Nipah Virus: A Global Emerging Threat and Its Implications for Myanmar

By Dr Aung Tun

1. What is Nipah Virus?

Nipah virus (NiV) is a zoonot­ic virus, meaning it is primari­ly transmitted from animals to humans and other animals. The virus belongs to the family Par­amyxoviridae and genus Heni­pavirus. First identified in 1999 during an outbreak among pig farmers in Kampung Sungai Ni­pah, Malaysia, the virus has since been recognized as a significant public health threat in South and South-East Asia.

Fruit bats (flying foxes) of the genus Pteropus are the natural reservoir hosts of Nipah virus. These bats carry the virus without showing symptoms and can trans­mit it to other animals and hu­mans through their saliva, urine, and partially eaten fruits. The vi­rus can also spread from person to person through close contact with infected bodily fluids, making it a particularly concerning pathogen in healthcare settings and among family members caring for infect­ed individuals.

The World Health Organi­zation (WHO) has identified Ni­pah virus as a priority pathogen requiring urgent research and development of diagnostic tools, treatments, and vaccines due to its pandemic potential.

2. Current Situation

West Bengal State, India

As of January 2026, an out­break of Nipah virus infection has emerged in West Bengal State, In­dia, with several confirmed cases, some in critical condition. Health authorities are implementing in­tensive control measures, includ­ing monitoring nearly 100 people in proximity to confirmed cases, actively tracing contacts, and en­forcing quarantine protocols.

The current outbreak ap­pears to be linked to a private hospital in the Bharat/Kolkata area, with cases including a doc­tor, nurses, and other healthcare workers. While the exact source of infection is still under inves­tigation, there is suspicion that the initial patient may have been infected through the consumption of date palm sap. This represents the first recurrence in the state in nearly two years.

Kerala State, India

Kerala State has experi­enced recurring outbreaks since 2018, with cases reported in 2025 as well. However, due to robust public health measures including enhanced surveillance, monitor­ing, and quarantine protocols, the virus has been successfully controlled. The state's experience with previous outbreaks has en­abled more effective response mechanisms.

Regional Response

The World Health Organi­zation (WHO) has assessed the risk of the Nipah virus outbreak crossing the Myanmar-India bor­der as moderate for both India and Myanmar. The Nepali gov­ernment has accordingly imple­mented strict health screening procedures at border entry points to prevent cross-border transmis­sion.

Although no Nipah virus in­fections have been detected in Myanmar to date, special em­phasis is being placed on disease surveillance activities in areas near the India- Myanmar border, where infections frequently occur. This enhanced vigilance is crucial given the region's connectivity and shared fruit bat populations.

3. Transmission

Animal-to-Human Transmis­sion

The primary mode of trans­mission is from fruit bats to hu­mans. This can occur through:

• Direct contact with infected bats or their body fluids

• Consumption of fruits or date palm sap contaminated with bat saliva or urine

• Contact with infected pigs or other intermediate animal hosts

Pigs can serve as intermedi­ate hosts, amplifying the virus be­fore transmitting it to humans. In the original Malaysian outbreak, infected pigs were the primary source of human infections.

Human-to-Human Transmis­sion

Person-to-person transmis­sion occurs through close contact with infected individuals' bodily fluids, including:

• Respiratory secretions (drop­lets from coughing or sneez­ing)

• Saliva

• Blood and other body fluids

• Contact with contaminated surfaces or materials

Healthcare workers and fam­ily members caring for infected patients are at particularly high risk of infection. Nosocomial transmission (hospital-acquired infection) has been documented in multiple outbreaks, highlighting the importance of proper infection control measures.

4. Signs and Symptoms

The incubation period (time from exposure to symptom onset) typically ranges from 4 to 14 days, though it can extend up to 45 days in some cases. The clinical pres­entation of Nipah virus infection varies considerably, ranging from asymptomatic infection to severe encephalitis and death.

Initial Symptoms

The disease typically begins with flu-like symptoms:

• High fever

• Severe headache

• Muscle pain (myalgia)

• Vomiting

• Sore throat

• Dizziness

Progression to Severe Disease

Within 24 to 48 hours, symp­toms can rapidly progress to in­clude:

• Drowsiness and confusion

• Disorientation and mental confusion

• Difficulty breathing (respira­tory distress)

• Seizures

• Encephalitis (brain inflam­mation)

• Coma

Atypical pneumonia and se­vere respiratory problems are common complications. The rapid progression from initial symptoms to coma is a hallmark of Nipah virus encephalitis and distinguishes it from many other viral infections.

Atypical Presentations

Some patients may present primarily with respiratory symp­toms, making initial diagnosis challenging. These atypical cas­es can be difficult to differentiate from common respiratory infec­tions in the early stages, potential­ly delaying appropriate isolation and treatment.

5. Diagnosis and Treat­ment

Diagnostic Methods

Early diagnosis of Nipah vi­rus infection is critical but chal­lenging. Laboratory confirmation requires specialized testing:

• Real-time polymerase chain reaction (RT-PCR) from throat swabs, nasal swabs, blood, urine, or cerebrospinal fluid

• Antibody detection by ELI­SA (enzyme-linked immuno­sorbent assay)

• Virus isolation in cell culture (performed only in biosafety level 4 laboratories)

• Immunohistochemistry on tissue samples

Testing must be conducted in specialized facilities with ap­propriate biosafety measures due to the highly infectious nature of the virus.

Current Treatment Options

Currently, there are no ap­proved vaccines or specific anti­viral treatments for Nipah virus infection. Treatment is primarily supportive and focuses on:

• Intensive supportive care to manage symptoms

• Respiratory support and mechanical ventilation when needed

• Management of seizures and neurological complications

• Prevention and treatment of secondary infections

• Careful monitoring of vital signs and organ function

• Psychological support for patients and families

Some experimental treat­ments have shown promise in animal studies, including mon­oclonal antibodies and antiviral drugs, but these have not been conclusively proven effective in humans. The WHO has prioritized Nipah virus for urgent research and development of therapeutic interventions.

6. Risk Factors and Mor­tality

Case Fatality Rate

Nipah virus infection is char­acterized by an extremely high mortality rate, ranging from 40 per cent to 75 per cent depend­ing on the outbreak location and available healthcare resources. This makes it one of the deadli­est emerging infectious diseases known to humanity. The mortality rate can vary significantly based on:

• Strain of the virus (Bangla­desh strain appears more deadly)

• Access to intensive care fa­cilities

• Speed of diagnosis and sup­portive care initiation

• Overall health status of af­fected individuals

High-Risk Groups

Certain populations face elevated risk of Nipah virus infection:

• Healthcare workers caring for infected patients

• Family members and caregiv­ers of confirmed cases

• People living in or near fruit bat habitats

• Individuals who consume raw date palm sap or fruits that may have been contaminated

• Pig farmers and slaughter­house workers (in areas with infected pig populations)

• Border residents and trave­lers between endemic areas

Long-term Complications

Survivors of Nipah virus en­cephalitis may experience long-term neurological consequences, including persistent seizures, per­sonality changes, and cognitive impairment. Some survivors have experienced late-onset encepha­litis months or even years after initial infection, highlighting the need for long-term medical fol­low-up.

7. Prevention Strategies

Personal Protective Meas­ures

Individual prevention is cru­cial in areas where Nipah virus is known to occur or during out­breaks:

• Practice frequent hand hy­giene with soap and water or alcohol-based hand sanitizer, especially after any potential exposure

• Avoid touching eyes, nose, and mouth with unwashed hands

• Avoid direct contact with sick animals, particularly bats and pigs

• Stay away from areas where fruit bats roost, especially caves and trees with large bat

colonies

Food Safety Practices

Given the role of contaminated food in transmission:

• Avoid consuming raw date palm sap or toddy. If con­sumed, ensure it has been boiled

• Thoroughly wash all fruits before consumption and peel them when possible

• Discard any fruits that show signs of bat bites or contami­nation

• Avoid consuming fruits found on the ground or partially eat­en

• Do not drink unpasteurized fruit juices of unknown origin

Healthcare Setting Precautions

For healthcare workers and car­egivers:

• Use appropriate personal protective equipment (PPE) including N95 masks, gloves,

gowns, and eye protection when caring for suspected or confirmed cases

• Implement strict isolation procedures for confirmed cases

• Follow proper infection con­trol protocols for handling specimens and contaminated materials

• Ensure proper disposal of medical waste

Community-Level Prevention

• Surveillance systems should be strengthened to detect cases early

• Contact tracing and monitor­ing of exposed individuals

• Public education campaigns about transmission risks and prevention

• Quarantine measures for individuals with known ex­posure

• Restriction of movement in affected areas when neces­sary

8. Public Health Advi­sory for Myanmar Citizens

Given the current outbreak in West Bengal, India, the follow­ing advisory is issued for Myan­mar citizens, particularly those living near the Myanmar-India border or planning travel to af­fected areas:

For Border Area Residents and Travellers

Myanmar-India border resi­dents and travellers should exer­cise heightened caution:

• Submit to health screening: When returning from India or crossing the border, com­ply fully with health screen­ing at border checkpoints. Do not attempt to bypass screening points.

• Report travel history and symptoms: If experiencing symptoms such as fever, headache, muscle pain, diffi­culty breathing, or confusion, openly inform healthcare workers about travel histo­ry to India so appropriate testing and treatment can be provided.

• Follow quarantine instruc­tions: If directed by health authorities to stay at a des­ignated quarantine center or self-isolate at home, comply systematically with these re­quirements for the specified period.

General Public Health Guide­lines

All Myanmar citizens should observe the following pre­ventive measures:

• Maintain personal hygiene: Wash hands frequently with soap and water or use hand

sanitizer. Avoid touching eyes, nose, and mouth with un­washed hands.

• Practice food safety: Since Nipah virus can transmit from fruit bats, do not con­sume any fruits suspected of being bitten by bats. Wash all fruits thoroughly before eat­ing and peel them whenever possible. Avoid drinking raw date palm sap or any bever­ages that may have been ex­posed to bat contamination.

• Avoid animal contact: Avoid direct contact with bats, sick pigs, or other animals. Do not

enter areas where bats roost.

• Watch for symptoms: If you or family members develop severe fever, headache, mus­cle pain, vomiting, difficulty breathing, or confusion, im­mediately seek medical at­tention at the nearest health facility, hospital, or doctor. Be sure to inform healthcare providers about any travel history or potential expo­sure.

Stay Informed

Stay alert to updates from the Ministry of Health and follow official instructions. By actively cooperating with health meas­ures, you can protect not only yourself but also your family and community from this dangerous disease.

The public should avoid un­necessary visits to areas where Nipah virus is currently spread­ing (for example, West Bengal State, India). Those currently in areas where the disease is oc­curring should avoid unneces­sary hospitalization, especially in facilities with high numbers of sick individuals. Those who have recently traveled to areas where the disease is occurring should watch for symptoms and experi­ence suspected symptoms such as fever and headache, cough and difficulty breathing, confusion, or drowsiness upon returning. If symptoms appear within 14 days of returning from an affected area, it is necessary to immedi­ately contact a healthcare facility and be sure to inform the doctor regarding the travel history to the affected area so that one can receive the necessary test and treatment promptly.

9. Conclusion

Nipah virus represents a significant public health threat due to its high mortality rate, person-to-person transmission capability, and lack of specific treatment or vaccine. The cur­rent outbreak in West Bengal, India, serves as a reminder of the ongoing risk this pathogen poses to the region, including Myanmar.

While no cases have been detected in Myanmar to date, the country's proximity to endem­ic areas and shared ecological conditions necessitate continued vigilance. The Myanmar Minis­try of Health has appropriately strengthened surveillance activ­ities in border areas and imple­mented screening procedures at entry points.

Prevention remains our strongest defense against Ni­pah virus. Individual protective measures, particularly food safe­ty practices, avoiding contact with potentially infected animals, and maintaining good hygiene, are essential. Healthcare facilities must maintain preparedness with proper isolation capabilities and infection control procedures.

Public awareness and edu­cation are critical components of outbreak prevention and control. Citizens should stay informed about the disease, recognize warning signs, and seek imme­diate medical attention if symp­toms develop, especially after potential exposure or travel to affected areas.

The international commu­nity, including WHO, continues to prioritize research and devel­opment of diagnostics, thera­peutics, and vaccines for Nipah virus. Until these tools become available, our response relies on early detection, rapid isolation of cases, meticulous contact tracing, and community engagement in preventive practices.

By working together – health authorities, healthcare workers, and the general public – we can minimize the risk of Nipah virus entering Myanmar and protect our communities from this deadly disease. Vigilance, preparedness, and cooperation are our best strategies in the face of emerging infectious disease threats.

References

World Health O r ­ganization. ( 2 0 2 4 ) . Nipah virus. WHO Fact Sheets. https:// www.who.int/news-room/ fact-sheets/detail/nipah-vi­rus

1. Centres for Disease Con­trol and Prevention. (2024). Nipah Virus (NiV). CDC Emerging Infectious Dis­eases. https://www.cdc.gov/ vhf/nipah/

2. Luby SP, Gurley ES, Hos­sain MJ (2009). Transmis­sion of human infection with Nipah virus. Clinical Infectious Diseases, 49(11), 1743-1748.

3. Ministry of Health, India. (2026). Current situation reports on Nipah virus outbreak in West Bengal State. Government of India Health Bulletins.

4. WHO Regional Office for South-East Asia. (2025). Nipah virus disease sur­veillance and response guidelines. WHO SEARO Publications.

5. Ang BSP, Lim TCC, Wang L. (2018). Nipah virus in­fection. Journal of Clinical Microbiology, 56(6), e01875- 17.