Nipah virus is a newly emerging zoonotic virus that causes severe disease in both animals and humans. It is transmitted to humans from fruit bats, pigs, or through contaminated foods. Symptoms in humans include fever, headache, vomiting and neurological issues such as disorientation and coma. There is no vaccine and treatment focuses on supportive care. Prevention involves avoiding contact with bats, pigs and contaminated foods or fluids.

1. Nipah Virus Infection
Dr. T.N.Purushotham
District Surveillance Officer
Integrated Disease Surveillance Programme
Tumkur
District Health & Family
Welfare Office , Tumkur

2. Introduction
2
Nipah virus (NiV) infection is a newly
emerging zoonosis that causes severe
disease in both animals (except Bats) and
humans.
The natural host of the virus are fruit bats
of the Pteropodidae Family, Pteropus
genus.

3. Distribution Map
3

4. Epidemiology
4
Family : Paramyxoviridae
Genus : Henipavirus (Nipah and Hendra viruses)
Enveloped, Single stranded, non-segmented RNA genome
Virus named after village near Kuala Lumpur from where it was first isolated -
Sep 1998- Apr 1999- 265 cases, 105 died
Seasonality - All of the outbreaks occurred during the months of winter to spring
(December-May).
Incubation period: varies from 6-21 days.

5. History of NiV Infection:
5
NiV was first identified during an outbreak of disease that took place in
Kampung Sungai Nipah, Malaysia in 1998. On this occasion, pigs were the
intermediate hosts. However, in subsequent NiV outbreaks, there were no
intermediate hosts.
In Bangladesh in 2004, humans became infected with NiV as a result of
consuming date palm sap that had been contaminated by infected fruit bats.

6. Outbreaks In India
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7. NiV Present Outbreak in Kozhikode- Kerala
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Twelve (12) people have been confirmed dead due to
Nipah virus in Kerala. (six are from Waynadu, Kozhikode
Dist and the others from Mallappuram)
More deaths with similar symptoms have been reported
from the State and the authorities have sent the sample
to NIV-Pune for confirmation.
The Centre has rushed a rapid response team from the NCDC, NIV and IDSP to
contain the outbreak

8. Mode of Transmission
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Infected bats shed virus in their secretion such as saliva, urine, blood, semen
and excreta
The NiV is highly contagious among pigs, spread by coughing.
Direct contact with infected pigs.
Human-to-human transmission has also been documented, including in a
hospital setting in India.
There is no vaccine for either humans or animals. The primary treatment for
human cases is intensive supportive care.

9. Possible Transmission of NiV
9

10. Signs & Symptoms
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Nipah virus infection is associated with
encephalitis (inflammation of the brain).
Symptoms appears after incubation
period of 5 to 14 days.
Clinical features of Nipah virus with
following characteristics
Fever
Migraine
Vomiting
Emphysema
Myalgia
Encephalitis (May
relapse after
recovery)
Meningitis
Disorientation
Neurological
deficit (May persist
after recovery)
Coma
Death

11. Nipha Casues Morbidity And Mortality
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• These signs and symptoms can progress
to coma within 24-48 hours. Some
patients have a respiratory illness during
the early part of their infections, and half
of the patients showing severe
neurological signs showed also
pulmonary signs.

12. Long Term Sequelae
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• 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.

13. Mistaken as JE / Herpes simplex
encephalitis in the past
• Many of the original human
cases of the Nipah Virus disease
were provisionally diagnosed as
Japanese encephalitis (JE) / Herpes
simplex encephalitis before the
isolation and identification of the
newly discovered Nipah Virus.
13

14. Case Definitions
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Suspect Nipah Case
Person from a community affected by a Nipah outbreak who has:
•Fever with new onset of altered mental status or seizure and/or
•Fever with headache and/or
•Fever with Cough or shortness of breath
Probable Nipah Case
Suspect case-patient/s who resided in the same village where confirmed case-patient/s
were living during the outbreak period and who died before complete diagnostic specimens
could be collected.

15. Case Definitions
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OR
Suspect case-patients who came in direct contact with confirmed case-patients in a
hospital setting during the outbreak period and who died before complete diagnostic
specimens could be collected.
Confirmed Nipah Case .
Suspected case who has laboratory confirmation of Nipah virus infection either by:
•Nipah virus RNA identified by PCR from respiratory secretions, urine, or cerebrospinal
fluid.
Isolation of Nipah virus from respiratory secretions, urine or cerebrospinal fluid

16. Definition of a Contact:
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A Close contact is defined as a patient or a person who came in contact with a Nipah case
(confirmed or probable cases) in at least one of the following ways.
•has slept in the same household as a case
•has had direct physical contact with the case (alive or dead) during the illness
•has had direct physical contact with the (deceased) case at a funeral or during burial
preparation rituals
•has touched the blood or body fluids (saliva, urine, sputum etc.) of a case during their illness
•has touched the clothes or linens of a case
These contacts need to be followed up for appearance of symptoms of NiV for the longest
incubation period (21 days).

17. Diagnosis tests
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In India, National Institute of Virology (NIV)- Pune is the designated
Laboratory for diagnosis of Nipah Virus.
Nipah virus is classified as a Biosecurity level(BSL )4 agent.
Procedures for the laboratory diagnosis of NiV include
1. Serology,
2. Histopathology,
3. PCR and virus isolation.
4. Serum Neutralization Test,
5. ELISA,
6. RT-PCR are used for laboratory confirmation.

18. The Samples May Be As Follows
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The samples may be as follows -
Throat swab in viral transport medium
Urine 10 ml in universal sterile container
Blood in plain vial (atleast 5ml)
CSF (atleast 1 ml) in sterile container
•Samples should reach the testing facility within 48 Hrs & should be
transported at 2- 6°C
•The sample must be stored at – 70°C if storage is required for longer period.

19. Sample Collection & Transport
Guidelines:
• Nipah virus being a BSL-4 agent, universal, standard droplet and bio-
containment precautions should be followed during contact with
excretions, secretions and body fluids of suspected patient.
• Adequate biosafety precautions should be adopted during
collection/transport/ storage/ processing of suspected sample.
• Sample should be collected as early as possible (within 4 days) with all
bio safety precautions.
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20. Transportation & Storage of Samples:
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•Samples should be safely packed in triple container packing and should
be transported under cold chain (2-6°C)
•Sample containing vials should be kept in good quality plastic bags tide
with rubber bands so that inside material if leaks should not come out of
bag. The plastic bag should be kept in another container which should be
sealed with adhesive tape. . This carrier should be placed in another plastic
bag sealed with rubber bands and placed in thermocol/vaccine carrier
containing ice

21. Treatment
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1. There is no effective treatment for Nipah virus
disease.
2. Ribavarin may alleviate the symptoms of
nausea, vomiting, and convulsions.
3. Treatment is mostly focused on managing fever and the neurological
symptoms.
4. Severely ill individuals need to be hospitalized and may require the use
of a ventilator.

22. Prevention & Control
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Human-to-human transmission of NiV has been reported in recent
outbreaks demonstrating a risk of transmission of the virus from infected
patients to healthcare workers through contact with infected secretions,
excretions, blood or tissues.
Healthcare workers should implement Standard Precautions when caring
for patients and handling specimens from them

23. Prevention & Control
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Nipah virus infection can be prevented by avoiding exposure to
sick pigs and bats in endemic areas.
The main strategy is to prevent NiV in humans. Establishing
appropriate surveillance systems will be necessary so that NiV
outbreaks can be detected quickly and appropriate control
measures initiated.

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Keep the wells and other water sources closed with mesh to avoid the
entry of Bats. Treated water should be used for body sanitization and
cleaning. Consume boiled water.
Moving patients to other locations could result in the spreading of the
virus since it is a transmittable disease. Minimum mobility & quarantine
is hence often advised.
Monitor if anybody in your family shows symptoms of flu. Avoid self-
treatment and do check with medical professionals. Do not panic as
sudden influx of fear could only worsen the situation.
Precautions:

25. 25
Avoid the consumption of fruits bitten by bats and other animals. It is
advisable not to harvest fruits which might seem fallen naturally from a
tree in your premise although it looks untouched by any animals.
Avoid consumption of toddy (liquor) collected from areas where fruit
bats are found in plenty as the beverage is brewed in open containers.
Wear masks and gloves while attending patients and wash hands using
anti-bacterial soaps or liquids if you happen to make any physical
contact with an infected person.
Precautions: