Nipah Virus: Symptoms, Treatment and Transmission


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What is Nipah virus?

According to the World Health Organisation (WHO), Nipah virus (NiV) is one of the “newly emerging zoonosis” (a disease that can spread from animals to humans) that can affect both humans and animals. This is a highly contagious and deadly virus for which there is currently no vaccine and treatment for humans, as well as animals.
Apart from animal to human and human to animal transmission of this virus, human to human transmission of this virus also occurs. 

The natural hosts of this virus are fruit bats who are symptomless carriers. And since fruit bats abound in South Asia, this infection occurs mostly in this region. Outbreaks of this virus have been reported from India, Bangladesh, Thailand, Cambodia, the Philippines, Laos, and Malaysia.

The first outbreak of this disease occurs in Malaysia and Singapore in 1998. In this instance, pigs were the intermediate hosts who transmitted the virus to humans. In fact, the name Nipah comes from the village in Malaysia, where the person from whom the virus was first extracted and identified succumbed to the disease. 

How does Nipah virus infection occur? 

Transmission of Nipah virus to humans may occur when one comes in direct contact with infected bats, infected pigs or infected people. The recent outbreak of Nipah virus in Kerala (May 2018), occurred when people consumed fruits bit by infected fruit bats. When bats carrying the virus bites into fruits, the virus enters the fruits and then infects the humans who consume it.  Bats shed the virus in their excrement and secretions which can infect humans, as well as animals such as pigs, dogs, cows, etc who come into contact with the droppings. 

The Nipah virus is also suspected to get transmitted through coughing. This infection can also easily affect people who come in direct contact with contaminated bodies.

What are the symptoms of Nipah virus infection? 

NiV infection can progress silently in humans without showing any symptoms. However, people infected with this virus usually display influenza-like symptoms

Once a person is infected with Nipah virus, it usually takes five to 14 days for the symptoms of an infection to appear. The symptoms of Nipah virus infection include: 

  • Acute respiratory infection, which can be mild to severe and cause interference in breathing
  • Fever
  • Muscle pain (myalgia)
  • Headaches
  • A sore throat
  • Nausea
  • Vomiting
  • Dizziness
  • Drowsiness
  • Mental confusion and disorientation
  • Atypical pneumonia
  • Brain swelling or fatal encephalitis
  • Gradual progression to coma within 24 to 48 hours.

People who survive the infection may suffer from long-term side effects such as convulsions and personality changes.

How is Nipah virus infection diagnosed? 

Nipah virus is diagnosed with a combination of tests such as:

  • Throat and nasal swabs which are sent to the laboratory for testing
  • Blood test
  • Virus isolation and detection
  • Cerebrospinal Fluid analysis
  • Urine test

What complications can Nipah virus infection lead to?

The complications of Nipah virus include:

  • Acute respiratory infections causing interference in breathing
  • Seizures
  • Encephalitis
  • Mental confusion and disorientation
  • Atypical pneumonia
  • Brain swelling or fatal encephalitis
  • Progression to a state of coma within 24 to 48 hours.

What is the treatment for Nipah virus infection? 

Currently, there is no known treatment for Nipah virus. If any influenza-like symptoms appear, it would be wise to immediately consult a general physician, who may, in turn, refer you to an Infectious Disease Specialist, depending on the severity of your symptoms. 
The primary treatment is focused on managing the symptoms such as managing the fever and neurological symptoms if any.

The only thing that can help a patient suffering from Nipah virus infection is intensive supportive care. The caretaker though needs to take precautions that the infection does not spread to him/her. Thus, whilst providing the necessary care and support, the caretaker must take basic precautions like wearing a mask, cap, wearing gloves, and washing hands. 

How can Nipah virus infection be prevented?

Since there is no vaccine or treatment currently for the Nipah virus, prevention is the key to stop the spread and remain safe from this virus. Some important preventive measures include:

  • Since fruits bats are the primary cause of Nipah virus infection, people who have domestic animals or have farm animals should prevent the animals from eating fruits contaminated by bats.

  • Consumption of contaminated date palm sap including toddy should also be avoided.

  • Physical barriers can be erected in order to prevent fruit bats from accessing and contaminating palm sap.

  • People raising pigs can consider putting wire screens to prevent contact between fruit bats and pigs if the pigs are raised in open pig sheds.

  • Caretakers need to be able to swiftly recognize symptoms of infections in animals so that the infected among them can be isolated and an outbreak of infection prevented.

  • Avoiding any form of direct contact with infected pigs, bats and humans are imperative to prevent infection. Health professionals such as nurses and doctors tending to infected patients must take precautionary measures, such as wearing gloves, using a gown, wearing a cap, wearing a  mask and washing hands.

  • Hospitals need to take care of necessary sanitation procedures while treating NiV patients to avoid transmission of the virus to other humans in those settings.  

  • Domestic animals may also become carriers of NiV as fruit bats often drop partially eaten fruits, which the domestic animals may consume. Try to keep the domestic animals indoors. Feed them yourself. And if you think that there’s a chance they may be infected, take precautionary measures yourself by keeping your distance from them and get them treated.

  • Do not climb trees which you suspect have bat secretions such as saliva or droppings.

  • The primary carriers of NiV in humans are the respiratory secretions. If you are near an infected person, chances are you may get infected if you breathe in their out-breath. The risk is even higher if the patient starts showing respiratory symptoms, such as coughing and sneezing. Due to its highly contagious nature, refrain from sharing food, the bed, and the washroom with an infected patient.  Do not stay close to a sneezing or coughing NiV patient and make sure not to come into contact with the saliva of an infected person.

  • The urine of a NiV person has traces of the virus, therefore be cautious while sharing a washroom with an infected person.

  • You can prevent fruit bats from nesting near your house and surroundings by hanging bits of foils around since they reflect light and can deter bats. You can also hang mothballs by placing them in a cloth and hanging it near the entrances of your home from where bats might enter. To know more about how to prevent bats from nesting near your surroundings, without harming them as well, please see: Preventing Bats From Entering Your Area

In the Spotlight - Latest News on Nipah Virus

Would you like to consult a doctor for Nipah Virus ?

Questions answered by trusted doctors

Verified User
What is Nipah virus? I want to know more as it is in news from last few days.
Dr. Pallavi R Hegde
Ayurveda, Bangalore
An Ayurveda Perspective ....

1. What is Nipah Virus ..

The suddenly changed world environment in few parts of globe has developing such new (previously not recognised by humans) organisms ...they are on highlight due to their exhibiting health issues on us.. previously it was chikungunya , dengue , H1 N1... the list will never end...as new environmental change...New (identified) organisms...and health issues raise in new way ...

2. Why such organisms affect to humans/ animals/ living beings during such imbalanced weather?
This universe has a formula of cause and effect.. both are not existing without each other..
Eco cycle / seasonal pattern changed suddenly.. so the effect on living beings..like variation in their basic biological nonvoluntary functions like hunger, thirst, ...
as season changes , biological functions too alter..but we need to observe those in body and should taken care as seasonal regime ( an Ayurveda way to be healthy in all seasons).
If we are unable to do so, then our body itself creates such environment to catch up many infections like Nipah, chikungunya, dengue... or any external organisms to grow inside body once exposed to them. So our body tendency becomes so.
Summer is suddenly changed to rainy..this is general pattern seen in all such viral/ epidemics outburst.
3. What is solution for such incidents ?
A. Prevention : Need to Take care of our body environment by maintaining hunger, bowel movement, sleep, activity. Eating 3 times home made freshly prepared food, drinking boiled water along with food and avoiding junks, frequent munching, outside foods maintains hunger, thirst, bowel movement. adding good lipids to diet like ghee, butter, virgin oil / filtered oils helps to keep body toxin free.
Early sleep, early get up aids to maintain the all functions of our body smoothly. Specifically for Nipah virus avoid eating fruits of unknown source, heavy nonveg eg pork, which are really not necessary to body during such weather.
Avoid the infected people and place of outburst.
Application of any edible oil to whole body maintains blood circulation, so maintains hunger etc biological functions too.
B. Cure: As per the category of fever in Ayurveda it comes under Agantuja (External source induced) _ Abhishangaja (infectious ) fever. The treatment protocol is clear what to do for which type of infection.

Always better to prevent , rather than searching a cure.

If failed take a help of a doctor.

Dr. Bipin Ninan Abraham
General Physician, Bangalore
As per the World Health Organisation (WHO), Nipah Virus is a newly emerging zoonosis that causes a severe disease in both animals and humans. The natural host of the virus are fruit bats of the Pteropodidae Family, Pteropus genus. Direct contact with infected pigs, other infected animals or through contaminated fruits (half-eaten fruits left by fruit bats), and even direct contact with sick persons have been cited as the underlying cause of outbreaks. Nipah Virus is not an airborne transmission infection, it can only affect those who come in direct contact with contaminated bodies. The symptoms of Nipah Virus are: - Fever from 3-14 days of exposure associated with severe headache due to encephalitis(swelling of the brain) which lead to a state of confusion, disorientation, nausea, persistent drowsiness and fainting. - Choking, stomach pain, vomiting, fatigue and blurred vision could also be there. - There are many patients who show neurological, respiratory and pulmonary signs as well - These symptoms can lead to coma in 24-48hours. If any of the above symptoms are present you should visit the nearest hospital and get evaluated. Investigations: - Real time polymerase chain reaction(RT-PCR) from throat, nasal swabs, CSF, urine and blood should be done in the early stages of the disease. - ELISA Test -Immunohistochemistry of tissues Prevention: - Do not eat fruits that may have been bitten by bats. - Do not drink toddy that is brewed in open containers near palm trees. - Refrain from consuming date palm sap. - Do not drink unpasteurized fruit juices - Wash,peel and/or cook all fruit thoroughly before eating - Safeguard oneself after coming in contact with someone who has contracted the virus. It is important to maintain a distance from the patient, to sanitize and wash hands thoroughly. Treatment: - Treatment is limited to intensive supportive care
Dr. AJIT S H
Ayurveda, Sorab
Q : What is Nipah Virus ?

A : Nipah virus was initially discovered when it caused an outbreak of brain fever among pig farmers in Malaysia.

Q : Should I be worried ?

A :  A little. As it is transmitted from person to person and there is no effective antiviral therapy for this infection .

Q : Who is at high risk ? How is it transmitted ?

A : 1. People working with pigs and consuming pigs.

2. Farmers who come in contact with bats.

3. Consuming Fruits which are already bitten by bat.

4. Contact with people who already have Nipah virus infection.

Q : What are the early symptoms  ?

A : The initial presentation is non-specific, characterized by the sudden onset of fever, headache, muscle pain , nausea and vomiting. Neck rigidity and photophobia are also  seen.
The disease rapidly progresses, with deterioration in consciousness *leading to coma within five to seven days.*

Q :How is it diagnosed ?

A : The rdiagnosis is by ELISA which is currently  done at National institute of Virology, Pune.

Q : How is it treated ?

A : Supportive care is the mainstay of treatment and infected patients may require intensive care monitoring.
*THERE IS NO APPROVED  SPECIFIC THERAPY FOR THIS INFECTION* . So prevention is the only cure !

Q : How do i prevent it ?

A : 1. Avoid contact with pigs and pig handlers  .

2. Maintain personal hygeine and intensive hand washing practices

3. *Avoid consuming raw fruits,* Consume only well cooked, clean, home made food till the outbreak settles down.

4. Preferably use N95 mask while travelling or working in public places to avoid person to person transmission.

5. Be aware of the symptoms and report to the doctor immediately for early diagnosis and treatment.

Verified User
What ways are there for prevention of nipah virus? If i have a fever how will i know it is due to nipah virus?
Dr. Bipin Ninan Abraham
General Physician, Bangalore
The incubation period for the virus ranges from 5 to 14 days and symptoms become visible after this period. The symptoms of Nipah Virus are: - Fever from 3-14 days of exposure associated with severe headache due to encephalitis(swelling of the brain) which lead to a state of confusion, disorientation, nausea, persistent drowsiness and fainting. - Choking, stomach pain, vomiting, fatigue and blurred vision could also be there. - There are many patients who show neurological, respiratory and pulmonary signs as well - These symptoms can lead to coma in 24-48hours. If any of the above symptoms are present you should visit the nearest hospital and get evaluated. Prevention: - Do not eat fruits that may have been bitten by bats. - Do not drink toddy that is brewed in open containers near palm trees. - Refrain from consuming date palm sap. - Do not drink unpasteurized fruit juices - Wash,peel and/or cook all fruit thoroughly before eating - Safeguard oneself after coming in contact with someone who has contracted the virus. It is important to maintain a distance from the patient, to sanitize and wash hands thoroughly.
Dr. A. Salam
General Physician, Pune
Nipah virus (NiV) infection is a newly emerging zoonosis that causes severe disease in both animals and humans. The natural host of the virus are fruit bats of the Pteropodidae Family, Pteropus genus.

NiV was first identified during an outbreak of disease that took place in Kampung Sungai Nipah, Malaysia in 1998. On this occasion, pigs were the intermediate hosts. However, in subsequent NiV outbreaks, there were no intermediate hosts. In Bangladesh in 2004, humans became infected with NiV as a result of consuming date palm sap that had been contaminated by infected fruit bats. Human-to-human transmission has also been documented, including in a hospital setting in India.

NiV infection in humans has a range of clinical presentations, from asymptomatic infection to acute respiratory syndrome and fatal encephalitis. NiV is also capable of causing disease in pigs and other domestic animals. There is no vaccine for either humans or animals. The primary treatment for human cases is intensive supportive care.
      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. 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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Did you know?

First instance of Nipah Virus

NiV was first identified during an outbreak of disease that took place in Kampung Sungai Nipah, Malaysia in 1998. On this occasion, pigs were the intermediate hosts. However, in subsequent NiV outbreaks, there were no intermediate hosts.

Regarding the name Nipah

The name Nipah comes from the village in Malaysia, where the person from whom the virus was first extracted and identified succumbed to the disease.

Ten Lives Claimed in Nipah Virus in May 2018

A sudden outbreak of Nipah virus infection has claimed at least 10 lives in Kerala as per the reports of various newspapers on 23rd May2018.

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