More than two decades ago, in 1998, a mysterious outbreak of encephalitis among pig farmers in Malaysia captured the attention of scientists worldwide. The culprit was a previously unknown virus, Nipah virus (NiV), closely related to Hendra virus. Within months, the virus had infected hundreds, causing over 100 deaths in Malaysia and spreading to Singapore. What seemed like a localized outbreak quickly revealed the danger of a silent, deadly pathogen capable of leaping from animals to humans.
Nipah virus is primarily carried by fruit bats, also known as flying foxes (genus Pteropus). Humans can become infected through direct contact with infected animals, consumption of contaminated food, or even close contact with infected individuals. Its incubation period ranges from 4 to 14 days, but the disease can progress rapidly, with mortality rates reaching 40–75%.
Certain regions have experienced repeated Nipah outbreaks, forming what scientists call the “Nipah belt.” These include parts of Bangladesh, India, Malaysia, and Singapore.
Major outbreaks occurred in:
Malaysia and Singapore (1998–1999)
Bangladesh (2001 onwards)
India (2001 onwards)
Kerala, India (2018, 2019, 2021, 2023–2024)
From January to February 2024, two laboratory-confirmed cases emerged in Dhaka, Bangladesh, and in total, five cases were reported in 2024, all of which proved fatal. Bangladesh continues to record one of the highest Nipah mortality rates in the world (71%). In July 2024, the virus resurfaced in Kerala, India, tragically killing a 14-year-old boy.
Nipah virus begins subtly, often resembling the flu. Early symptoms include:
- Fever
- Headache
- Muscle pain
- Fatigue
- Cough
For some patients, the disease escalates to severe complications such as:
- Encephalitis (brain inflammation)
- Confusion and disorientation
- Seizures and coma
- Acute respiratory distress
Alarmingly, relapse encephalitis can occur months or even years after recovery, making the virus unpredictable.
During outbreaks, pharmacists are more than medication experts—they are frontline educators and health advocates. Their key roles include: providing vaccination services (when available), sharing accurate, evidence-based health information, reducing fear and misinformation, supporting infection prevention and control, managing medications and supportive therapies etc. Pharmacists bridge the gap between public health authorities and communities, helping to contain outbreaks and guide proper care.
The fight against Nipah virus involves diagnosis, treatment, and prevention. Researchers are exploring multiple approaches:
Understanding the Virus: NiV is a negative-sense RNA virus, meaning its genetic material is carried in a single-stranded RNA format. Scientists have studied viral proteins such as the P protein, crucial for replication and immune evasion, and the M protein, which plays a key role in virus assembly and release. Understanding these proteins is essential for designing drugs and vaccines.
Vaccines and Antivirals: Currently, no licensed vaccines or specific treatments exist for humans. However, progress is underway:
1. Several vaccine candidates have shown promising results in animal studies and are in Phase I and II trials through CEPI.
2. Some antiviral therapies, including monoclonal antibody m102.4, Remdesivir, and Ribavirin, show potential.
3. m102.4 is particularly promising, offering protection if given within 3–5 days post-infection. Ribavirin has reduced mortality by approximately 36% in some cases.
Reverse Genetics: Researchers use reverse genetics to create laboratory versions of NiV, allowing them to study viral replication, test drugs, and develop vaccines. This approach also helps identify which viral genes are responsible for transmission and disease severity.
Diagnostics: Early detection is critical. Current methods include:
1.RT-PCR (the gold standard)
2.ELISA
3.Virus isolation
Efforts are underway to create rapid, point-of-care tests suitable for rural and outbreak-prone areas.
Nipah virus has been identified as a priority disease by the World Health Organization (WHO) and the National Institutes of Health (NIH) due to its potential to cause epidemics. Researchers adopt a One Health approach, studying the virus at the intersection of human, animal, and environmental health.
This approach is crucial for predicting outbreaks and preventing human infections, especially in regions where humans and wildlife interact closely.
More than two decades after its discovery, Nipah virus remains a deadly and unpredictable threat. While advances in diagnostics, antivirals, and vaccines are encouraging, major gaps remain in surveillance, testing, and therapeutic options. Strengthening laboratory capacity, improving public health systems, and advancing research are essential to protect vulnerable populations. As humans continue to expand into wildlife habitats and climate changes alter ecosystems, Nipah virus reminds us that the next outbreak could be just around the corner—highlighting the ongoing importance of research, education, and preparedness.
This article is taken from the Galen Gazette, January 2026, Issue No. 08. The author, Jannatul Tasfiha, is a pharmacy student at Comilla University.
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