India: Nipah virus outbreak

An outbreak of Nipah virus has been confirmed in India

As of 24 September 2023, six confirmed cases of Nipah virus (NiV), including two deaths, have been reported. All of the cases have been reported from Kozhikode District in Northern Kerala [1]. The latest reported case was on 15 September 2023.

The first ever report of NiV in India was in 2018 [2], also in Kerala state (initially reported in Kozhikode District, with later cases also reported in Mallapuram District). An outbreak was reported in Bangladesh in February 2023.

NiV is a virus that spreads to humans from animals (a zoonosis); the natural hosts of the virus are fruit bats. Most human infections result from direct contact with sick animals, particularly pigs and bats, or their environments, which become contaminated with the virus [3].

Eating or drinking fruit or fruit products (such as raw date palm juice), contaminated with urine/saliva from infected fruit bats, is also a likely source of infection [3].

Person-to-person transmission of NiV has also been reported among close contacts, such as family and care givers of NiV patients, including in hospital settings [3].

NiV can cause a range of illnesses including fatal encephalitis. Treatment is limited to intensive supportive care to treat severe infections [3].

Advice for travellers

Before you travel

Check and follow the advice from the Foreign, Commonwealth & Development Office on safety, security, and any travel restrictions at your destination.

Check our Country Information pages to research general health risks, prevention advice and any vaccine recommendations or malaria advice for your destination.

There is currently no licensed vaccine to prevent NiV [3].

While you are away

The risk of NiV infection for tourists to India is currently very low if the following precautions [3, 4] are taken:

• Pay careful attention to personal hygiene.
• Do not consume raw date palm sap (NiV can survive in the palm sap for days). Raw or partially fermented date palm juice should be boiled.
• All fruit should be thoroughly washed with clean water and peeled before consumption; fruit found on the ground which may have been partially eaten by animals, should not be eaten.
• Close, unprotected physical contact with people with NiV infection should be avoided. Avoid contact with blood or body fluids of anyone infected with NiV. Regular hand washing should be carried out after caring for or visiting sick people.
• Avoid contact with sick bats (e.g., areas where they roost), and pigs, as much as possible.
• Gloves and other protective clothing should be worn if handling sick animals or their tissues, and during slaughtering and culling.

The risk to other UK travellers (such as those visiting friends and family) may be higher, depending on activities undertaken (e.g., local practices such as collection of raw or fermented date sap) [3].

You should seek advice from a health professional if you develop symptoms whilst you are overseas.

When you return

If you think you, or anyone in your family has symptoms after you return to the UK you should seek medical advice. It is important to tell your healthcare provider about any recent travel to an affected area in India.

Advice for health professionals

In the UK NiV is classed as a high consequence infectious disease. UK Health Security Agency provides Guidance: High consequence infectious diseases for health professionals and for the management of Nipah virus infections.

Healthcare professionals should be aware of the signs and symptoms of NiV in any patient with a relevant travel history and symptoms compatible with NiV infection, within 14 days of exposure. Specialist advice must be sought when persons suspected of having NiV infection are evaluated [3].

Health professionals caring for patients with suspected or confirmed NiV infection, or handling specimens from them, should always implement standard infection control precautions.