Nipah virus

Nipah virus, scientific name Nipah henipavirus, is a bat-borne virus that is associated with a highly fatal infection. Numerous disease outbreaks caused by Nipah virus have occurred in South and Southeast Asia. Nipah virus belongs to the genus Henipavirus along with the Hendra virus, which has also caused disease outbreaks.

Nipah henipavirus
False-color electron micrograph showing a Nipah virus particle (purple) by an infected Vero cell (brown)
Virus classification
(unranked): Virus
Realm: Riboviria
Kingdom: Orthornavirae
Phylum: Negarnaviricota
Class: Monjiviricetes
Order: Mononegavirales
Family: Paramyxoviridae
Genus: Henipavirus
Species:
Nipah henipavirus

Virology

Tropism

Ephrin B2 and B3 have been identified as the main receptor for Nipah virus.[1] Ephrin subtypes have a complex distribution of expression throughout the body, where the B3 is noted to have particularly high expression in some fore-brain subregions.[2]

Evolution

The most likely origin of this virus was in 1947 (95% credible interval: 1888–1988).[3] There are two clades of this virus—one with its origin in 1995 (95% credible interval: 1985–2002) and a second with its origin in 1985 (95% credible interval: 1971–1996). The mutation rate was estimated to be 6.5 × 10−4 substitution/site/year (95% credible interval: 2.3 × 10−4 –1.18 × 10−3), similar to other RNA viruses.

Geographic distribution

Nipah virus has been isolated from Lyle's flying fox (Pteropus lylei) in Cambodia[4] and viral RNA found in urine and saliva from P. lylei and Horsfield's roundleaf bat (Hipposideros larvatus) in Thailand.[5] Infective virus has also been isolated from environmental samples of bat urine and partially eaten fruit in Malaysia.[6] Antibodies to henipaviruses have also been found in fruit bats in Madagascar (Pteropus rufus, Eidolon dupreanum)[7] and Ghana (Eidolon helvum)[8] indicating a wide geographic distribution of the viruses. No infection of humans or other species have been observed in Cambodia, Thailand or Africa as of May 2018.

History

Emergence

Pteropus vampyrus (large flying fox), one of the natural reservoirs of Nipah virus

The first cases of Nipah virus infection were identified in 1998, when an outbreak of neurological and respiratory disease on pig farms in peninsular Malaysia resulted in 265 human cases, including 105 human deaths.[9][10][11] The virus itself was isolated the following year in 1999.[12] This outbreak resulted in the culling of one million pigs. In Singapore, 11 cases, including one death, occurred in abattoir workers exposed to pigs imported from the affected Malaysian farms. The Nipah virus has been classified by the Centers for Disease Control and Prevention as a Category C agent.[13] The name "Nipah" refers to the place, Sungai Nipah in Port Dickson, Negeri Sembilan, the source of the human case from which Nipah virus was first isolated.[14][15] Nipah virus is one of several viruses identified by WHO as a likely cause of a future epidemic in a new plan developed after the Ebola epidemic for urgent research and development before and during an epidemic toward new diagnostic tests, vaccines and medicines.[16][17]

The outbreak was originally mistaken for Japanese encephalitis, but physicians in the area noted that persons who had been vaccinated against Japanese encephalitis were not protected in the epidemic, and the number of cases among adults was unusual.[18] Despite the fact that these observations were recorded in the first month of the outbreak, the Ministry of Health failed to react accordingly, and instead launched a nationwide campaign to educate people on the dangers of Japanese encephalitis and its vector, Culex mosquitoes.

Symptoms of infection from the Malaysian outbreak were primarily encephalitic in humans and respiratory in pigs. Later outbreaks have caused respiratory illness in humans, increasing the likelihood of human-to-human transmission and indicating the existence of more dangerous strains of the virus.

Based on seroprevalence data and virus isolations, the primary reservoir for Nipah virus was identified as Pteropid fruit bats, including Pteropus vampyrus (large flying fox), and Pteropus hypomelanus (small flying fox), both of which occur in Malaysia.

The transmission of Nipah virus from flying foxes to pigs is thought to be due to an increasing overlap between bat habitats and piggeries in peninsular Malaysia. At the index farm, fruit orchards were in close proximity to the piggery, allowing the spillage of urine, faeces and partially eaten fruit onto the pigs.[19] Retrospective studies demonstrate that viral spillover into pigs may have been occurring in Malaysia since 1996 without detection.[9] During 1998, viral spread was aided by the transfer of infected pigs to other farms, where new outbreaks occurred.

Outbreaks

Locations of henipavirus outbreaks (red stars–Hendra virus; blue stars–Nipah virus) and distribution of henipavirus flying fox reservoirs (red shading–Hendra virus; blue shading–Nipah virus)

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.[20] 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.[21] In 2001, Nipah virus was reported from Meherpur District, Bangladesh[22][23] and Siliguri, India.[22] The outbreak again appeared in 2003, 2004 and 2005 in Naogaon District, Manikganj District, Rajbari District, Faridpur District and Tangail District.[23] In Bangladesh, there were also outbreaks in subsequent years.[24][25]

  • September 1998 – May 1999, in the states of Perak, Negeri Sembilan and Selangor in Malaysia. A total of 265 cases of acute encephalitis with 105 deaths caused by the virus were reported in the three states throughout the outbreak.[26] The Malaysian health authorities at the first thought Japanese encephalitis (JE) was the cause of infection which hampered the deployment of effective measures to prevent the spread.[27]
  • 2001 January 31–23 February, Siliguri, India: 66 cases with a 74% mortality rate.[28] 75% of patients were either hospital staff or had visited one of the other patients in hospital, indicating person-to-person transmission.
  • 2001 April – May, Meherpur District, Bangladesh: 13 cases with nine fatalities (69% mortality).[29]
  • 2003 January, Naogaon District, Bangladesh: 12 cases with eight fatalities (67% mortality).[29]
  • 2004 January – February, Manikganj and Rajbari districts, Bangladesh: 42 cases with 14 fatalities (33% mortality).
  • 2004 19 February – 16 April, Faridpur District, Bangladesh: 36 cases with 27 fatalities (75% mortality). 92% of cases involved close contact with at least one other person infected with Nipah virus. Two cases involved a single short exposure to an ill patient, including a rickshaw driver who transported a patient to hospital. In addition, at least six cases involved acute respiratory distress syndrome, which has not been reported previously for Nipah virus illness in humans.
  • 2005 January, Tangail District, Bangladesh: 12 cases with 11 fatalities (92% mortality). The virus was probably contracted from drinking date palm juice contaminated by fruit bat droppings or saliva.[30]
  • 2007 February – May, Nadia District, India: up to 50 suspected cases with 3–5 fatalities. The outbreak site borders the Bangladesh district of Kushtia where eight cases of Nipah virus encephalitis with five fatalities occurred during March and April 2007. This was preceded by an outbreak in Thakurgaon during January and February affecting seven people with three deaths.[31] All three outbreaks showed evidence of person-to-person transmission.
  • 2008 February – March, Manikganj and Rajbari districts, Bangladesh: Nine cases with eight fatalities.[32]
  • 2010 January, Bhanga subdistrict, Faridpur, Bangladesh: Eight cases with seven fatalities. During March, one physician of Faridpur Medical College Hospital caring for confirmed Nipah cases died[33]
  • 2011 February: An outbreak of Nipah Virus occurred at Hatibandha, Lalmonirhat, Bangladesh. The deaths of 21 schoolchildren due to Nipah virus infection were recorded on 4 February 2011. IEDCR confirmed the infection was due to this virus.[34] Local schools were closed for one week to prevent the spread of the virus. People were also requested to avoid consumption of uncooked fruits and fruit products. Such foods, contaminated with urine or saliva from infected fruit bats, were the most likely source of this outbreak.[35]
  • 2018 May: Deaths of seventeen[36] people in Perambra near Calicut, Kerala, India were confirmed to be due to the virus. Treatment using antivirals such as Ribavirin was initiated.[37][38]
  • 2019 June: A 23-year-old student was admitted into hospital with Nipah virus infection at Kochi in Kerala.[39] Health Minister of Kerala, K. K. Shailaja confirmed that 86 people who have had recent interactions with the patient were under observation. This included two nurses who treated the patient, and had fever and sore throat. The situation was monitored and precautionary steps were taken to control the spread of virus by the Central[40] and State Government.[39] 338 people were kept under observation and 17 of them in isolation by the Health Department of Kerala. After undergoing treatment for 54 days at a private hospital, the 23-year-old student was discharged. On 23 July, the Kerala government declared Ernakulam district to be Nipah-free.[41]

See also

References

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