The first recognized human infection occurred in the Malaysian village of Kampung Sungai Nipah in September 1998. It began a deadly outbreak that lasted through mid-June 1999. During this outbreak, 265 encephalitis cases, including 105 deaths, had been reported in Malaysia, and 11 cases of encephalitis or respiratory illness with one death had been reported in Singapore1. Ever since, smaller sporadic outbreaks have recurred nearly annually within South Asia, with case fatality rates reaching greater than 90%
The first case in India was identified in 2018. In May 2018, 23 cases of Nipah virus (NiV) infection were identified in Kozhikode District, Kerala State, India. The case-fatality rate reached 91%, with 21 individuals dying and only 2 surviving. While the outbreak lasted for barely a 1 month, it created fear and panic both locally and internationally.2
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The first human NiV infections were found to be associated with contact with swine. It was later confirmed that NiV could be isolated from the nose and oropharynx of pigs. Infected persons expressed fever for up to 14 days, meningitis and/or encephalitis, with rapid neurological decline and progression to coma within 24-48 hours. 3
However, later outbreaks outside the Malay Peninsula have been characterised by different transmission dynamics and clinical presentation. These included the development of severe respiratory symptoms in addition to neurological complications. human infection has also been traced to the consumption of horse meat, proximity to other infected humans, and ingestion of raw date palm sap contaminated with the bodily fluids of bats.4
Even though NiV outbreaks have not recurred in Malaysia or Singapore since the initial outbreak in 1999, they have occurred in Bangladesh and have been recurrent, sporadic outbreaks in India nearly every year.
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References
- Chua, K. B. (2000). Nipah Virus: A Recently Emergent Deadly Paramyxovirus. Science, 288(5470), 1432–1435. https://doi.org/10.1126/science.288.5470.1432 ↩︎
- Spiropoulou, C. F. (2018). Nipah Virus Outbreaks: Still Small but Extremely Lethal. The Journal of Infectious Diseases, 219(12), 1855–1857. https://doi.org/10.1093/infdis/jiy611 ↩︎
- Centers for Disease Control and Prevention (CDC). (2024). Update: outbreak of Nipah virus–Malaysia and Singapore, 1999. MMWR. Morbidity and Mortality Weekly Report, 48(16). https://pubmed.ncbi.nlm.nih.gov/10366143/ ↩︎
- Nikolay, B., Salje, H., Hossain, M. J., Khan, A. K. M. D., Sazzad, H. M. S., Rahman, M., Daszak, P., Ströher, U., Pulliam, J. R. C., Kilpatrick, A. M., Nichol, S. T., Klena, J. D., Sultana, S., Afroj, S., Luby, S. P., Cauchemez, S., & Gurley, E. S. (2019). Transmission of Nipah Virus — 14 Years of Investigations in Bangladesh. The New England Journal of Medicine, 380(19), 1804–1814. https://doi.org/10.1056/NEJMoa1805376 ↩︎
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