Nipah Virus Infection

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Nipah virus infection (NiV) facts

  • Nipah virus (NiV) is a member of the family Paramyxoviridae, genus Henipavirus and is related to Hendra virus that infects horses.
  • NiV is a zoonotic virus (a disease that animals can transmit to humans, known as a zoonosis); the virus often infects animals such as pigs and fruit bats (Pteropodidae), but they may be asymptomatic (not show any symptoms). In addition, flying foxes of the genus Pteropus in the Malaysian peninsula can carry NiV.
  • People first discovered NiV in a village named Kampung Sungai Nipah in 1999 in Malaysia; the virus was named after the village. This first recorded outbreak began in 1998-1999 and reached Singapore. A new strain occurred in 2001 in Bangladesh and India. Small outbreaks of NiV have happened in these countries since 2001. An outbreak in India (state of Kerala) occurred in May 2018. Fruit bats and rabbits are the likely sources of NiV that infected people. The Indian government sources say that the situation is currently under control. During this outbreak, at least 11 people have died and another 14 people contracted the virus, while another 22 are awaiting test results.
  • Humans who have direct contact with infected fruit bats or infected pigs is the usual way an outbreak begins. However, consumption of raw date palm sap contaminated with bat feces is another common way to get the disease. Human-to-human transmission occurs during close contact between family members and/or medical caregivers.
  • Encephalitis (brain inflammation), nerve disorders, and respiratory problems are the major symptoms of Nipah virus infection.
  • Treatment is limited to supportive care although some physicians suggest the drug, ribavirin, may be useful. A monoclonal antibody targeting the viral G glycoprotein has been beneficial in a ferret model of the disease.

The following is a set of common questions and answers about NiV and the disease it causes.

Quick GuideSymptoms of Mono: Infectious Mononucleosis Treatment

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Nipah Virus Infection (NiV) Symptom

Encephalitis

  • Encephalitis is a rare condition that is most often caused by viruses.
  • It can also be caused by noninfectious diseases, such as systemic lupus erythematosus and Beh├žet's disease.
  • The leading cause of severe encephalitis is the herpes simplex virus.
  • Other causes include enterovirus infections or mosquito-borne viruses.
  • The very young and the elderly are more likely to have more severe encephalitis.

Exposure to viruses can occur through breathing in respiratory droplets from infected people, certain insect bites, and direct skin contact.

What is Nipah virus infection (NiV)?

Nipah virus infection is a zoonosis transferred by contact with an NiV-infected animal or person or their secretions that has a high fatality rate in infected humans.

What causes a Nipah virus infection?

Nipah virus causes NiV.

Is a Nipah virus infection contagious?

Yes, the virus is moderately contagious as it needs close contact and usually infects the family members and/or medical caregivers of NiV-infected individuals.

What is the incubation period for a Nipah virus infection?

The incubation period (time from initial exposure to virus to when symptoms begin) for NiV usually varies from about five to 14 days. There have been a few cases with much longer incubation periods, as long as 45 days.

What is the contagious period for a Nipah virus infection?

Doctors do not completely understand the contagious period for infection, but it likely begins during the incubation period (proven in pigs) and continues until the patient stops shedding virus. In most patients, this occurs when the symptoms and signs of the infection are diminished or gone.

What are risk factors for a Nipah virus infection?

The risk factors for this infection include having close contact with infected animals such as pigs, bats, and/or humans infected with the virus. In addition, consumption of raw date palm sap is a significant risk factor since bat excrement often contaminates this substance.

What are signs and symptoms of a Nipah virus infection?

The signs and symptoms of NiV infection begin with

Encephalitis follows and those infected may exhibit drowsiness, disorientation, mental confusion, altered consciousness, and seizures that can progress, within 24-48 hours, to coma and eventually death.

What tests diagnose a Nipah virus infection?

A combination of tests diagnose NiV. Viral isolation, RT-PCR, and antibody detection by the ELISA tests are the tests that health care professionals use most often to diagnose Nipah virus infection.

What are treatments for a Nipah virus infection?

According to the U.S. Centers for Disease Control and Prevention (CDC), supportive care is the only current treatment for this viral infection. There is no vaccine specifically available to protect humans. However, some researchers suggest that the antiviral drug ribavirin may be useful, but there is little or no data to support this. A human monoclonal antibody that targets the G glycoprotein of NiV has shown benefit in a ferret animal model of this disease, but researchers have not studied the effects of the antibody in humans.

What is the prognosis of a Nipah virus infection?

The prognosis of NiV infections is fair to poor. The fatality rate is estimated by the World Health Organization (WHO) to range from 40%-75%, depending upon the local capabilities for surveillance and clinical management (supportive care). Survivors may have residual neurological problems such as seizures and/or personality changes. A few survivors who recover may subsequently relapse or develop delayed onset encephalitis.

Is there a way to prevent Nipah virus infections?

There are ways to reduce the risk of developing NiV infections. For example, individuals should avoid date palm sap and any bats or potentially infected domestic animals such as infected pigs. The WHO suggests that health care professionals wear gloves and other protective clothing during any pig slaughtering and culling procedures. Avoid contagion, the communication of disease from one person to another by close contact. Medical caregivers should employ quarantine methods and use barrier methods such as gloves, masks, and disposable gowns, as they are at high risk of person-to-person transmission of NiV.

Medically Reviewed on 5/25/2018
References
REFERENCE:

Switzerland. World Health Organization (WHO). "Nipah Virus." May 22, 2018. <http://www.who.int/news-room/fact-sheets/detail/nipah-virus>.

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