NIPAH VIRUS

(NiV)
basics concerns and prevention
Dr.T.V.Rao MD

5/21/2018 Dr.T.V.Rao MD 1
 What is Nipah virus (NiV)
• Nipah virus (NiV) is a
member of the family
Paramyxoviridae,
genus Henipavirus.
NiV was initially isolated
and identified in 1999
during an outbreak of
encephalitis and respiratory
illness among pig farmers
and people with close
contact with pigs in
Malaysia and Singapore.
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 Origin of
Name
• Its name
originated from
Sungai Nipah, a
village in the
Malaysian
Peninsula where
pig farmers
became ill with
encephalitis.
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Transmission
of
NIPAH
Virus

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 NIPHA VIRUS
• Given the
relatedness of NiV to
Hendra virus, bat
species were quickly
singled out for
investigation and
flying foxes of the
genus Pteropus
were subsequently
identified as the
reservoir for NiV
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Out Break of NIPAH Virus Infection
in 1999
• In the 1999 outbreak, Nipah virus caused a
relatively mild disease in pigs, but nearly 300
human cases with over 100 deaths were reported.
In order to stop the outbreak, more than a million
pigs were euthanized, causing tremendous trade
loss for Malaysia. Since this outbreak, no
subsequent cases (in neither swine nor human)
have been reported in either Malaysia or
Singapore.
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 • 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
Out break in was identified retrospectively
in Siliguri,
Bangladesh and
Siliguri
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 • 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.

Spread by Nosocomial
route
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 Mistaken as Japanese
Encephalitis in the past
• Many of the original
human cases of the
Nipah Virus disease
were provisionally
diagnosed as Japanese
encephalitis (JE) before
the isolation and
identification of the
newly discovered
Nipah Virus
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 Zoonotic
transmission
cycles of
Nipah virus
• Zoonotic transmission cycles of
Nipah virus in Malaysia and
Bangladesh. Pteropus species fruit
bats are the natural reservoir of
Nipah virus. In Malaysia (left), Nipah
virus was transmitted from bats
roosting in fruit trees on pig farms
to pigs; subsequently, pigs
transmitted Nipah virus to people in
close contact with the pigs. In
Bangladesh (right), Nipah virus is
thought to be transmitted via the
consumption of raw date palm sap
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 1
1

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.

Dr.T.V.Rao MD

5/21/2018
Economic Loses with
NIPAH viral infection
• In the 1998-1999
outbreaks of Malaysia
and Singapore, over 1
million pigs were
destroyed to control the
disease, causing
devastating economic
Dr.T.V.Rao MD

and social
consequences 5/21/2018 12
 Events on Human
Cases in Bangladesh
and India
• Human cases
occurred in
Bangladesh and
India in 2003,
2004, 2007, 2008
without apparent
related domestic
animal outbreaks.
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•Transmission of
Nipah virus to
humans may occur
after direct contact
with infected bats,
infected pigs, or
from other NiV
infected people.
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• In Malaysia and
Singapore, humans were
apparently infected with
Nipah virus only through
close contact with
infected pigs. The NiV
strain identified in this
outbreak appeared to
have been transmitted
initially from bats to pigs,
with subsequent spread
within pig populations
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 Countries with reported outbreak of at risk
based on serological evidence or molecular
detection in Pteropus bats

•Australia,
Bangladesh,
Cambodia, China,
India, Indonesia,
Madagascar, PNG
Taiwan, Thailand
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 Home range of Pteropus bats
• Bhutan, Brunei,
China, India,
Indonesia, Laos,
Madagascar,
Myanmar, Nepal,
Philippines, PNG,
Singapore, Taiwan,
Thailand, Vietnam
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•Incidental human
infections resulted
after exposure to
infected pigs. No
occurrence of person-
to-person
transmission was
reported in this
outbreaks in the past
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 Person-to-person transmission of Nipah
virus
• Conversely, person-to-
person transmission of
Nipah virus in Bangladesh
and India is regularly
reported. This is most
commonly seen in the family
and caregivers of Nipah
virus-infected patients..
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 Infected Pigs
spread the
Infections
• In the Malaysia and
Singapore outbreak,
Nipah virus infection was
associated with close
contact with Nipah virus-
infected pigs.

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 Transmission of NIPAH
• Transmission also
occurs from direct
exposure to infected
bats. A common
example is consumption
of raw date palm sap
contaminated with
infectious bat excretions
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 Signs and
Symptoms
• infection with Nipah
virus is associated with
encephalitis
(inflammation of the
brain). After exposure
and an incubation
period of 5 to 14 days,
illness presents with 3-
14 days of fever and
headache, followed by
drowsiness,
disorientation and
mental confusion..
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 Human Infections with NIPAH
• Typically the human infection
presents as an encephalitic
syndrome marked by fever,
headache, drowsiness,
disorientation, mental
confusion, coma, and
potentially death. During the
outbreak in Malaysia, up to
50% of clinically apparent
human cases died
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 NIPHA CASUES MORBIDITY AND
MORTALITY
• These signs and symptoms
can progress to coma
within 24-48 hours. Some
patients have a respiratory
illness during the early part
of their infections, and half
of the patients showing
severe neurological signs
showed also pulmonary
signs.
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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
exposure.
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 Infection of NIPHA
in Bangladesh and
India
• In Bangladesh and India, where
Nipah virus infection is more
frequent, exposure has been linked
to consumption of raw date palm
sap and contact with bats.
Importantly, human-to-human
transmission has been documented
and exposure to other Nipah virus
infected individuals is also a risk
factor.

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Diagnosis with
Real Time PCR
• Laboratory diagnosis of a patient with a
clinical history of NiV can be made
during the acute and convalescent
phases of the disease by using a
combination of tests. Virus isolation
attempts and real time
polymerase chain reaction
(RT-PCR) from throat and nasal
swabs, cerebrospinal fluid, urine, and
blood should be performed in the early
stages of disease.
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 Classification of Cases
Case Definitions
• *Classified an encephalitis case as laboratory-confirmed
Nipah in a patient with NiV IgM in serum and a probable
Nipah case as a case with an epidemiologic link with a
laboratory-confirmed Nipah case in a person who died before
blood could be collected for testing. We defined a Nipah
spreader as a person with a probable or confirmed case who
had close contact with at least 1 person in whom Nipah
illness developed 5–15 days after contact
• *Nipah Virus Contamination of Hospital Surfaces during Outbreaks, Bangladesh, 2013–2014
Md Zakiul Hassan et al Volume 24, Number 1—January 2018 Emerging Infectious Diseases
CDC / EID
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 DETECTION BY
ELISA
METHODOLOGY

• Antibody detection by
ELISA (IgG and IgM)
can be used later on.
In fatal cases,
immunohistochemistry
on tissues collected
during autopsy may
be the only way to
confirm a diagnosis
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 UNIVERSAL PRECAUTIONS A PRIORITY TO
PREVENT NIAPH VIRAL SPREAD
• Treatment is limited to
supportive care. Because
Nipah virus encephalitis
can be transmitted
person-to-person,
standard infection control
practices and proper
barrier nursing
techniques are important
in preventing hospital-
acquired infections
(nosocomial
transmission).
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UNIVERSAL PRECAUTIONS A PRIORITY
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 Yet No Specific treatment for
NIPAH
• There is no specific
treatment for Nipah
Virus. Supportive
care is the general
treatment for this
disease.
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NIPAH Patients to be treated as Septic
patients caring the Encephalitis TOO

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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
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 Preventing
Nipah virus
infection
• Nipah virus
infection can be
prevented by
avoiding exposure
to sick pigs and
bats in endemic
areas and not
drinking raw date
palm sap.
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 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
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Research on Bats and
surveillance a priority
• Surveillance tools should
include reliable laboratory
assays for early detection of
disease in communities and
livestock, and raising awareness
of transmission and symptoms is
important in reinforcing
standard infection control
practices to avoid human-to-
human infections in hospital
settings (nosocomial infection).
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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
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 What is the public
4
2

health risk associated

with this disease?

• Nipah Virus is a zoonotic

disease. Transmission to
humans in Malaysia and
Singapore has almost
always been from direct,
contact with the
excretions or secretions of
infected pigs.
Dr.T.V.Rao MD

5/21/2018
 What is being done
to prevent or control
this disease?
• *Prevention and control
measures focus on
immediate eradication by
mass culling of infected
and in-contact pigs and
on antibody surveillance
of high risk farms to
prevent future outbreaks
• The regulations of the
country/ health regulations to
be followed as it causes great
economic loses ?

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 Measures to be followed in outbreaks

• After culling, the burial sites

are disinfected with
chlorinated lime. It is also
recommended to use sodium
hypochlorite (bleach) to
disinfect the contaminated
areas and equipment. Other
important control measures have
been a ban on transporting pigs
within the countries affected, a
temporary ban on pig production
in the regions affected, as well as
improvement of biosecurity
practices

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Outbreaks in
Bangladesh
Reports from outbreaks
in Bangladesh suggest
transmission from bats
without an
intermediate host by
drinking raw palm sap
contaminated with bat
excrement, or climbing
trees coated in bat
excrement is less
common
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 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.
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 How to Contain the Spread of
NIPAH Viruses
• One of the most important
biosecurity measures for
affected areas is to decrease
the likelihood of the bat
reservoir coming into contact
with pig production facilities.
• Research into development of
vaccines has been ongoing in
Australia and France.

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Scientific views/ studies
How the NIPAH spread
in the 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
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Caring the Towels is a
priority to contain the
spread of NIPAH
Virus
• Efforts to reduce the
risk for person-to-
person NiV
transmission in
healthcare settings
should target patient
caregiving practices
related to the use of
towels
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 Caring the Patients in
5
2

Resource Poor health care

• Resources are limited for
hospitals and for patients’
families; however,
affordable options exist
that deserve additional
investigation to
determine their
acceptability and
feasibility
Dr.T.V.Rao MD

5/21/2018
 Resources and References
• • www.oie.int • oie@oie.int
• Nipah Virus Contamination of Hospital Surfaces during
Outbreaks, Bangladesh, 2013–2014 Md Zakiul Hassan
et al Volume 24, Number 1—January 2018 Emerging
Infectious Diseases CDC / EID
• CDC and WHO resources o NIPAH infections
• Google resources search for NIPAH

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 • Program Created by Dr.T.V.Rao MD for benefit
of Medical, Nursing, and paramedical
Professionals in the Developing world
• Email
• doctortvrao@gmail.com

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