DEPARTMENT OF HEALTH

RESEARCH INSTITUTE FOR TROPICAL

MEDICINE

Laboratory
Investigation of
Henipah Virus
Outbreak in 2014
ASEAN Regional Forum
March 7, 2018
 National Referral Center and Reference Laboratory for
Emerging and Re-emerging Infectious Diseases

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 Timeline of Outbreak
• April 2, 2014 – DOH-Epidemiology Bureau EB)
received an Event-Based Surveillance Report
from the Regional Epidemiology Surveillance
Unit (RESU) 12 of suspected food-poisoning due
to consumption of horsemeat in a municipality of
Sultan Kudarat
• April 8, 2014 – RITM received 4 rectal swab
samples in cary-blair transport media from
RESU. All cases were deaths. All samples were
negative for suspected bacterial pathogens.

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 Timeline of Outbreak
• April 15, 2014 – RITM internal meeting to discuss the
outbreak after RESU reported that a nurse who
handled one of the cases who died went into coma.
Agreements were:
1. could not only be food poisoning and based on
clinical symptoms, the causative agent may be viral
in origin
2. Safety precautions in the field for specimen
collection
3. Biosafety in the lab who are handling and
processing samples

- National Meat Inspection Service found no

significant results in a horse’s bone marrow test.
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 Timeline of Outbreak
• April 16, 2014 – RITM received 6 sera and 3 CSF
samples from RESU tested for Japanese
encephalitis (IgM), dengue (IgM and PCR),
chikungunya (IgM and PCR), HSV 1 and 2,
enteroviruses; followed by bacteriology, including
aerobic culture, streptococcus B, HIB, S.
pneumoniae, N.meningitidis, and cryptococcal
antigen

• April 17-23, 2014 – 1st investigating team (DOH-

FETP, RITM and RESU)
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 Timeline of Outbreak
• April 20, 2014 – all virological samples of April
16th had negative results
• April 23, 2014 – serum and NPS/OPS samples
from 1st outbreak investigation received by RITM
(includes human case-control samples). Tested
for all etiologies above plus MERS-CoV,
influenza A and B, and B. anthracis. Including 10
serum and NPS/OPS samples of horses to be
sent to Australian Animal Health Laboratory
(AAHL)

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 Timeline of Outbreak
• April 26, 2014 – all samples of April 16th were
negative for bacteriological testing; April 23rd
samples had 1 positive for dengue IgM, 1
positive for JE IgM and 2 positives for ChikV IgM
(all positive samples were from asymptomatic
control groups)

• April 30, 2014 – All April 23rd samples were

negative for bacteriological testing

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 Timeline of Outbreak
• May 3, 2014 – RITM decided to tests for Hendra
and Nipah virus detection through RITM-Tohoku
University collaborating research laboratory
• May 14, 2014 – symptomatic human samples
received in April 16th and 23rd sent to Japan-
National Institute of Infectious Diseases (NIID)
as per IATA guidelines
• May 15, 2014 - Teleconference between WHO,
DOH and RITM regarding laboratory testing of
acute encephalitis syndrome specimens

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 Timeline of Outbreak
• May 20-25, 2014 – 2nd outbreak investigation
team (WHO, DOH, RITM, CDC, AAHL, RESU,
PHO, PVO, MHO, PNP)
• May 16, 2014 – human and animal samples sent
to AAHL
• May 20, 2014 – Japan-NIID results showed 2
samples positive for nipah-related virus by
serum neutralization test (SNT) using
pseudotyped VSV detected neutralizing
antibodies against Nipah virus (NiV)

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 Timeline of Outbreak
• May 27, 2014 –AAHL results showed 1 human
sample positive for Nipah virus by serum NAT
and 2 human samples both positive for Nipah
and Hendra virus by Serum NT and all 3 human
samples positive by Luminex (next generation
sequencing)
• May 26, 2014 – last batch of human samples
from RESU 12
• July 7-18, 2014 – bat surveillance (BAI, DENR,
RITM)

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 Summary of the outbreak
• 17 cases (13 with AES, 5 Influenza-like-illness
and 1 aseptic meningitis); 21-60 years old
(median=41 years); 94% males
• 9 deaths (CFR=53%); all males

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 Summary of the outbreak
• Animal samples collected:
- 17 horses serum and 15 NPS/OPS
- 10 pigs serum
- 6 dogs serum
- 4 goats serum
- 3 carabao serum
- 144 bats serum
• 5 dogs and 6 bats samples positive for Nipah
Virus by serological NT

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 References and Acknowledgements:
1. Special Pathogens Laboratory, RITM
2. Molecular Biology Laboratory, RITM
3. Philippine National Influenza Center, RITM
4. Clinical Laboratory, RITM
5. National Reference Laboratory for Dengue and other Arboviruses, RITM
6. Field Epidemiology Training Program, Epidemiology Bureau
7. Public Health Surveillance and Informatics Division, Epidemiology Bureau
8. Bureau of Animal Industry, Department of Agriculture
9. Biodiversity Management Bureau, Department of Environment and Natural
Resources

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