KATHMANDU, FEBRUARY 3

Nepal has not recorded any case of Nipah virus infection so far, but the government has placed the country on high public health alert following confirmed cases in neighbouring India and heightened regional surveillance, the Ministry of Health and Population (MoHP) said on Monday.

Issuing a press statement, the Ministry said nationwide preparedness and precautionary measures have been intensified to minimise potential risks. All hospitals and health institutions have been instructed to remain on high alert, while systems have been put in place for the collection, transportation, and laboratory testing of samples from suspected patients.

According to the Ministry, the Epidemiology and Disease Control Division (EDCD) has alerted health facilities across the country and prepared an interim Nipah virus testing algorithm, despite the World Health Organization (WHO) assessing the global and South-East Asia regional public health risk as low.

Health officials said the Nipah virus can spread through fruits contaminated by the saliva, urine, or faeces of fruit bats, as well as through close contact with infected individuals via blood, saliva, urine, or respiratory secretions. Transmission from bats to humans via pigs has also been documented.

The Ministry has urged the public to strictly follow basic public health and food safety measures, including thoroughly washing fruits, properly cooking vegetables, drinking boiled or safe water, maintaining hygiene in animal sheds and farms, using gloves and masks while handling meat, practising regular handwashing, and wearing masks in crowded places.

Health authorities have also called for early identification, isolation, reporting, and strict infection prevention and control measures for patients showing suspicious symptoms such as fever, headache, muscle pain, dizziness, cough, breathing difficulty, nausea, vomiting, and, in severe cases, loss of consciousness. Anyone experiencing such symptoms has been advised to immediately visit the nearest health facility or call the health hotline 1115.

Reiterating that no Nipah cases have been confirmed in Nepal, the Ministry urged the public not to panic, but to remain alert and cautious. It also warned against misinformation, stating that the situation is being closely monitored in coordination with national and international partners, and urged people to rely only on official information.

MoHP spokesperson Dr Prakash Budhathoki said the Ministry remains fully committed to safeguarding public health and is prepared to take all necessary measures should the situation evolve.

Regional situation raises vigilance

Nepal's heightened preparedness comes amid confirmed Nipah virus cases in India's West Bengal state, where authorities said the outbreak has been contained. According to the Associated Press (AP), India's Health Ministry confirmed two cases since December and said all 196 identified contacts tested negative, with no spread detected beyond India.

Following the latest developments in India, several countries in Asia have tightened preventive measures. According to the BBC, Thailand has begun screening passengers at three international airports in Bangkok and Phuket receiving flights from West Bengal, with arriving travellers required to submit health declarations. Thailand has also introduced stricter health checks in parks and wildlife tourism areas. Meanwhile, Taiwanese health authorities have proposed listing Nipah virus as a "Category 5 disease", a classification reserved for emerging or rare infections posing major public health risks, requiring immediate reporting and special control measures, BBC reported.

According to the reports, surveillance has been stepped up at western border checkpoints with India from Tuesday to prevent the spread of the Nipah virus, following its detection in the neighboring country. The Sudurpaschim Health Directorate has intensified monitoring at five key points, Gauriphanta and Khakaruna in Kailali, Khalanga in Darchula, Jhulgahat in Baitadi, and Gaddachauki in Kanchanpur. Health desks at these crossings have been made operational, staff have been trained on Nipah virus precautions, and isolation wards established during COVID-19 are being kept ready.

According to the District Health Office, passengers showing symptoms such as fever are being closely monitored, with swabs collected from suspected cases and sent to the Provincial Public Health Laboratory. Preventive measures are focused on bats, pigs, and infected individuals, the primary sources of Nipah virus transmission. While the risk is considered higher at eastern borders, authorities remain vigilant along the western frontier.

What is Nipah Virus?

According to the World Health Organization, Nipah virus is a zoonotic disease transmitted from animals to humans and can also spread through contaminated food or direct human-to-human contact. Fruit bats of the Pteropodidae family are the natural hosts.

The incubation period of Nipah virus infection typically ranges from 3 to 14 days, though rare cases of up to 45 days have been reported. While some infected individuals may remain asymptomatic, most develop fever along with neurological symptoms such as headache and confusion, and/or respiratory symptoms including cough and difficulty breathing. Other commonly reported symptoms include chills, fatigue, dizziness, drowsiness, vomiting, and diarrhoea.

WHO states that severe illness can occur in any patient but is more common among those with neurological involvement, which may progress to encephalitis, brain swelling, and often death. Survivors generally recover fully; however, around one in five may experience long-term neurological complications. Close monitoring and timely supportive care are crucial during the critical phase of the illness.

Diagnosis of Nipah virus infection is challenging without laboratory testing, as symptoms resemble other infections. Real-time PCR testing of respiratory samples, blood, or cerebrospinal fluid is the primary diagnostic method, with antibody testing also used in some cases. There is no specific treatment or approved vaccine for Nipah virus, and management relies on early detection and high-quality supportive care, including oxygen therapy, organ support, hydration, and nutrition, while research on vaccines and treatments remains ongoing, according to the WHO.

First identified in Malaysia in 1998, Nipah outbreaks have since been reported in Bangladesh, India, the Philippines, and Singapore, with a case fatality rate ranging from 40 to 75 percent.

Bangladesh has borne the heaviest toll of Nipah virus in recent decades, with more than 100 deaths reported since 2001, according to international health records. In India, previous outbreaks were reported in West Bengal in 2001 and 2007, while the southern state of Kerala has emerged as a recurring hotspot. In 2018, Kerala recorded 19 cases, of which 17 were fatal, and in 2023, two people died out of six confirmed cases, according to the reports.

WHO has listed Nipah among its priority diseases due to its epidemic potential and continues to work with countries to strengthen preparedness, surveillance, laboratory capacity, and infection prevention measures.

Testing preparedness in Nepal

The Ministry said Nepal's National Public Health Laboratory (NPHL) is prepared to conduct real-time PCR testing for suspected cases under high-containment conditions. Samples will be collected following strict biosafety protocols and transported under controlled temperatures.

If a first positive case is detected, samples will be reconfirmed through the Central Veterinary Laboratory, while negative cases will be further evaluated for other infectious diseases.

Health officials stressed that Nepal remains safe, but vigilance, hygiene, and responsible behaviour are essential to prevent any potential outbreak.