Isolation Guidelines for Nipah Virus
Isolation Guidelines for Nipah Virus
Abstract & commentary
Synopsis: Nosocomial transmission of Nipah virus was not observed in this 3-hospital study.
Source: Mounts AW, et al. A cohort study of health care workers to assess nosocomial transmissibility of Nipah virus, Malaysia, 1999. J Infect Dis. 2001;183:810-813.
The emergence of 2 new viral illnesses in the South Pacific has been carefully followed. Hot on the heels of Hendra virus infection, first identified in Australia in 1995, came a more devastating infection of pigs in Malaysia in 1999.1 Thousands of pigs were infected and millions were sacrificed. Furthermore, secondary cases of Nipah virus infection occurred among humans manifested primarily as encephalitis, thereby necessitating hospitalization.
This study was performed to ascertain if health care workers (HCWs) attendant to patients sick with Nipah contracted the virus. There was an attempt to identify an equal number of nurses and doctors at the 3 hospitals in the study—one group exposed to Nipah patients and the other group not exposed. Infection with Nipah (or Hendra) virus was documented by an EIA for anti-Nipah IgM and IgG.
At the 3 study hospitals, there was a total of 211 patients admitted with Nipah virus infection. There were 388 HCWs exposed to these patients. More than half of the HCWs had contact with Nipah patients before isolation practices were in place.
None of the HCWs exposed became sick with Nipah virus illness. There were 3 exposed HCWs who developed IgG antibodies on the second serum tested, likely a false-positive result since none was positive for IgM.
Comment by Joseph F. John, MD
It is probably much easier to contract Nipah infection from infected pigs than from infected humans. The reason for this is that pigs probably harbor much more virus in the upper respiratory tract. Nevertheless, because the pathogenesis of Nipah in humans is not well understood and since Nipah and Hendra are Paramyxoviruses, a group that includes the measles virus, caution is needed to protect HCWs.
This small study cannot exclude the possibility of nosocomial transmission. Thus, for the time being, HCWs caring for Nipah patients should observe standard and droplet precautions: good handwashing, and use of a mask and gloves when coming in contact with "secretions, excretions, and body fluids" of patients suspected or proven to have these 2 emerging viruses.
Reference
1. Deresinski SC. Another new human pathogen: The Nipah virus. Infectious Disease Alert. 1999;18:
113-114.
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