Brief information about nipah virus infection and more emphasis on factors responsible for emergence of disease in India and prevention & control strategies relevant to Indian conditions.

1. NIPAH VIRUS InfectionNIPAHVIRUSINFECTION(NiV) –
An emerging bioterrorism
Dr. ANGAPPAN, M
PhD Scholar
IVRI - VPE

2. What is Nipah virus (NiV)
• A paramyxovirus (genus
Henipavirus)
• First identified in 1999 in Malaysia
caused an outbreak of respiratory
illness and encephalitis in pig
farmers.
Synonyms:
• Barking Pig Syndrome
• Porcine Respiratory and
Encephalitis Syndrome,
• Porcine Respiratory and Neurologic
Syndrome

3. Origin of
Name
• Its name originated
from Sungai Nipah, a
village in the Malaysian
Peninsula where pig
farmers became ill with
encephalitis.
In the 1998-1999
outbreaks of Malaysia
and Singapore, over 1
million pigs were
destroyed to control the
disease, causing (Kamil et al., 2001; Lam and Chua,2002)

4. Transmission of NIPAH Virus

5. 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

6. Spread by Nosocomial
route
• 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.

7. Mistaken as Japanese
Encephalitis in the past

8. 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.

9. Cases in
Bangladesh and
India
• Human cases occurred
in Bangladesh and India
in 2003, 2004, 2007,
2008 without apparent
related domestic animal
outbreaks.

12. 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

13. Diagnosis
Initial signs and symptoms are
non- specific and the diagnosis
is often not suspected at the
time of presentation.NiV infection can be diagnosed
together with clinical history
during the acute and
convalescent phase of the
disease.
Main tests including RT-PCR
from bodily fluids as well as
antibody detection via ELISA.
Different tests include:
– ELISA
– PCR assay
– virus isolation by cell culture.

14. NIPAH Patients to be treated as Septic
patients caring the Encephalitis TOO

15. Undertrials with
Antiviral Drug
Ribavirin
• The drug ribavirin
has been shown to
be effective against
the viruses in vitro,
but human
investigations to
date have been
inconclusive and the
clinical usefulness of
ribavirin remains
uncertain

16. 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
Henipavirus protection in
humans as well
Broder, C.C et al., 2016

17. (Anonymous, 2004a; Epstein et al., 2008; Hsu et al., 2004) (Arankalle et

18. Kerala outbreak
• Throat swabs, urine and blood
samples collected from
suspected patients
• The Virus Research
Diagnostic Laboratory at
Manipal Hospital and the
National Institute of Virology
are conducting laboratory
testing to confirm cases.
• 3 samples were confirmed
positive for Nipah virus (NiV)
by (RT-PCR) and IgM Elisa for
NiV.

19. Cont..
 As of 28 May, 13 deaths have been
reported: three from Malappuram
district and ten from Kozhikode district
(WHO, 2018 )
 In the current outbreak, acute
respiratory distress syndrome and
encephalitis have been observed.
Public health response:
 A multi-disciplinary central team from
the National Centre for Disease Control
was sent to Kerala to investigate and
respond.
 Acute fever and acute encephalitis
syndrome (AES) surveillance have
been enhanced across the state.
 “One Health” approach

20. Preventing
Nipah virus
infection
• Avoid exposure to
sick pigs and bats in
endemic areas and not
drinking raw date
palm sap.
• Mass culling of
infected and in-
contact pigs and on
antibody surveillance
of high risk farms to

21. Research on Bats
a priority
• 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

22. Measures to be
followed in outbreaks
• After culling, the burial sites are
disinfected with chlorinated lime.
• Ban on transporting pigs within
the countries affected, a
temporary ban on pig production
in the regions affected.
• Improvement of biosecurity
practices

23. Effective use of personal
protective equipment (PPE )
reduces the spread
• Education and use of personal
protective equipment (PPE) by
persons exposed to potentially
infected pigs is highly recommended.
• Also, improved hygiene at pig
operations is suggested.

24. Scientific views/
studies How the
NIPAH spread inthe
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

25. Caring the Towels is a priority to contain the spread of NIPAH Virus

26. NIPAH AS A BIOLOGICAL WEAPON
Conclusion
• CDC Category C Bioterrorism Agent
• Emerging pathogen
• Potentially high morbidity and
mortality
• Major health impact
• Aerosolization potential
• Economic impact