Abstract
Based on epidemiological data, it is believed that human-to-human transmission plays an important role in Nipah virus outbreaks. No experimental data are currently available on the potential routes of human-to-human transmission of Nipah virus. In a first dose-finding experiment in Syrian hamsters, it was shown that Nipah virus was predominantly shed via the respiratory tract within nasal and oropharyngeal secretions. Although Nipah viral RNA was detected in urogenital and rectal swabs, no infectious virus was recovered from these samples, suggesting no viable virus was shed via these routes. In addition, hamsters inoculated with high doses shed significantly higher amounts of viable Nipah virus particles in comparison with hamsters infected with lower inoculum doses. Using the highest inoculum dose, three potential routes of Nipah virus transmission were investigated in the hamster model: transmission via fomites, transmission via direct contact and transmission via aerosols. It was demonstrated that Nipah virus is transmitted efficiently via direct contact and inefficiently via fomites, but not via aerosols. These findings are in line with epidemiological data which suggest that direct contact with nasal and oropharyngeal secretions of Nipah virus infected individuals resulted in greater risk of Nipah virus infection. The data provide new and much-needed insights into the modes and efficiency of Nipah virus transmission and have important public health implications with regards to the risk assessment and management of future Nipah virus outbreaks.
Highlights
IntroductionNipah virus first emerged in humans in Malaysia in 1998–1999, during a large outbreak of encephalitis and respiratory disease in humans, causing 276 cases of encephalitis, with 106 fatalities [1]
Nipah virus is a member of the Henipavirus genus in the Paramyxoviridae family
Nipah virus has been isolated from human urine, saliva, nasal and oropharyngeal secretions and epidemiological data suggest that direct contact with these secretions of Nipah virus spreaders resulted in greater risk of Nipah virus infection
Summary
Nipah virus first emerged in humans in Malaysia in 1998–1999, during a large outbreak of encephalitis and respiratory disease in humans, causing 276 cases of encephalitis, with 106 fatalities [1]. In Malaysia, Nipah virus-infected pigs formed the intermediate and amplifying host in the transmission cycle from the natural reservoir to humans [6]. Clinical presentation of Nipah virus in Bangladesh is somewhat different from that in Malaysia, with a higher proportion of respiratory disease and a higher case-fatality rate of up to 90% [8]. Epidemiological data suggest transmission of Nipah virus from bats to humans through the consumption of fruit or date palm sap contaminated by infected fruit bats [9,10]. Three potential modes of human-to-human transmission of Nipah virus could be transmission via fomites, direct contact or aerosols
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