The document discusses Nipah virus, a zoonotic virus that causes severe disease in humans and animals. It originated in Malaysia in 1998. Bats are natural reservoirs, transmitting the virus to pigs who act as amplifying hosts. Humans contract it through contact with infected bats, pigs, or other humans. Symptoms include fever, cough, vomiting and neurological issues like altered mental status. There is no treatment, only supportive care. Outbreaks have occurred in Bangladesh and India. Prevention involves avoiding contact with bats/pigs and their secretions, proper hygiene and isolation protocols for patients.

1. NIPAH VIRUS
Dr. Vinay tuteja
MU1

3. INTRODUCTION
 Human Nipah Virus(NiV) infection is an emerging zoonotic
disease which causes severe disease in both humans and
animals.
 Nipah virus (NiV) is a member of the family
Paramyxoviridae,genus Henipavirus.
 It was first recognized in Malaysia and Singapore during an
outbreak from September 1998 through May 1999.
 Its name originated from kampung Sungai Nipah, a village in
the Malaysian Peninsula where pig farmers became ill with
encephalitis.

4. Distribution map of pteropus bat
EPIDEMIOLOGY

5. GEOGRAPHICAL DISTRIBUTION OF OUTBREAKS OF NIV
INFECTION IN BANGLADESH AND INDIA

6. TRANSMISSION
 Fruit bats of the genus Pteropus have been identified as
natural reservoirs of NiV.
 Infected bats shed the virus in their excretion and secretions
such as saliva, urine, semen and excreta, but they are
symptomless carriers.
 Pigs acquire NiV after contact with infected bats or their
secretions or by consumption of raw date palm sap n other
fruits contaminated with infectious bat excretions.
 Pigs act as an intermediate and possibly amplifying host.

7. TRANSMISSION IN HUMANS
• Direct contact with infected bats, infected pigs, or from other
NiV infected people.

8. ABOUT THE AGENT
 NiV is a highly pathogenic paramyxovirus belonging to genus
Henipavirus [1].
 It is an enveloped negative sense ssRNA virus [2].
 SUSCEPTIBILITY TO DISINFECTANTS: Inactivated by 0.1% formalin,
and 0.5% household bleach(11).
 PHYSICAL INACTIVATION: Samples containing Nipah virus diluted in
phosphate buffered saline containing Tween-20 and Triton-X100
have been heat inactivated at 56ºC for 30 minutes (12).

9.  There is strong evidence that the emergence of bat-related viral
infection communicable to humans and animals has been
attributed to loss of natural habitat of bats.[5]
 Seasonality was strongly implicated in NiV outbreaks in
Bangladesh and India.
 All of the outbreaks occurred during the months of winter to
spring (December-May).
 Seasonality could be associated with several factors like the
breeding season of the bats, increased shedding of virus by the
bats and the date palm sap harvesting season.

10.  The median incubation period of the secondary cases who
had a single exposure to Nipah case is 9 days (6–11 days)[6, 7,
8].
 The median incubation period following single intake of raw
date palm sap to onset of illness is 7 days (2-12 days) [6, 7, 8].
 The nucleotide sequences of NiV strains isolated from pigs
and persons in Malaysia were remarkably similar and suggest
that the entire outbreak was caused by 1 or 2 closely related
strains[3].
 But recurrent Nipah outbreaks have been recognized since
2001 and the strains of Nipah isolates show substantial
heterogeneity in their nucleotide sequences.[4]

11. PATHOGENESIS
 The pathologic findings in the brain of Nipah encephalitis
cases showed evidence of necrotizing vasculitis[8].
 The main pathology appeared to be widespread ischemia and
infarction caused by vasculitis-induced thrombosis, although
direct neuronal invasion may also play a major role in the
pathogenesis of the encephalitis.
 Alveolar hemorrhage, pulmonary edema and aspiration
pneumonia were often encountered in the lungs [8].
 These may lead to pneumonia and acute respiratory distress
syndrome (ARDS) ultimately.

12. PRPRIMARY VIRUS
REPLICATION
VIVIREMIA
VVASCULAR INFECTION
VASCULITIS
VIREMIATHROMOSIS &
OBSTRUCTION
VIREMIAEXTRAVASCULAR
SPREAD
VIREMIAISCHEMIA &
INFARCTION
VIRPARENCHYMAL INFECTION
AND CELLULAR INJURY

13. CLINICAL FEATURES
 Fever
 Cough
 Vomiting
 Severe weakness
 Headache
 Altered mental status
 Respiratory distress
 Muscle pain
 Convulsion
 Diarrhoea

14. DISEASE IN ANIMALS
 Highly contagious
 May be asymptomatic
 Acute fever
 Severe respiratory disease
 Barking pig syndrome(characteristic cough)
 Encephalitis
 Low mortality

15. Relapsed encephalitis:
 A case is considered to be relapsed encephalitis if the
neurological symptoms recur after recovery from encephalitis.
 Relapsed encephalitis with acute onset of fever, headache,
seizures and focal neurological signs occurring months to
years after recovery from the initial acute encephalitis.
 Manifesting in oculomotor palsy and cervical dystonia.
Late-onset encephalitis:
 If the neurological signs and symptoms of encephalitis
develop after more than 10 weeks of the initial exposure, it is
known as late onset encephalitis.

16. DIFFERENTIAL DIAGNOSIS
 Viral encephalitis (Herpes simplex encephalitis, Japanese B
Encephalitis )
 Bacterial meningitis
 Cerebral Malaria

17. CASE DEFINITION OF NIPAH ENCEPHALITIS(1)
SUSPECTED CASE
A person fulfilling both of the following criteria is defined as
a suspected case
1. Features of acute encephalitis as demonstrated by
a. Acute onset of fever AND
b. Evidence of acute brain dysfunction as manifested by
i. Altered mental status OR
ii. New onset of seizure OR
iii. Any other neurological deficit
2. Epidemiological linkage
a. Drinking raw date palm sap OR
b. Occurring during Nipah season OR
c. Patient from Nipah endemic area
1.Surveillance, Prevention and Control of Nipah Virus Infection: A Practical Handbook

18. PROBABLE CASE
A person with features of acute encephalitis
1.During a Nipah outbreak in the area or
2.With history of contact with confirmed Nipah patient
In both suspected and probable cases, the patient might
present with respiratory features with or without encephalitis.
• The respiratory features are Illness < 7 days
duration
• Acute onset of fever
• Severe shortness of breath, cough
• Chest radiograph showing diffuse infiltrates.

19. CONFIRMED CASE
A suspected or probable case with laboratory confirmation
of Nipah virus infection either by:
 IgM antibody against Nipah virus by ELISA in serum or
cerebrospinal fluid
 Nipah virus RNA identified by PCR from respiratory
secretions, urine, or cerebrospinal fluid.
Definition of Cluster
 Two or more suspect cases living within a 30 minute
walk of each other who develop symptoms within 21
days of each other.

20.  CSF study- mild pleocytosis. Normal or slightly raised protein
and normal sugar level.
 MRI of brain- diffuse confluent high signal lesions involving
mainly the cortical grey matter and to a lesser extent sub-
cortical and deep white matter on T2W and FLAIR sequences.
 Electroencephalogram: The electroencephalogram (EEG)
shows continuous diffuse slow waves with or without periodic
bitemporal independent sharp wave discharges.
 It is important especially to differentiate from HSV encephalitis.
[periodic lateralized epileptiform discharges (PLED) mainly from
temporal lobe]
SPECIAL INVESTIGATIONS

21. Enzyme-linked immunoassay
The diagnosis of Nipah virus infection can be established by
ELISA for CSF & SERUM
Nipah IgM capture ELISA and an indirect IgG ELISA have high
specificity for the diagnosis.
Rapid immune plaque assays have been developed to
quantify Hendra and NiV and detect neutralizing antibodies to
both viruses.
Polymerase chain reaction (PCR)
RT PCRs can be used for detection of viral sequences in CSF,
throat swab or urine specimens.

22. Various outbreaks
Location No. cases No. deaths Case fatality (%)
Jan–Feb 2001 Siliguri (India) 66 45 68
Apr–May 2001 Meherpur (Bangladesh) 13 9 69
Jan 2003 Naogaon (Bangladesh) 12 8 67
Jan 2004 Rajbari(Bangladesh) 31 23 74
Apr 2004 Faridpur (Bangladesh) 36 27 75
Jan–Mar 2005 Tangail (Bangladesh) 12 11 92
Jan–Feb 2007 Thakurgaon
(Bangladesh)
7 3 43
Mar 2007 Kushtia, Pabna, Natore
(Bangladesh)
8 5 63
Apr 2007 Naogaon (Bangladesh) 3 1 33
April 2007 Nadia (India) 5 5 101
Feb 2008 Manikgonj (Bangladesh) 4 4 101
Apr 2008 Rajbari and Faridpur
(Bangladesh)
7 5 71
Jan 2009 Gaibandha, Rangpur
and Nilphamari
(Bangladesh)
3 0 0
Jan 2009 Rajbari (Bangladesh)

23. Jan 2009 Gaibandha, Rangpur
and Nilphamari
(Bangladesh)
3 0 0
Jan 2009 Rajbari (Bangladesh) 1 1 101
Feb–Mar 2010 Faridpur,
Rajbari,Gopalganj,M
adaripur
(Bangladesh)
16 14 87.5
Jan–Feb 2011 Lalmohirhat,
Dinajpur, Comilla,
Nilphamari and
Rangpur
(Bangladesh)
44 40 91
Feb 2012 Joypurhat, Rajshahi,
Natore, Rajbari and
Gopalganj
(Bangladesh)
12 10 83
Jan–Feb 2013 Gaibandha, Natore,
Rajshahi, Naogaon,
Rajbari, Pabna,
Jhenaidah,
Mymensingh
(Bangladesh)
12 10 83
Total 292 221 75.7

24. OUTBREAKS IN INDIA !!!

25. MOST RECENT OUTBREAK:
 MAY 2018
 Perambra town in Kozhikode district.
 The outbreak started with the death of three members of a
family in Perambra in a span of two weeks.
 Many bats were found to be housed in the well from where
the family was drawing water.

26. SURVEILLANCE(1)
 Setting up a surveillance system is important in those
countries where there has been an outbreak or evidence of
infection in bats.
 Various types of surveillance for Nipah:
 Event-based surveillance
 Case-based (hospital-based) surveillance
 Surveillance in bats
1.Surveillance, Prevention and Control of Nipah Virus Infection: A Practical Handbook

27. TREATMENT
 There is no effective specific treatment for NiV infection.
 Treatment is symptomatic and supportive
 Because NiV encephalitis can be transmitted person-to-
person, standard infection control practices and proper
measures are important in preventing nosocomial infections.

30. Precautions

31. • VARIOUS RISK OF TRANSMISSION OF THE VIRUS
AND PREVENTION(1)
1. Preventing transmission from bat to human
 Don’t drink raw date palm sap
 Consuming boiled sap or molasses is safe
2. Preventing transmission from human to human
 Wash hands thoroughly with soap and water after coming in
contact with patient.
 Sleep in separate bed.
 Maintain >1 full-stretched arm distance (1 metre or 3 feet)from
patient.
 Keep personal items of patient separately.
 Wash used items of patient with soap and water, separately.
1.Surveillance, Prevention and Control of Nipah Virus Infection: A Practical Handbook

32. 3. In health care facility
 Segregate Nipah patients from other patients in the isolation
ward/facility.
 Restrict the number of service providers in the isolation ward.
 Maintain at least 1 meter (3 feet: one fully stretched arm’s length)
distance between two beds for Nipah patient.
 Admit all cases with fever and unconsciousness/ convulsion/difficulty
breathing to the isolation ward/ facility in the hospital.
 Use mask and gloves during history- taking, physical examination,sample
collection and other care-giving to suspected Nipah cases.
 Avoid unnecessary contact with suspected Nipah cases

33. 4. Waste disposal
 Keep disposable and non-disposable PPEs and items in separate
containers/ biohazard bags.
 Keep sharp wastes in separate designated rigid container (box, bottle
etc.).
 Decontaminate wastes by autoclaving/chemical [Sodium
hypochlorite].
 Clean and disinfect patient’s room (detergent and sodium
hypochlorite) at least once daily specially frequently touched surfaces
(e.g. doors, windows, table top, etc).
 Soak reusable items in 0.05%-0.5% bleach solution or in
soap/detergent water for 10-30 min.
 Autoclave for reuse.

34. 5. Handling of deceased body
 During transportation of dead body from hospital to home, avoid
close contact with deceased’s face, especially respiratory secretion.
 Cover face with a piece of cloth during washing/ritual bath of
deceased body.
 Wash hands with soap, if possible take bath with soap immediately
after performing ritual bath of the dead body.
 Wash reusable items (cloths, utensils, etc.) with soap/detergent and
Dry mattress, quilt/comforter, pillow, etc. in sunlight for several
consecutive days.

38. NIPAH AS A BIOLOGICAL AGENT
 It is a CDC category c bioterrorism agent
 Emerging pathogen
 Potentially high morbidity and mortality.
 Major health impact
 Aerosolization potential
 Economic impact
 Social disruption (fear,panic)

40. REFERENCES
1.Chua, K.B., Nipah virus outbreak in Malaysia. J Clin Virol, 2003. 26(3): p. 265-275.
2. Chua, K.B., et al. Nipah virus: a recently emergent deadly paramyxovirus. Science, 2000. 288
3. Goh KJ, Tan CT, Chew NK, Tan PSK, Chua KB,Lam SK. Clinical features of Nipah virus encephalitis
Med. 2000;342 (17): 1229–1235.
4. Paton, N.I., et al. Outbreak of Nipah-virus infection among abattoir workers in Singapore.Lancet
1999. 354(9186): p. 1253-1256.
5. Field, H., et al. The natural history of Hendra and Nipah viruses., 2001. 3(4): p.307-314.
6. Chua, K.B., et al., Isolation of Nipah virus from Malaysian Island flying-foxes. Microbes Infect.,
2002. 4(2): p. 145-151.
7. Middleton, D.J., et al. Experimental Nipah virus infection in pteropid bats (Pteropus
poliocephalus). J Comp Pathol, 2007. 136(4): p. 266-272.
8. Yob, J.M., et al. Nipah virus infection in bats (order Chiroptera) in peninsular Malaysia. Emerg
Infect Dis. 2001. 7(3): p. 439.
9.Hossain, M.J., et al. Clinical presentation of nipah virus infection in Bangladesh. Clin Infect Dis,
2008. 46(7): p. 977-84.
10. Chong HT, H.M., Tan CT. Difference in epidemiologic and clinical features of Nipah viurs
encephalitis between Malaysian and Bangladesh outbreaks. Neurology Asia, 2008. 13: p. 23-26.
11.Daniels, P., Ksiazek, T., & Eaton, B. T. (2001). Laboratory diagnosis of Nipahand Hendra virus
infections. Microbes and Infection, 3(4), 289-295
12.Sewell, D. L. (2003). Laboratory safety practices associated with potential agents of biocrime
or bioterrorism. Journal of Clinical Microbiology, 41(7), 2801-2809.Imada

41. Take home message
 Destroying Nature Unleashes Infectious
Diseases !!!!
 Good food hygiene is great for health. Cont’d

42. QUESTIONS
Q 1. Nipah virus belongs to which genus?
1. Henipavirus
2. Morbillivirus
3. Respirovirus
4. Rubulavirus

43. Q2. Nipah belongs to which category of
bioterrorism ?
1. A
2. B
3. C
4. D

44. Q3. Chemical disinfection for Nipah virus is done
with?
1. Alcohol
2. Sodium hypochlorite
3. Hydrogen peroxide
4. Iodophors

45. Q4. Genome of Nipah virus is ?
1. (+) ssRN
2. (-) ss DNA
3. (-) ss RNA
4. (+) ds RNA

46. Q5. Most recent drug in development for NiV
infection?
1. Ribavirin
2. Tenofovir
3. Retonavir
4. Favipiravir

47. THANK YOU !