Guidance

When to suspect Nipah virus (NiV) infection

Published 2 April 2026

Who this guidance is for

This guidance is for healthcare professionals on when to suspect Nipah virus (NiV) infection. More information on NiV can be found on the Nipah virus: epidemiology, outbreaks and guidance page.

Clinicians should be aware that NiV is classed as an airborne high consequence infectious disease (HCID).

For personal protective equipment (PPE) requirements for the management of NiV cases, please see local trust HCID guidance. Further information can be found in the National Infection Prevention and Control Manual for England (NIPCM).

Any individual who has had contact with a potential source of NiV within the last 21 days before the onset of illness may be at risk of NiV infection

Clinical assessment

Consider NiV infection where an individual has both:

• fever [note1] with one or more of the following –
  • clinical features of acute encephalitis
  • severe headache
  • cough or shortness of breath
• and in the 21 days before the onset of symptoms, a history of one or more of –
  • direct contact with an identified potential source of NiV infection (for example, direct contact with a suspected or confirmed case)
  • exposure to NiV infected body fluids or tissues with or without wearing adequate PPE or where there were breaches in PPE
  • travel to an area known to have a current outbreak of NiV infection
  • direct handling of bats or pigs from an NiV affected country
  • consumption of fruit or raw sap from date palms which were potentially contaminated with bat secretions in an NiV affected country

Note 1: Fever alone plus a strong epidemiological link (for example direct contact with a confirmed NiV case in the 21 days before symptom onset) should prompt discussion with local infection services, even in the absence of additional symptoms.

Deceased individuals with a history of clinical features and epidemiological risks compatible with NiV infection should be discussed with the Imported Fever Service (IFS) for suitable post-mortem testing.

Actions for a case of NiV

For all suspected NiV cases

For patients being assessed for suspected NiV infection, infection prevention and control (IPC) measures should be undertaken per the NHS NIPCM.

Clinicians should be aware that NiV is classed as an airborne HCID.

If NiV infection is suspected from initial case investigation, then the patient should be immediately isolated in a single side room. Enhanced IPC measures, appropriate to the patient’s symptoms and clinical care procedures should be implemented, including use of HCID assessment PPE and appropriate handling of waste, linen and specimens.

Clinicians treating patients with suspected NiV infection should discuss the case with local infection specialists. Infection specialists should discuss possible NiV cases with the UKHSA IFS on 0844 778 8990 for clinical advice and undertake testing for other diagnoses if clinically appropriate and if not done already. Suspected cases should also be notified to the local health protection team (HPT).

For confirmed cases

A confirmed case is defined as an individual (alive or deceased) with a positive laboratory test result for NiV (real time polymerase chain reaction) from a blood or other body fluid sample. Once the patient’s NiV infection is confirmed by appropriate laboratory testing, they should be offered admission or transfer to an airborne HCID treatment centre for on-going management. Confirmed cases should be notified urgently to the local HPT and managed under HCID pathways.