Paramyxoviruses (Hendra and Nipah Virus)
Boston University
Research Occupational Health Program (ROHP)
617-358-7647
Agent
Hendra and Nipah viruses belong to the Henipavirus genus within the family of Paramyxoviridae and are of zoonotic origin. The natural reservoir of these viruses are pteropid fruit bats. Hendra virus is endemic in Australia. Since 1994, there were 7 human cases of Hendra virus infection. Close contact to sick horses that were infected with Hendra virus was the route of transmission for all human cases. Nipah virus outbreaks have occurred Malaysia, Bangladesh and India. The Nipah virus infections in Malaysia alerted the global public health community of the severe pathogenic and wide distribution of these paramyxoviruses. Nipah virus infection occurred among people close to pigs.
Ghana virus (or Ghanian bat henipavirus or Kumasi virus, GhV or KV) was first detected in bat guano in the zoo in Kumasi, Ghana. Ghana Virus has not yet been shown to cause symptoms in animals other than bats due to less of an ability to replicate in hosts outside of the natural bat reservoir. Langya virus was first detected in Eastern China and is found mainly in shrews, though goats and dogs have also shown evidence of prior infection. Langya virus has been known to cause illness in humans, though no known deaths have been identified. Mojiang Virus is a rat-borne henipavirus first identified in Southern China and has not yet been known to infect humans.
Disease/Infection
Nipah virus infection
Hendra virus infection
Pathogenicity
Hendra virus case fatality has been reported to be up to 57%. Case fatality rates during Nipah virus outbreaks range between 10-92%.
a. Special populations at risk
- Three people with close contact to horses contracted Hendra disease and two died. Contact with fruit bats can also cause disease.
Biosafety Information
Risk Group/BSL
Risk group 4
Biosafety level: BSL4
Modes of Transmission
Possible direct contact with fluids of animals cause disease. Close contact with horses, pigs, and pteropus bats has been recorded in infections. Hendra and Nipah virus have been isolated in tissues of infected animals. No lab-acquired infections have been recorded.
| Transmission | |
| Skin Exposure (Needlestick, bite, or scratch): | Yes |
| Mucous Membrane Splash to Eye(s), Nose or Mouth: | Yes |
| Human to human transmission reported with Nipah virus: | Yes |
| Inhalation: | Transmission via droplets is suspected. |
| Ingestion: | Unlikely in laboratory setting |
Host Range/Reservoir
Natural reservoir hosts for Hendra and Nipah appear to be fruit bats, genus Pteropus, and other bat species. Horses and pigs are accidental hosts similar to humans.
Symptoms
Human illness consists of fever, myalgia, severe headache and signs of encephalitis. 40% of people with encephalitis die.
Hendra and Nipah virus infections are characterized by fever, severe headache, myalgia, and encephalitis. Nipah virus patients also present with drowsiness, cough, abdominal pain, nausea, and blurred vision. A few patients with Hendra virus infection developed a respiratory disease. Platelet counts are sometimes decreased with elevated LFT’s and CSF abnormalities.
Incubation Period
Hendra virus: 9-16 days
Nipah virus: 5-14 days
Viability
Henipaviruses have similar susceptibility to common disinfectants; 70% ethanol, 1% sodium hypochlorite, 2% glutaraldehyde, potassium permanganate, ether, and temperatures >60°C.
Survival Outside Host
Unknown
Information for Lab Workers
Laboratory PPE
One-piece positive pressure ventilated suit with life support system is utilized. Long sleeve scrubs will be worn under the positive pressure suit with inner gloves providing added protection against outer glove tear.
Containment
All work with infectious henipaviruses must be performed in BSL-4/ABSL-4 containment.
PRIMARY HAZARDS:
- Accidental parenteral inoculation, respiratory exposure to infectious droplets, and/or direct contact with broken skin or mucous membranes.
SPECIAL HAZARDS:
- Work with, or exposure to, infected non-human primates, rodents, or their carcasses represents a risk of human infection; use of sharps when handling virus-containing material.
In Case of Exposure/Disease
Immediately after exposure, lab workers should follow the HIGH AND MAXIMUM CONTAINMENT MEDICAL INCIDENT RESPONSE PLAN (ERP C.1) as provided on site and during training.
- For all lab exposures which involve BSL-4 pathogens (needle sticks, punctures, cuts, scratches, etc.) and for all medical events which require immediate evaluation and treatment (traumatic injury, heart attack, stroke, seizure, etc.):
- Medical Campus: call or have a coworker call the Control Center at 617-414–6666. You will be referred to or transported to the appropriate health care location by the emergency response team.
- The Control Center operator will activate a communication tree which includes the BU Research Occupational Health Program (ROHP) Officer will help guide the response.
- To reach the ROHP directly use the 24/7 hour number (617-358-ROHP (7647)).
- You will be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you the appropriate health care location.
- Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
- Present the Medical Surveillance Card that every BSL-4 researcher has been provided by ROHP, this wallet size card identifies the agents that the researcher works with; provide the ID card to the treating physician.
Vaccination
There are no FDA approved vaccinations for either virus in humans.
Information for First Responders/Medical Personnel
Public Health Issues
After exposure: Immediately after an exposure to a henipavirus, the lab worker is not considered infectious. He/she can be cared for with standard PPE. On campus exposures will be escorted directly from NEIDL triage room to the Special Pathogens Unit (SPU) at Boston Medical Center (BMC) where lab workers will be received by a team of physicians and nurses. In case of a lab worker presenting to BMC ED or other outside medical facility, either the exposed or the caring physicians should immediately contact ROHP for further instructions.
In case of (suspected) illness: Lab worker should contact ROHP directly and when possible, transport will be arranged to bring the patient to BMC’s Patient Isolation Unit. Patient should prevent close contact with household members pending evaluation, if possible. If the worker presents to BMC ED or other outside medical facility, caring physicians should contact ROHP for further instructions and ROHP will consult infectious diseases specialists at SPU.
Person-to-person transmission is reported via close personal contact with an infected individual or their body fluids during the late stages of the infection. PPE requirements for care of this patient are listed below.
PPE: SPU staff use advanced PPE including coveralls, fluid proof aprons, PAPR’s, and double gloves. CDC recommendations: Airborne, Droplet Precautions plus Contact Precautions, with face/eye protection, emphasizing safety sharps and barrier precautions when blood exposure likely. Avoid aerosol-generating procedures.
Other guidance for outside providers: No blood work should be drawn until contact is made with ROHP.
Specimen should be handled with extreme care and enclosed in appropriate shatter-proof and leak-proof packing for transport to lab. Diagnostic laboratory staff should be notified of suspicion of infection, and tests should be performed under proper containment. Please contact ROHP immediately for further details.
Public health officials will be notified.
Diagnosis/Surveillance
RT-PCR of blood or CSF have been developed, but virus isolation must be performed in designated reference or BSL-4 lab. ELISA and rapid immune plague assays have been developed.
First Aid/Post Exposure Prophylaxis
Standard management of potential exposure to Nipah or Hendra virus is solely based on observation, potential isolation and with symptomatic and supportive treatments.
No approved post exposure prophylaxis or post exposure vaccination available. Passive immunization using monoclonal antibodies targeting the Hendra or Nipah virus G glycoproteins has been examined in post-exposure prophylaxis.
Medical countermeasures may be available post exposure through CDC, ROHP, and Infection Control. NEIDL should be contacted immediately to coordinate potential access to investigational measures.
Treatment
Remdesivir is effective in African green monkeys, Nipah challenge model, and active against Hendra, in vitro.
Ribavirin has been used but there is no clear successful treatment for Nipah or Hendra infection. Intensive supportive therapy is provided.
References
Luby et al. Epidemiology of Henipavirus disease in humans. Curr Top Microbiol Immunol, 2012; 359:25-40.
Field HE et al. Henipaviruses: Emerging paramyxoviruses associated with fruit bats. Curr Top Microbiol Immunol, 2007;315:133-59.
Chua KB. Introduction: Nipah virus – discovery and origin. Curr Top Microbiol Immunol, 2012;359:1-9.
UptoDate: May 2, 2016, Kamarulzaman, A. et al, https://www.uptodate.com/contents/nipah-and-hendra-viral-encephalitis
Pathogen Safety Data Sheets: Infectious Substances – Nipah Virus. Outbreak of Hendra-like virus – Malaysia and Singapore, 1198-99, (1999) Morbidity and Mortality Weekly Report, 48(13)265-269.
Sci Transl Med. 2019 May 29;11 (494):eaau 9242
Scientific Reports 7, Article number: 43395 (2017)
Biosafety in Microbiological and Biomedical Laboratories (BMBL) 6th Edition, Viral Agents, Hendra and Nipah Viruses, p. 248-250
CDC. 2018, Nipah Virus (NiV) https://www.cdc.gov/vhf/nipah/prevention/index.html
CDC. 2018, Hendra Virus. https://www.cdc.gov/vhf/hendra/symptoms/index.html
Rev. 9/6/23