Nipah virus is a zoonotic virus that causes disease in both animals and humans. It was first identified during an outbreak in Malaysia and Singapore in 1998-1999. The natural host is fruit bats of the Pteropodidae family, and it is transmitted to other animals and humans through contact with bat secretions or excretions. In humans it causes a range of illnesses from asymptomatic infection to fatal encephalitis. Outbreaks have occurred in Bangladesh, India and other Southeast Asian countries. There is no vaccine available for humans currently, though supportive care is provided for symptomatic treatment.

1. NIPAH VIRUS
By:
Dr Harivansh Chopra
Dr Abhishek Agarwal

2. Introduction
• Nipah virus (NiV) infection is a newly
emerging zoonosis that causes severe
disease in both animals and humans
• It is named after the Malaysian Village
from where it was first discovered.

3. Introduction
• Nipah virus causes a range of
illnesses from asymptomatic
(subclinical) infection to acute
respiratory illness and fatal
encephalitis.

4. Introduction
• Nipah virus is closely related to Hendra
virus.
• Both are members of the
genus Henipavirus, a new class of virus
in the Paramyxoviridae family.

5. NIPAH Virus : A public Health Problem
• Though Nipah virus has caused
only a few outbreaks, it infects a
wide range of animals and causes
severe disease and death in
people, making it a public health
concern.

6. Distribution

8. Problem
• 1st Case reported from Malaysia in 1998
• 1st Outbreak in south east asia was in Bangladesh in 2001
• 1st Outbreak in India was in Siliguri killing over 33 Health workers
• Recent Outbreak was in Kerela, killed upto 11 health workers
• Till now over 457 cases of Nipah Virus has been reported killing
more then 252 persons

9. Agent: Nipah Virus
Paramyxovirus
Highly pathogenic
Closely related to Hendra virus
Epidemiology

10. Incubation Period
4 – 18 days

11. Host
• Reservoir Host: Fruit Bats
• Amplifier Hosts: Pig and Horses
• Dead End Host: Humans
Epidemiology

13. Epidemiology
ENVIRONMENT
• Cases are more in Winter and Spring (December–May).
– Breeding Season of bats
– Date palm sap harvesting season

14. Transmission cycle of Nipah Virus

15. Direct Transmission: Pig to Human
• Direct human contact with infected
pigs was identified as the
predominant mode of transmission
in humans when it was first
recognized in Malaysia. (outbreak
of Nipah virus, 1998-99)

16. Direct Transmission: Human to Human
• The evidence of human to human
transmission of Nipah Virus was first
reported from India.
• During the outbreak in Siliguri, 33 health
workers and hospital visitors became ill after
exposure to patients hospitalized with Nipah
Virus, suggesting nosocomial infection.

17. Body fluids responsible for human to human
transmission of Nipah Virus
Cerebrospinal Fluid
Respiratory Secretions
Saliva
Urine

18. Direct Transmission: Bat to
Human
• Direct transmission of Nipah
Virus from fruit bats to
humans has been reported
during Bangladesh
Outbreak.

19. Indirect Transmission: Fruit Bat
• The natural host of the virus are
fruit bats of the Pteropodidae
Family, Pteropus genus
• In India the sub species Pteropus
giganteus is the causative agent

20. Fluids from bats transmitting the disease
• Virus present in its excretions and secretions
– Urine
– Semen
– Saliva
– Excreta

21. Indirect Transmission: Date palm sap
• Drinking of date palm sap,
possibly contaminated by fruit
bats may have been responsible
for the transmission of Nipah
Virus to Humans.

22. Indirect Transmission: Date palm sap
• Fruit bats also consume date
palm sap and can contaminate it
with saliva, urine feces.
• This is the means by which
Nipah Virus is thought to have
been transmitted from infected
fruit bats to humans.

23. Case Definition : Suspected Nipah Case
High Grade Fever with :-
• acute onset of altered mental status, or
• Seizure, or
• Headache, or
• acute onset of cough with shortness of breath

24. Case Definition : Probable Nipah Case
• Suspect cases, and/or who
died before complete
diagnostic specimens could
be collected, including a
serum antibody test 14 days
after onset of illness
Death: 14
days of onset
of illness

25. Case Definition : Confirmed Nipah Case
i) IgM antibody
ii) RNA identified by RT-PCR
iii) isolation of Nipah Virus
Confirmed Nipah case: Suspected/probable case
having:

26. Clinical Features
• The classical form is an acute and
rapidly progressive encephalitis with or
without respiratory involvement in all
age groups.

27. Clinical Features
• The Nipah encephalitis presents with 3–14 days of
fever and headache, followed by drowsiness,
disorientation and mental confusion.
• The acute encephalitis progresses then to coma
within 24–48 hours, with high mortality rate.

28. Clinical Features
• The respiratory involvement consists of non-productive
cough during the early part of the disease, which can
evolve later to severe acute lower respiratory disease,
i.e., from breathing difficulties to acute respiratory
distress syndrome (ARDS)

29. Clinical Features
• Post-encephalitis sequelae have been commonly
observed in NiV infection.
• One third of Nipah survivors in Bangladesh have
moderate to severe objective neurological dysfunction
7–30 months after infection

30. Lab Diagnosis
Serology
PCR
ELISA
Virus Isolation
Neutralization test

31. Treatment : Supportive
• Fluid maintenance and electrolyte balance.
• Nutrition
• Anticonvulsant
• Oropharyngeal suction in closed circuit.

32. Treatment : Supportive
• Oxygen inhalation using disposable cannula.
• Bronchodilators through large spacer
devices.
• Severely ill individuals may require Intensive
Care Unit (ICU) support

33. Treatment: Drug
• Ribavirin:
• Monoclonal Antibodies (Post exposure therapy)

34. Prevention
• hand hygiene
• injection safety
• facial protection
• glove and gown wearing
• waste disposal,

35. Prevention
• Linen cleaning
• Environmental cleaning
• Patient care equipment and
• Respiratory Hygiene

36. Prevention
# Avoid intake of
fruits bitten by
animals

37. Prevention
# Proper handling of
specimen

38. Prevention
# Strong Disease
Surveillance

39. Prevention
Alvac Canary Pox Vaccine
(Presently for cat)
Human trials are underway

40. Reach us at:
Dr Harivansh Chopra: harichop@gmail.com
Dr Abhishek Agarwal: abhishek3april@gmail.com