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Nipah Virus: Transmission, Symptoms And Diagnosis

First identified in Malaysia in 1998 among pig farmers, the Nipah virus has resurfaced a year after its last reported case in Kerala. The fresh case confirmed in the district of Ernakulam, Kerala is of a 23-year-old student, who is under extensive care now. The health officials have identified 86 people who interacted with the student who is under observation for possible infection [1] .

So, what is the Nipah virus? According to the World Health Organisation, Nipah virus (NiV) is a viral infection which has emerged newly and falls under the zoonosis category. Zoonosis means, this virus can not only affect humans, but it can also affect other types of animals too. The Nipah virus can be transmitted to humans from animals, which have been affected by this virus. It can also be transmitted from infected humans to other humans through direct contact [2] .

The natural host of the Nipah virus is the fruit bat of the Pteropodidae family, as reported by the World Health Organisation (WHO) [3] .

Transmission Of Nipah Virus

The virus can spread to human beings when one comes in contact with an infected bat or pig (although bats are considered as the primary cause). The virus can also spread from other NiV infected people.

Consumption of fruits or fruit products that have been contaminated with the saliva or urine of infected bats is regarded as being the primary source of infection. In the initially reported cases, the infection spread from pigs to human beings who came in close contact with the animals. Fruits bitten by infected bats were the major cause of the infection being wide-spread [4] .

Human-to-human transmissions have been reported in the family and caregivers of Nipah virus-infected patients. Around 75 per cent of the cases reported during the 2001 outbreak was all among health care providers, hospital staffs and visitors.

Symptoms Of Nipah Virus Infection

The initial signs of the infection are as follows [5] , [6] :

  • Fever
  • Headache
  • Muscle pain
  • Sore throat
  • Vomiting
  • Dizziness
  • Drowsiness
  • Altered consciousness
  • Acute respiratory syndrome

The infections of humans range from an acute respiratory infection, fatal encephalitis and asymptomatic infection. When the Nipah virus infects you, you may experience encephalitis or inflammation of the brain [7] .

Some people may also experience atypical pneumonia and severe respiratory problems. In severe cases, encephalitis and seizures may lead to coma within 24 to 48 hours. However, it takes 5 to 14 days for the signs and symptoms of the virus infection to start appearing [8] . There have been reports of the incubation period stretching out as long as 45 days. According to the CDC, long-term side effects among survivors can include personality changes and convulsions.

Around 20 per cent of patients are left with residual neurological consequences such as seizure disorder and other neurological conditions that have been reported in survivors, according to the reports of World Health Organisation (WHO) [9] .

Diagnosis Of Nipah Virus Infection

The first signs and symptoms of Nipah virus are non-specific and the diagnosis is often not suspected at the time when the infection starts; which can hinder accurate diagnosis and create challenges in early detection. Likewise, it also poses a limitation on timely effective control measures and outbreak response activities [10] .

The quantity, quality, timing of collection, type and the time necessary to transfer samples from patients to laboratories can affect the accuracy of the laboratory results [11] . The infection can be diagnosed together with clinical history during the acute phase of the disease.

The diagnosis tests include real-time polymerase chain reaction (RT-PCR) from bodily fluids as well as antibody detection via ELISA [12] , [13] . Other tests like polymerase chain reaction (PCR) assay, enzyme-linked immunosorbent assay (ELISA) and virus isolation by cell culture are also performed to diagnose the same.

Treatment For Nipah Virus Infection

Currently, there are no known treatments or vaccine available. Ribavirin, an antiviral has been asserted to have the ability to reduce mortality among patients with encephalitis caused by the Nipah virus [14] . People who are infected are treated with supportive care, like keeping the person hydrated and treating vomiting and nausea [15] .

View Article References
  1. [1] Yob, J. M., Field, H., Rashdi, A. M., Morrissy, C., van der Heide, B., Rota, P., ... & Ksiazek, T. (2001). Nipah virus infection in bats (order Chiroptera) in peninsular Malaysia.Emerging infectious diseases,7(3), 439.
  2. [2] Paton, N. I., Leo, Y. S., Zaki, S. R., Auchus, A. P., Lee, K. E., Ling, A. E., ... & Sng, I. (1999). Outbreak of Nipah-virus infection among abattoir workers in Singapore.The Lancet,354(9186), 1253-1256.
  3. [3] Chua, K. B., Bellini, W. J., Rota, P. A., Harcourt, B. H., Tamin, A., Lam, S. K., ... & Goldsmith, C. S. (2000). Nipah virus: a recently emergent deadly paramyxovirus.Science,288(5470), 1432-1435.
  4. [4] Clayton, B. A. (2017). Nipah virus: transmission of a zoonotic paramyxovirus.Current opinion in virology,22, 97-104.
  5. [5] Nikolay, B., Salje, H., Hossain, M. J., Khan, A. D., Sazzad, H. M., Rahman, M., ... & Nichol, S. T. (2019). Transmission of Nipah Virus—14 Years of Investigations in Bangladesh.New England Journal of Medicine,380(19), 1804-1814.
  6. [6] Verma, M. K., Verma, P., Singh, S., Gaur, P., Siddiqui, A. H., & Pandey, S. (2018). Nipah Virus-Infectious Agent: An Overview.Int. J. Life. Sci. Scienti. Res. EISSN,2455(1716), 1716.
  7. [7] Ang, B. S., Lim, T. C., & Wang, L. (2018). Nipah virus infection.Journal of clinical microbiology,56(6), e01875-17.
  8. [8] Reddy, K. R. (2018). Nipah Virus (NiV) Infection: An Emerging Zoonosis of Public Health Concern.Journal of Gandaki Medical College-Nepal,11(02).
  9. [9] Sharma, V., Kaushik, S., Kumar, R., Yadav, J. P., & Kaushik, S. (2019). Emerging trends of Nipah virus: A review.Reviews in medical virology,29(1), e2010.
  10. [10] Wacharapluesadee, S., Jittmittraphap, A., Yingsakmongkon, S., & Hemachudha, T. (2016). 53 Nipah Virus.Molecular Detection of Animal Viral Pathogens, 455.
  11. [11] Fischer, K., Diederich, S., Smith, G., Reiche, S., dos Reis, V. P., Stroh, E., ... & Balkema-Buschmann, A. (2018). Indirect ELISA based on Hendra and Nipah virus proteins for the detection of henipavirus specific antibodies in pigs.PloS one,13(4), e0194385.
  12. [12] Satterfield, B. A., Dawes, B. E., & Milligan, G. N. (2016). Status of vaccine research and development of vaccines for Nipah virus.Vaccine,34(26), 2971-2975.
  13. [13] Hassan, M. Z., Sazzad, H. M., Luby, S. P., Sturm-Ramirez, K., Bhuiyan, M. U., Rahman, M. Z., ... & Daszak, P. (2018). Nipah virus contamination of hospital surfaces during outbreaks, Bangladesh, 2013–2014.Emerging infectious diseases,24(1), 15.
  14. [14] Dawes, B. E., Kalveram, B., Ikegami, T., Juelich, T., Smith, J. K., Zhang, L., ... & Freiberg, A. N. (2018). Favipiravir (T-705) protects against Nipah virus infection in the hamster model.Scientific reports,8(1), 7604.
  15. [15] Lo, M. K., Feldmann, F., Gary, J. M., Jordan, R., Bannister, R., Cronin, J., ... & Zaki, S. R. (2019). Remdesivir (GS-5734) protects African green monkeys from Nipah virus challenge.Science translational medicine,11(494), eaau9242.

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