Nipah virus infection

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Nipah virus infection
Henipavirus structure.svg
Structure of a Henipavirus
SpecialtyInfectious disease Edit this on Wikidata
SymptomsNone, fever, cough, headache, confusion[1]
ComplicationsInflammation of the brain, seizures[2]
Usual onset5 to 14 days after exposure[1]
CausesNipah virus (spread by direct contact)[3]
Diagnostic methodBased on symptoms, confirmed by laboratory testing[4]
PreventionAvoiding exposure to bats and sick pigs, not drinking raw date palm sap[5]
TreatmentSupportive care[2]
Frequency~700 human cases (1998 to May 2018)[6][7]
Deaths~50 to 75% risk of death[6][8]

Nipah virus infection is a viral infection caused by the Nipah virus.[2] Symptoms from infection vary from none to fever, cough, headache, shortness of breath, and confusion.[1][2] This may worsen into a coma over a day or two.[1] Complications can include inflammation of the brain and seizures following recovery.[2]

The Nipah virus is a type of RNA virus in the genus Henipavirus.[2] It can both spread between people and from other animals to people.[2] Spread typically requires direct contact with an infected source.[3] The virus normally circulates among specific types of fruit bats.[2] Diagnosis is based on symptoms and confirmed by laboratory testing.[4]

Management involves supportive care.[2] As of 2018 there is no vaccine or specific treatment.[2] Prevention is by avoiding exposure to bats and sick pigs and not drinking raw date palm sap.[5] As of May 2018 about 700 human cases of Nipah virus are estimated to have occurred and 50 to 75 percent of those who were infected died.[6][8][7] In May 2018, an outbreak of the disease resulted in at least 17 deaths in the Indian state of Kerala.[9][10][11]

The disease was first identified in 1998 during an outbreak in Malaysia while the virus was isolated in 1999.[2][12] It is named after a village in Malaysia, Sungai Nipah.[12] Pigs may also be infected and millions were killed by Malaysian authorities in 1999 to stop the spread of disease.[2][12]

Signs and symptoms[edit]

The symptoms start to appear after 5–14 days from exposure.[12] Initial symptoms are fever, headache, drowsiness followed by disorientation and mental confusion. These symptoms can progress into coma as fast as in 24–48 hours. Encephalitis, inflammation of the brain, is a potentially fatal complication of Nipah virus infection. Respiratory illness can also be present during the early part of the illness.[12] Nipah-case patients who have breathing difficulty are more likely than those without respiratory illness to transmit the virus,[13] as are those who are more than 45 years of age.[14] The disease is suspected in symptomatic individuals in the context of an epidemic outbreak.


How the Nipah virus spreads
Fruit bats are the natural reservoirs of Nipah virus

The risk of exposure is high for hospital workers and caretakers of those infected with the virus. In Malaysia and Singapore, Nipah virus infection occurred in those with close contact to infected pigs. In Bangladesh and India, the disease has been linked to consumption of raw date palm sap (toddy) and contact with bats respectively.[15]


Laboratory diagnosis of Nipah virus infection is made using reverse transcriptase polymerase chain reaction (RT-PCR) from throat swabs, cerebrospinal fluid, urine and blood analysis during acute and convalescent stages of the disease. IgG and IgM antibody detection can be done after recovery to confirm Nipah virus infection. Immunohistochemistry on tissues collected during autopsy also confirms the disease.[12] Viral RNA can be isolated from the saliva of infected persons.[16]


Prevention of Nipah virus infection is important since there is no effective treatment for the disease. The infection can be prevented by avoiding exposure to bats in endemic areas and sick pigs. Drinking of raw palm sap (palm toddy) contaminated by bat excrete,[17] eating of fruits partially consumed by bats and using water from wells infested by bats[18] should be avoided. Bats are known to drink toddy that is collected in open containers, and occasionally urinate in it, which makes it contaminated with the virus.[17] Surveillance and awareness are important for preventing future outbreaks. The association of this disease within reproductive cycle of bats is not well studied. Standard infection control practices should be enforced to prevent nosocomial infections. A subunit vaccine using the Hendra G protein was found to produce cross-protective antibodies against henipavirus and nipavirus has been used in monkeys to protect against Hendra virus, although its potential for use in humans has not been studied.[19]


Currently there is no specific treatment for Nipah virus infection as of 2019.[20] The mainstay of treatment is to supportive care.[21][20] Standard infection control practices and proper barrier nursing techniques are recommended to avoid the spread of the infection from person to person.[21] All suspected cases of Nipah virus infection should be isolated.[22] Well tentative evidence supports the use of ribavirin, it has not yet been studied in people with the disease.[21] Specific antibodies have also been studied in an animal model with potential benefit.[21] Acyclovir and favipiravir has also been tried.[20]


Map showing locations of outbreaks of Nipah and Hendra virus as well as the range of Pteropus bats as of 2014

Nipah virus outbreaks have been reported in Malaysia, Singapore, Bangladesh and India. The highest mortality due to Nipah virus infection has occurred in Bangladesh. In Bangladesh, the outbreaks are typically seen in winter season.[23] Nipah virus first appeared in Malaysia in 1998 in peninsular Malaysia in pigs and pig farmers. By mid-1999, more than 265 human cases of encephalitis, including 105 deaths, had been reported in Malaysia, and 11 cases of either encephalitis or respiratory illness with one fatality were reported in Singapore.[24] In 2001, Nipah virus was reported from Meherpur District, Bangladesh[25][26] and Siliguri, India.[25] The outbreak again appeared in 2003, 2004 and 2005 in Naogaon District, Manikganj District, Rajbari District, Faridpur District and Tangail District.[26] In Bangladesh, there were also outbreaks in subsequent years.[27][8]

Outbreak in Kerala[edit]

In May 2018, an outbreak was reported in the Kozhikode district of Kerala, India.[28] Twenty one deaths[29] were recorded, including one healthcare worker among a total of 23 cases.[30][10][31] Those who have died were mainly from the districts of Kozhikode and Malappuram, including a 31-year-old nurse, who was treating patients infected with the virus. Two of the infected were completely cured. On 10 June 2018, the outbreak was officially declared to be over.[32]

Again by the end of May, 2019 a young student was admitted with Nipah symptoms in Ernakulam district of Kerala and was confirmed Nipah infected on 4 June 2019. The disease was confirmed and the student left the hospital cured of the disease after near 2 months of treatment on 23 July 2019. No casualties related to Nipah has been in the second outbreak of Nipah till now and the infection seems contained due to the early identification and caution by health department of Kerala Government.[33]

Popular culture[edit]

The fictional MEV-1 virus and following outbreak featured in the film Contagion is loosely based on the emergence of the Nipah virus.

A Malayalam movie "Virus" was released in 2019, based on the 2018 Kerala (India) outbreak of Nipah virus.[34][35]


Ribavirin, m102.4 monoclonal antibody and favipiravir are being studied as treatments as of 2019.[36]


Ribavirin has been studied in a small number of people, however whether or not it is useful is unclear as of 2011 but this medicine helped a few people to come back to their normal life.[37] In vitro studies and animal studies have shown conflicting results in the efficacy of ribavirin against NiV and Hendra, with some studies showing effective inhibition of viral replication in cell lines[38][39] whereas some studies in animal models showed that ribavirin treatment only delayed but did not prevent death after  NiV or Hendra virus infection.[40][41]


Passive immunization using a human monoclonal antibody- m102.4 that targets the ephrin-B2 and ephrin-B3 receptor binding domain of the henipavirus Nipah G glycoprotein has been evaluated in the ferret model as post-exposure prophylaxis.[6][12] The anti-malarial drug chloroquine was shown to block the critical functions needed for maturation of Nipah virus, although no clinical benefit has yet been observed.[42] m102.4, has been used in people on a compassionate use basis in Australia and was in pre-clinical development in 2013.[6]


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