Nipah virus has a high fatality rate: Doctor shares what makes the virus dangerous and what is the timeline of the infection

Nipah is a virus that comes from fruit bats and can spread to humans through contaminated food or close contact with infected people. Recently, there are reports of Nipah virus being detected in West Bengal in two nurses.

In India, the first big scare was in 2018 when a few cases in Kozhikode made national news. People were scared because the symptoms start like a regular viral fever, but can escalate quickly. Hospitals had to scramble to isolate patients and trace contacts. There were strict quarantines, travel restrictions, and a lot of confusion because, honestly, no one expected it.

One reason less is known about Nipah in India is that it’s rare so people aren’t constantly talking about it. That makes early detection tricky. Symptoms can be vague at first, mild fever, headache, body ache, and by the time severe neurological or breathing problems appear, the infection is already serious.

Nipah virus: Doctor shares dos and don'ts

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So why should we care if Nipah virus infection is so rare?

Because history has shown that viruses with high fatality rates can be deadly fast. "Clinically speaking, Nipah virus causes high fatality rates and rapid progression, it can also lead to the development of encephalitis, or severe swelling of the brain. This disease has a different mode of transmission compared to most viral diseases, transmission occurs after close contact with infected individuals/ infected animals rather than through physical contact with contaminated objects. There is currently no antiviral treatment available for Nipah virus. The rapid onset of severe symptoms leaves minimal time for intervention once they occur," Dr. Santosh Kumar Agrawal, Director - Internal Medicine, Yatharth Super Speciality Hospital Faridabad told TOI Health.

As per the World Health Organisation (WHO), the case fatality rate is estimated at 40% to 75%. "Although Nipah virus has caused only a few known outbreaks in Asia, it infects a wide range of animals and causes severe disease and death in people, making it a public health concern," the WHO has said.

Nipah symptoms that are easily overlooked

Dr Santosh highlighted the symptoms that were overlooked by patients in the past outbreaks in India. "Symptoms of Nipah virus usually present as mild fever with headache or body ache at initial exposure and are commonly mistaken for a typical viral illness because these initial symptoms are non-specific and appear after routine exposure. As such, people often treat themselves using over-the-counter medications when these symptoms arise, resulting in missed opportunities for early identification of the virus and potentially dangerous delays in seeking treatment due to potentially unnoticed progression of the virus until neurological symptoms arise," he said.

Dr Santosh said, the timeline from exposure to the moment symptoms turn severe is between 5 and 14 days. Symptoms include fever, headache, tiredness, and after several days, confusion, seizures, and trouble breathing may occur.

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"Rapid isolation, testing, and supportive care when a patient presents with fever are the most important interventions; timely intervention within the first fever phase can greatly decrease transmission rates and enhance a patient’s prognosis," the expert said.

Challenges

"In real Nipah outbreaks, the single biggest challenge inside hospitals is early diagnosis combined with fear-driven delays. Nipah often presents like a routine viral fever or encephalitis initially, so the first few cases are not recognised immediately. By the time suspicion is raised, multiple healthcare workers may already have been exposed," Dr. Souradeep Chowdhury, Department - Internal Medicine, Medanta Hospital Noida told TOI Health. "Isolation protocols and staffing can be arranged once the diagnosis is suspected, but fear among healthcare workers, especially when mortality rates are highlighted without context, can lead to hesitation, absenteeism, and breakdown of routine care. Clear protocols, training, and transparent communication are crucial to prevent panic while ensuring safety."

Common mistakes in public behaviour during outbreak

"The most common mistake during Nipah scares is panic-driven behaviour rather than risk-based behaviour. People avoid hospitals even when they have serious symptoms, rely on rumours on social media, or seek unverified ‘preventive remedies’ instead of medical advice," Dr. Souradeep said.

"Another harmful response is stigmatisation—villages, healthcare workers, or patients are sometimes ostracised, which discourages early reporting and contact tracing. Nipah does not spread casually like flu; avoiding fruit bats, not consuming fallen or partially eaten fruits, and reporting fever with neurological symptoms early are far more effective than panic or isolation of communities," he adds.