Nipah Virus updates

Overview

Nipah virus infection is cause by the zoonotic virus, Nipah virus (NiV), of the family Paramyxoviridae. It is related to the bat-borne virus, Hendra virus and fruit bats (genus Pteropus) are known to be natural host and reservoir of NiV. Spillover to animals and the human population can occur and results in a range of clinical presentations, from asymptomatic (subclinical) infection to acute respiratory illness and fatal encephalitis. Once it spreads to people, human-to-human spread can also occur, although this has been very limited involving close contacts. Between 1998 and February 2026, a total of 18 outbreaks have been reported, resulting in less than 1000 confirmed human cases, and with a case fatality rate in the range of 40-75%.

Where has Nipah virus infection occured?

The first human outbreak of NiV infection was identified amongst pig farmers in Malaysia in 1998-1999. In 1999, an outbreak was also reported from Singapore amongst slaughterhouse workers. In these outbreaks, close contact with pigs or pig excreta were shown to be a risk factor. No further outbreaks have been recorded from Malaysia or Singapore. Since 2001, outbreaks of NiV have occurred in Bangladesh, India and the Philippines. In Bangladesh, seasonal outbreaks occur annually during the winter months. In India, outbreaks have been more sporadic, occurring in 2018, 2019, 2021, 2023, 2025 and 2026. In 2014, an outbreak of henipavirus, most likely NiV or a virus that is (anti)genetically closely related to NiV, was also documented in the Philippines. Unlike the initial Malaysian outbreak, the subsequent outbreaks have shown limited human-to-human transmission, raising concerns about the potential for NiV to cause a global pandemic. It is thought that other countries in the South Asian and South-East Asian region (Nipah Belt), may be at risk for outbreaks, as evidence of the virus in the natural reservoir, Pteropus bats, has been widely reported in the region. Countries where the natural reservoir is found, and evidence of circulation of the NiV reported, are considered as endemic.

How is Nipah virus transmitted?

The NiV can spread to human from direct contact with infected animals, such as bats or pigs, or their bodily fluids (such as blood, urine or saliva) in endemic countries. Zoonotic transmission is not a risk in non-endemic countries. It should however be noted that the outbreak in Singapore in 1999, was associated with the exportation of infected swine from Malaysia. Transmission to human can also occur through consuming food products that have been contaminated by bodily fluids of infected animals (this has included palm sap or fruit contaminated by an infected bat). This transmission is only considered to be a risk in endemic countries. Close contact with a person infected with NiV or their bodily fluids (including nasal or respiratory droplets, urine, or blood) can also lead to infection. . Human-to-human spread of NiV has been reported during some outbreaks, but not all, and mostly involve relatives and caregivers (healthcare settings) of NiV-infected patients, i.e. close contacts.

What are the signs and symptoms of Nipah virus infection?

The range of symptoms associated with NiV infection can vary from mild to severe disease, including lower respiratory tract infection, swelling of the brain (encephalitis) and potentially death. The onset of symptoms typically occurs 4-14 days following exposure to the virus. The illness begins with prodromal signs such as fever and headache, vomiting and myalgia (muscle pain). It also frequently includes signs of respiratory illness, such as cough, sore throat and difficulty breathing. Infected persons may develop an atypical pneumonia. Signs of encephalitis develop within 3-21 days, and can include drowsiness, disorientation, and mental confusion, which can rapidly progress to coma within 24-48 hours. Those who survive the initial infection often struggle with debilitating, long-term neurological sequelae, including memory loss, impaired cognition, seizures, and personality changes. Some NiV infections have reportedly been known to remain dormant in people for months or even years before manifesting symptoms and, in extreme cases, resulting in death. Specialized laboratory testing is required to confirm or exclude the diagnosis in suspected cases of Nipah virus infection.

How is Nipah virus infection diagnosed?

The symptoms of NiV infection are similar to other viral diseases causing fever, which makes early diagnosis challenging. However, early detection and diagnosis are vital for proper patient care, to prevent transmission to other people and to contain outbreaks. Considering the epidemiological link (i.e. likelihood of exposure) is important for presumptive diagnosis of the disease. Infection can be diagnosed during the acute and convalescent stage of the disease. Bodily fluids can be tested during the early stages of the illness, using reverse transcription polymerase chain reaction (RT-PCR) or anti-NiV IgM enzyme-linked immunosorbent assays (ELISA). During convalescence, antibody detection of anti-NiV IgG ELISA can be conducted. The National Institute for Communicable Diseases provides laboratory testing (RT-PCR and or ELISA) for suspected cases of NiV infection.

How is Nipah virus infection treated?

Currently, there are no approved anti-viral therapies available for treating a NiV infection. Treatment is supportive and severe respiratory and neurologic complications require intensive care. The World Health Organization (WHO) has identified NiV as a priority disease for the WHO Research and Development Blueprint, largely due to its capacity to transmit from human-to-human and its potential to cause high mortality. Monoclonal antibody therapy is one treatment under development.

How can Nipah virus infection be prevented?

An important part of prevention and control is educating people about NiV routes of infection. As NiV may be spread from human-to-human through close and direct contact, outbreaks can be controlled following rapid laboratory diagnosis and laboratory confirmation of cases. This allows for contact tracing and monitoring to enable the proactive recognition of any other linked cases of NiV infection. It is recommended that confirmed cases of NiV self-isolate to minimise the risk of transmission. Isolation may be through self- isolation at home if circumstances allow, but cases may be isolated in hospital if required, where standard, contact and droplet infection control measures must be in place to prevent hospital-acquired (nosocomial) infections. Currently there are no vaccines available specific for NiV infection. Recommended prevention measures in areas where NiV outbreaks have occurred (Bangladesh, Malaysia, India, and Singapore), include regular handwashing with soap and water, avoiding contact with sick bats or pigs and avoiding areas where bats are known to roost. Avoid eating or drinking products that could be contaminated by bats, such as raw date palm sap (there is increased bat contamination of date palms), raw fruit, or fruit that is found on the ground. Avoid contact with the blood or bodily fluids of any person known to be infected with NiV.

Summary of recent and ongoing Nipah virus infection outbreaks

In 2025, Bangladesh experienced a small outbreak season consistent with its historical seasonal pattern (typically December–April) for previous outbreaks in this country. A total of four laboratory-confirmed fatal cases of Nipah virus infection were reported in Bangladesh. These outbreaks reflect the ongoing endemic cycle in Bangladesh, largely linked to spillover from bat reservoirs through consumption of raw date palm sap and occasional human-to-human transmission. No international spread was noted.

In January 2026, India reported a limited outbreak of Nipah virus infection in West Bengal involving two confirmed cases with strong contact tracing and no documented onward transmission to date (at 10 February 2026). In February 2026, Bangladesh reported a single fatal case from the Rajshahi Division. The case had exposure to raw date palm sap before falling ill. The detection of this case is consistent with its endemic transmission cycle noted during previous outbreaks, without wider spread and no further cases reported as at 10 February 2026. At 10 February 2026, no international spread has been noted.

What is the risk of contracting Nipah virus in South Africa?

The WHO continues to assess Nipah virus as a serious zoonotic pathogen with localized outbreak risk but low risk of broad international spread under current surveillance and response measures. Historically, NiV outbreaks have remained isolated and larger scale community spread have not been noted yet. The disease should be considered as a possible diagnosis in persons presenting with symptoms consistent with NiV infection AND who have recently travelled from areas where NiV outbreaks are reported (such as Bangladesh, Malaysia, India and Singapore), particularly if they had a known exposure. No cases of Nipah virus infection have been reported in South Africa to date, and at 10 February 2026 there are no suspected cases of the disease in the country.

For more information, read here.

Read the full media statement from the Department of Health here.