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Nipah virus

Overview

Nipah virus is a newly recognized zoonotic virus. The virus was 'discovered' in 1999. It has caused disease in animals and in humans, through contact with infectious animals. The virus is named after the location where it was first detected in Malaysia. Nipah is closely related to another newly recognized zoonotic virus (1994), called Hendra virus, named after the town where it first appeared in Australia. Both Nipah and Hendra are members of the virus family Paramyxoviridae. Although members of this group of viruses have only caused a few focal outbreaks, the biologic property of these viruses to infect a wide range of hosts and to produce a disease causing significant mortality in humans has made this emerging viral infection a public heath concern.

Natural Host

It is currently believed that certain species of fruit bats are the natural hosts of both Nipah and Hendra viruses. They are distributed across an area encompassing northern, eastern and south-eastern areas of Australia, Indonesia, Malaysia, the Philippines and some of the Pacific Islands. The bats appear to be susceptible to infection with these viruses, but do not themselves become ill. It is not known how the virus is transmitted from bats to animals.

Transmission

The mode of transmission from animal to animal, and from animal to human is uncertain, but appears to require close contact with contaminated tissue or body fluids from infected animals. Nipah antibodies have been detected in pigs, other domestic and wild animals. The role of species other than pigs in transmitting infection to other animals has not yet been determined.

It is unlikely that Nipah virus is easily transmitted to man, although previous outbreak reports suggest that Nipah virus is transmitted from animals to humans more readily than Hendra virus. Despite frequent contact between fruit bats and humans there is no serological evidence of human infection among bat carers. Pigs were the apparent source of infection among most human cases in the Malaysian outbreak of Nipah, but other sources, such as infected dogs and cats, cannot be excluded. Human-to-human transmission of Nipah virus has not been reported.

Clinical features

The incubation period is between 4 and 18 days. In many cases the infection is mild or inapparent (sub-clinical). In symptomatic cases, the onset is usually with "influenza-like" symptoms, with high fever and muscle pains (myalgia). The disease may progress to inflammation of the brain (encephalitis) with drowsiness, disorientation, convulsions and coma. Fifty percent of clinically apparent cases die.

Treatment

No drug therapies have yet been proven to be effective in treating Nipah infection. Treatment relies on providing intensive supportive care. There is some evidence that early treatment with the antiviral drug, ribavirin, can reduce both the duration of feverish illness and the severity of disease. However, the efficacy of this treatment in curing disease or improving survival is still uncertain.

Protection of health care professionals

The risk of transmission of Nipah virus from sick animals to humans is thought to be low, and transmission from person-to-person has not yet been documented, even in the context of a large outbreak. Therefore, the risk of transmission of Nipah virus to health care workers is thought to be low. However, transmission without percutaneous exposure (through a break in the skin barrier) is theoretically possible, as respiratory secretions contain the virus. This is why it has been categorized as a biohazardous agent that should be managed in a high-level biosecurity laboratory. It is recommended that close contact with body fluids and infected tissues be avoided if Nipah infection is suspected.

Outbreaks of Nipah and Hendra viruses

From September 1998 - April 1999, there was a large outbreak of encephalitis in Malaysia. During the investigation of this outbreak, Nipah virus, a previously unrecognized virus, was identified as the causal agent. A total of 265 people were infected, of whom 105 died. Ninety-three percent of cases had occupational exposure to pigs. An associated outbreak among abattoir workers in Singapore during March 1999 led to 11 cases, with 1 death. These workers had been handling pigs that had been imported from the outbreak areas in Malaysia.

There have been 3 recognized outbreaks of Hendra virus in Australia in 1994, 1995 and1999. Three human cases, leading to 2 deaths were recorded in the 1994 and 1995 outbreaks. In 1995 a horse was infected, with associated human cases. The precise mode of virus transmission to the three Australian patients is not fully understood. All 3 individuals appear to have acquired their infection as a result of close contact with horses which were ill and later died.


Sources: US Department of Health; The World Health Organization


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