevent infection in people
is by raising awareness of
the risk factors and
educating people about the
measures they can take to
reduce exposure to the
Nipah virus.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 14

15. Reducing the risk of bat-to-human transmission.
•Efforts to prevent transmission should first focus on
decreasing bat access to date palm sap and other
fresh food products. Keeping bats away from sap
collection sites with protective coverings (such as
bamboo sap skirts) may be helpful. Freshly collected
date palm juice should be boiled, and fruits should
be thoroughly washed and peeled before
consumption. Fruits with sign of bat bites should be
discarded.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 15

16. Reducing the risk of animal-to-human
transmission.
•Gloves and other protective clothing should be worn
while handling sick animals or their tissues, and
during slaughtering and culling procedures. As much
as possible, people should avoid being in contact
with infected pigs. In endemic areas, when
establishing new pig farms, considerations should be
given to presence of fruit bats in the area and in
general, pig feed and pig shed should be protected
against bats when feasible
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 16

17. Reducing the risk of human-to-human
transmission.
•Close unprotected
physical contact with
Nipah virus-infected
people should be
avoided. Regular hand
washing should be
carried out after caring
for or visiting sick
people.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 17

18. 05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 18

19. Controlling infection in health-care
settings
•Health-care workers
caring for patients with
suspected or confirmed
infection, or handling
specimens from them,
should implement
standard infection control
precautions at all times
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 19

20. human-to-human transmission
• As human-to-human
transmission has been
reported, in particular in
health-care settings,
contact and droplet
precautions should be
used in addition to
standard precautions.
Airborne precautions may
be required in certain
circumstances
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 20

21. NIPAH viral specimens are Bio
Hazard
•Samples taken from
people and animals with
suspected Nipah virus
infection should be
handled by trained staff
working in suitably
equipped laboratories.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 21

22. Prevention of Transmission of NIPAH by Fruits
• The risk of international
transmission via fruits or fruit
products (such as raw date
palm juice) contaminated
with urine or saliva from
infected fruit bats can be
prevented by washing them
thoroughly and peeling them
before consumption. Fruit
with signs of bat bites should
be discarded.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 22

23. Infection Control Precautions Standard,
contact and droplet precautions
•Patient Placement
•Place a patient who
may be infected
with Nipah virus in
a s i n g l e isolation
room.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 23

24. Keeping NIPAH infected
Patients
•If Single
accommodation
not available put
the patient in
separate bed >1
meter from other
patient
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 24

25. Caring the Rooms with Infected
patients
•The room should
undergo appropriate
cleaning and surface
disinfection before
unprotected individuals
are allowed to re-enter
it
•Standard room cleaning
agents suffice .
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 25

26. Hand Hygiene
• HCWs should apply “ The 5
moments for hand hygiene”:
• 1. Before touching a patient,
• 2. Before any clean or aseptic
procedure,
• 3. After body fluid exposure
risk,
• 4. after touching a patient,
• 5. And after touching a
patient’s surroundings.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 26

27. HAND HYGIENE A GREAT PRIORITY
•In addition to the
above mentioned
moments, HCWs
should perform hand
hygiene before
putting on and upon
removal of PPE,
including gloves
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 27

28. How well we can do the Hand
washing
•Hand hygiene in
healthcare settings can be
performed by washing
with soap and water
orusing alcohol-based
handrubs. If hands are
visibly soiled, use soap
and water, not alcohol
based hand rubs
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 28

29. Use of Gloves
• Gloves
• Put on clean, non-sterile gloves
upon entry into the patient room
or care area.Change the gloves if
they become torn or heavily
contaminated.
• Wear gloves whenever history
taking, physical examination,
sample collection and other care
giving to suspected, probable,
confirmed Nipah cases.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 29

30. Wearing of Hospital
Gowns
• Gowns
• Put on a clean gown upon
entry into the patient room or
area.
• Change the gown if it
becomes soiled.
• Remove and discard the gown
immediately upon leaving the
patient room or care area.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 30

31. Diagnosis of NIPAH Viral
Infections
• Initial signs and symptoms of
Nipah virus infection are
nonspecific, and the diagnosis
is often not suspected at the
time of presentation. This
can hinder accurate diagnosis
and creates challenges in
outbreak detection, effective
and timely infection control
measures, and outbreak
response activities.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 31

32. Optimal samples to be collected with
Scientfic approach
•In addition, the quality,
quantity, type, timing of
clinical sample
collection and the time
needed to transfer
samples to the
laboratory can affect
the accuracy of
laboratory results.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 32

33. NIPAH Diagnosis needs Serological
and Molecular Testing methods
• NIPAH virus infection can be
diagnosed with clinical history
during the acute and
convalescent phase of the
disease. The main tests used are
real time polymerase chain
reaction (RT-PCR) from bodily
fluids and antibody detection via
enzyme-linked immunosorbent
assay (ELISA).
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 33

34. Emerging Methods to Diagnose NIPAH
infections
•Other tests used
include
polymerase chain
reaction (PCR)
assay, and virus
isolation by cell
culture.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 34

35. Definitive Treatments and Vaccines
are yet to be made available
• There is no effective treatment
or vaccine available for either
people or animals. The primary
treatment for humans is
supportive care.
• The 2018 annual review of the
WHO R&D Blueprint list of
priority diseases indicates that
there is an urgent need for
accelerated research and
development for the Nipah
virus.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 35

36. Prevention
•Nipah virus infection
can be prevented by
avoiding exposure to
sick pigs and bats in
endemic areas and
not drinking raw date
palm sap.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 36

37. 05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 37

38. Our Vison to Control NIPAH
Infections
• Additional efforts focused on surveillance and awareness
will help prevent future outbreaks. Research is needed to
better understand the ecology of bats and Nipah virus,
investigating questions such as the seasonality of disease
within reproductive cycles of bats. Surveillance tools should
include reliable laboratory assays for early detection of
disease in communities and livestock, and raising
awareness of transmission and symptoms is important in
reinforcing standard infection control practices to avoid
human-to-human infections in hospital settings
(nosocomial infection).
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 38

39. Vaccines are Undergoing trails for
Control of NIPAH
• 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 henipavirus protection in
humans as well.
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 39

40. • Program file Created by Dr.T.V.Rao MD for benefit of
Medical, Nursing, and health care Professionals in
the developing countries with resources from WHO
CDC AND NIH and open resources in Google search
•Email
doctortvrao@gmail.com
05-06-2019 Dr.T.V.Rao MD @ NIPAH infection 40