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 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.

Risks[edit]

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.[15]

Diagnosis[edit]
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[edit]
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]

Treatment[edit]
Currently there is no effective treatment for Nipah virus infection. The treatment is limited
to supportive care. It is important to practice standard infection control practices and proper
barrier nursing techniques to avoid the spread of the infection from person to person. All
suspected cases of Nipah virus infection should be isolated.[20]
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.[21] Passive immunization using a human monoclonal antibody that targets the 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.[22] m102.4, a human monoclonal
antibody, has been used in people on a compassionate use basis in Australia and was in pre-
clinical development in 2013.[6]

Outbreaks[edit]
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]
Main article: 2018 Nipah virus outbreak in Kerala
In May 2018, an outbreak was reported in the Kozhikode district of Kerala, India.[28] Seventeen
deaths were recorded, including one healthcare worker.[29][10][30] 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 June 10, 2018,
the outbreak was officially declared to be over.[31]
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 June 4, 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.[32]