Nipah virus
KEY FACTS
- Nipah virus causes severe illness characterized by inflammation of the brain (encephalitis) or respiratory diseases.
- Nipah virus can be transmitted to humans from animals, and can also be transmitted directly from human-to-human; in Bangladesh, half of reported cases between 2001 and 2008 were due to human-to-human transmission.
- Nipah virus can cause severe disease in domestic animals such as pigs.
- There is no treatment or vaccine available for either people or animals.
- Fruit bats of the Pteropodidae family are the natural host of Nipah virus.
Nipah virus (NiV) is an emerging zoonotic virus (a virus transmitted to humans from animals). In infected people, Nipah virus causes severe illness characterized by inflammation of the brain (encephalitis) or respiratory diseases. It can also cause severe disease in animals such as pigs, resulting in significant economic losses for farmers.
Nipah virus is closely related to Hendra virus. Both are members of the genus Henipavirus, a new class of virus in the Paramyxoviridae family.
Although 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.
Outbreaks
Nipah virus was first recognized in 1999 during an outbreak among pig farmers in Malaysia. Since then, there have been another 12 outbreaks, all in South Asia.
Transmission
During the initial outbreaks in Malaysia and Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to have occurred via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.
In the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection.
During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission.
Signs and symptoms
Human infections range from asymptomatic infection to fatal encephalitis. Infected people initially develop influenza-like symptoms of fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.
The incubation period (interval from infection to onset of symptoms) varies from four to 45 days.
Most people who survive acute encephalitis make a full recovery, but around 20% are left with residual neurological consequences such as persistent convulsions and personality changes. A small number of people who recover subsequently relapse or develop delayed onset encephalitis. In the long term, persistent neurological dysfunctions are observed in more than 15% of people.
The case fatality rate is estimated at 40% to 75%; however, this rate can vary by outbreak depending on local capabilities for surveillance investigations.
Diagnosis
Nipah virus infection can be diagnosed by a number of different tests:
- serum neutralization
- enzyme-linked immunosorbent assay (ELISA)
- polymerase chain reaction (PCR) assay
- immunofluorescence assay
- virus isolation by cell culture.
Treatment
There are currently no drugs or vaccines available to treat Nipah virus infection. Intensive supportive care with treatment of symptoms is the main approach to managing the infection in people.
Natural host: fruit bats
Fruit bats of the family Pteropodidae – particularly species belonging to the Pteropus genus – are the natural hosts for Nipah virus. There is no apparent disease in fruit bats.
It is assumed that the geographic distribution of Henipaviruses overlaps with that of Pteropus category. This hypothesis was reinforced with the evidence of Henipavirus infection in Pteropus bats from Australia, Bangladesh, Cambodia, China, India, Indonesia, Madagascar, Malaysia, Papua New Guinea, Thailand and Timor-Leste.
Recently, African fruit bats of the genus Eidolon, family Pteropodidae, were found positive for antibodies against Nipah and Hendra viruses, indicating that these viruses might be present within the geographic distribution of Pteropodidae bats in Africa.
Nipah virus in domestic animals
Nipah outbreaks in pigs and other domestic animals (horses, goats, sheep, cats and dogs) were first reported during the initial Malaysian outbreak in 1999. Many pigs had no symptoms, but others developed acute feverish illness, laboured breathing, and neurological symptoms such as trembling, twitching and muscle spasms. Generally, mortality was low except in young piglets.
These symptoms are not dramatically different from other respiratory and neurological illnesses of pigs. Nipah should be suspected if pigs also have an unusual barking cough or if human cases of encephalitis are present.
Nipah virus is highly contagious in pigs. Pigs are infectious during the incubation period, which lasts from 4 to 14 days.
Prevention
Controlling Nipah virus in domestic animals
There is no vaccine against Nipah virus. Routine cleaning and disinfection of pig farms (with sodium hypochorite or other detergents) is expected to be effective in preventing infection.
If an outbreak is suspected, the animal premises should be quarantined immediately. Culling of infected animals – with close supervision of burial or incineration of carcasses – may be necessary to reduce the risk of transmission to people. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.
As Nipah virus outbreaks in domestic animals have preceded human cases, establishing an animal health surveillance system to detect new cases is essential in providing early warning for veterinary and human public health authorities.
Reducing the risk of infection in people
In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.
Public health educational messages should focus on the following.
- Reducing the risk of bat-to-human transmission. Efforts to prevent transmission should first focus on decreasing bat access to date palm sap. Freshly collected date palm juice should also be boiled and fruits should be thoroughly washed and peeled before consumption.
- Reducing the risk of human-to-human transmission. Close physical contact with Nipah virus-infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
- Reducing the risk of animal-to-human transmission. Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.
Controlling infection in health-care settings
Health-care workers caring for patients with suspected or confirmed Nipah virus infection, or handling specimens from them, should implement standard infection control precautions.
Samples taken from people and animals with suspected Nipah virus infection should be handled by trained staff working in suitably equipped laboratories.