Nipah virus disease is a newly discovered disease of swine and humans associated with infection with a new paramyxovirus given the name Nipah virus. This disease emerged in Malaysia in 1998 and 1999. It was linked to severe encephalitis among humans occupationally exposed to infected pigs in Malaysia and Singapore. The disease was eradicated from the national commercial swine population by control efforts. Fruit bats of the genus Pteropus appear to be reservoirs of the virus.

Etiology and Epidemiology

The etiologic agent, Nipah virus (genus Henipavirus, family Paramyxoviridae), is an enveloped negative-sense, single-stranded RNA virus. The virus is closely related to Hendra virus (see Hendra Virus Infection), the only other member of the genus. The human outbreak in Malaysia and Singapore followed contact with infected swine and resulted in encephalitis with ~40% case mortality. The virus is assumed to have been introduced into the swine population from 1 of the 2 species of Pteropus found with antibodies during investigation of the outbreak. Pteropus spp range from the Western Pacific through southeast Asia, and south Asia down through coastal African islands, including Madagascar; several species of Pteropus have been found with antibodies, suggesting that the virus or closely related viruses occur in other areas within the range of this genus of bats. In Malaysia, genetic analysis of virus from human and swine clinical materials strongly supported a single introduction of the virus with spread through the commercial swine population. There was evidence of infection among several other species of domestic animals including dogs, cats, and horses. Human encephalitis caused by Nipah viruses in south Asia has been a regular occurrence since 2001 in Bangladesh and more recently in adjacent areas of India. In these areas, epidemiology has not supported the role of intermediary domestic species, but rather more direct transmission from the flying fox reservoir of the virus.

Transmission and Pathogenesis

Infection in pigs is assumed to have been a transfer from the reservoir bat species to pigs. Once the virus was introduced into an intensive swine husbandry setting, infection of animals within premises was rapid, and serologic tests suggested that nearly all pigs on an affected premise were infected. Transmission between premises was thought to be by poor biosecurity procedures and movement of infected animals. Experimental infection of swine with Nipah virus in a high biosecurity facility in Geelong supported that transmission between swine in close contact occurred readily.

Clinical Findings

Because of the danger of human infection and the emergency setting, clinical observations were not detailed in the field during the original epidemic. Most pigs developed a febrile respiratory disease with a severe cough that led to the local names for the disease, “barking pig syndrome” and “one-mile cough.” Encephalitis was also noted, particularly in the sows and boars in affected facilities. The proportion of animals with each form of the disease is uncertain, although the respiratory form predominated. Overall mortality within affected facilities was also not well documented but it probably was not >5% among all age groups.

Diagnosis

Laboratory diagnosis can be made by isolation of the virus, identification of the RNA by use of reverse transcriptase-PCR, detection of antigens in tissues by immunohistochemical staining with specific antibodies, or serologic tests such as indirect ELISA and virus neutralization tests. The virus is considered biosafety level 4 in the USA and Australia, and stringent laboratory containment at limited laboratories is a special consideration.

Treatment

Treatment of affected swine was not attempted during the Malaysian emergency. Humans required intensive care with ventilation support to manage the encephalitis; no specific treatment is available. Ribavirin was administered to some patients, but subsequent studies in laboratory animals suggest that it is ineffective.

Control and Prevention

Control of the epidemic/epizootic in Malaysia was dependent on the initiation of strict quarantine procedures and the slaughter of all swine from affected facilities. Adherence to appropriate biosecurity and quarantine procedures within facilities, as with other contagious diseases, is of paramount importance in preventing spread of the infection. An active surveillance and slaughter program successfully eliminated the virus from the national commercial swine population and it has remained free of infection. Presence of the virus in reservoir species of bats in a wide geographic range emphasizes the importance of good disease surveillance and biosecurity practices to promote early detection and confine the disease to initial premises should reintroduction occur.

Zoonotic Risk

Transmission of the virus from infected pigs to humans was largely in an occupational setting, and a study of risk factors associated with human infection suggests that close contact with live infected swine is the means of infection of nearly all human Nipah virus infections.

Continued sporadic clusters in horses and subsequent human cases with serious disease in some of these clusters emphasize the importance of appropriate personnel protective equipment in veterinary clinical examinations or postmortem procedures when Hendra or Nipah virus infection is suspected.

Last full review/revision March 2012 by Thomas G. Ksiazek, DVM, PhD