Unmasking Nipah Virus: Public knowledge and Attitude Towards a Growing “Health Threat”

Unmasking Nipah Virus: Public knowledge and Attitude Towards a Growing “Health Threat” | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unmasking Nipah Virus: Public knowledge and Attitude Towards a Growing “Health Threat” Dr. Emmanuel Janagan Johnson, Dr. Arjunan Ramachandran This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6721001/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Nipah virus (NiV) was first discovered in 1999 following an outbreak of disease in pigs and people in Malaysia and Singapore. The recent outbreak resulted in nearly three hundred human cases and more than one hundred deaths and caused substantial economic impact as more than one million pigs were killed to help control the outbreak. Providing health information during disease outbreaks is a fundamental component of outbreak control strategies. This study aimed to identify the importance of providing information that increases community health awareness on personal hygiene, safety measures and reduce fear of the spread of disease15-item questionnaire was designed de novo and emailed to the selected public after telephone contact. The response choices were never open ended, either ‘yes’ or ‘no’ or ‘do not know,’ while one response was in a Likert scale of 1–5. Of the one hundred emailed questionnaires, eighty-four were returned eligible to be included for analysis (84% response rate). Majority of the responders were of the female gender (74%). Overall, only 48% of the responders knew the causative organism of the illness, while they were divided in their opinion regarding the mode of transmission of the disease. Health Economics & Outcomes Research Public health awareness Nipa Virus health information knowledge and attitude prevention Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Nipah virus (NiV) was first discovered in 1999 following an outbreak of disease in pigs and people in Malaysia and Singapore (Tan, et.al. 2003). The recent outbreak resulted in nearly three hundred human cases and more than one hundred deaths and caused substantial economic impact as more than one million pigs were killed to help control the outbreak. While there have been no other known outbreaks of NiV in Malaysia and Singapore since 1999, outbreaks have been recorded almost annually in some parts of Asia since then—primarily in Bangladesh and India. The virus has been shown to spread from person-to-person in these outbreaks, raising concerns about the potential for NiV to cause a global pandemic. What is Nipa Virus? NiV is a member of the family Paramyxoviridae, genus Henipavirus. It is a zoonotic virus, meaning that it initially spreads between animals and people. The animal host reservoir for NiV is the fruit bat (genus Pteropus), also known as the flying fox. Given that NiV is genetically related to Hendra virus, another henipavirus known to be carried by bats, bat species were quickly singled out for investigation and flying foxes were subsequently identified as the reservoir (Geisbert & Broder. 2010, Lo Presti, et.al.2016). Infected fruit bats can spread the disease to people or other animals, such as pigs. People can become infected if they have close contact with an infected animal or its body fluids (such as saliva or urine)—this initial spread from an animal to a person is known as a spillover event. Once it spreads to people, person-to-person spread of NiV can also occur. The symptoms of NiV infection range from mild to severe, with death occurring in 40–70% of those infected in documented outbreaks between 1998 and 2018. (CDC, 2023). Symptoms of Nipa Virus infection Nipah virus (NiV) can spread to people from the direct contact with infected animals, such as bats or pigs, or their body fluids (such as blood, urine or saliva), consuming food products that have been contaminated by body fluids of infected animals (such as palm sap or fruit contaminated by an infected bat), and close contact with a person infected with NiV or their body fluids (including nasal or respiratory droplets, urine, or blood). In the first known NiV outbreak, people were probably infected through close contact with infected pigs (Field, et.al, 2012 , Epstein, et.al, 2020). The NiV strain identified in that outbreak appeared to have been transmitted initially from bats to pigs, with subsequent spread within pig populations. Then people who worked closely with infected pigs began falling ill. No person-to-person transmission was reported in that outbreak. However, person-to-person spread of NiV is regularly reported in Bangladesh and India (Rahman, et. al.2012). This is most commonly seen in the families and caregivers of NiV-infected patients, and in healthcare settings. Transmission also occurs from exposure to food products that have been contaminated by infected animals, including consumption of raw date palm sap or fruit that has been contaminated with saliva or urine from infected bats. Some cases of NiV infection have also been reported among people who climb trees where bats often roost. Infection with Nipah virus (NiV) can cause mild to severe disease, including swelling of the brain (encephalitis) and potentially death (Ching, et al, 2015 ). Symptoms typically appear in 4–14 days following exposure to the virus. The illness initially presents as 3–14 days of fever and headache, and often includes signs of respiratory illness, such as cough, sore throat, and difficulty breathing. A phase of brain swelling (encephalitis) may follow, where symptoms can include drowsiness, disorientation, and mental confusion, which can rapidly progress to coma within 24–48 hours. Death may occur in 40–75% of cases. Long-term side effects in survivors of Nipah virus infection have been noted, including persistent convulsions and personality changes. Infections that lead to symptoms and sometimes death much later after exposure (known as dormant or latent infections) have also been reported months and even years after exposure. Nipah virus (NiV) infection can be diagnosed during illness or after recovery. Different tests are available to diagnose NiV infection. During early stages of the illness, laboratory testing can be conducted using real time polymerase chain reaction (RT-PCR) from throat and nasal swabs, cerebrospinal fluid, urine, and blood. Later in the course of illness and after recovery, testing for antibodies is conducted using an enzyme-linked immunosorbent assay (ELISA). What is the treatment for Nipa infection? Currently there are no licensed treatments available for Nipah virus (NiV) infection. Treatment is limited to supportive care, including rest, hydration, and treatment of symptoms as they occur. There are, however, immunotherapeutic treatments (monoclonal antibody therapies) that are currently under development and evaluation for treatment of NiV infections. One such monoclonal antibody, m102.4, has completed phase 1 clinical trials and has been used on a compassionate use basis. In addition, the antiviral treatment remdesivir has been effective in nonhuman primates when given as post-exposure prophylaxis and may be complementary to immunotherapeutic treatments. The drug ribavirin was used to treat a small number of patients in the initial Malaysian NiV outbreak, but its efficacy in people is unclear. Prevention In areas where Nipah virus (NiV) outbreaks have occurred (Bangladesh, Malaysia, India, and Singapore), people should practice handwashing regularly with soap and water, avoid contact with sick bats or pigs, avoid areas where bats are known to root. (Kulkarni, et.al. 2013 ). Avoid eating or drinking products that could be contaminated by bats, such as raw date palm sap, raw fruit, or fruit that is found on the ground, avoid contact with the blood or body fluids of any person known to be infected with NiV. Because NiV can be spread from person-to-person, standard infection control practices and proper barrier nursing techniques are important in preventing hospital-acquired infections (nosocomial transmission) in settings where a patient has confirmed or suspected NiV infection. Other geographic locations may be at risk for NiV outbreaks in the future, such as regions where flying foxes (bat genus Pteropus ) live. These bats are currently found in Cambodia, Indonesia, Madagascar, the Philippines, and Thailand. People living in or visiting these areas should consider taking the same precautions as those living in areas where outbreaks have already occurred. In addition to steps that individuals can take to lower their risk for NiV infection, it will be critical for scientists, researchers, and communities to continue learning about NiV to prevent future outbreaks. Broader prevention efforts include: Increasing surveillance of animals and people in areas where NiV is known to exist. Increasing research on the ecology of fruit bats to understand where they live and how they spread the virus to other animals and people. Evaluation of novel technologies or methods to minimize spread of the virus within bat populations. Improving tools to detect the virus early in communities and livestock. Reinforcing protocols for healthcare settings on standard infection control practices to prevent person-to-person spread (Johnson & Rodrigues. 2016). Raising awareness about the signs, symptoms, and risk of NiV among populations at higher risk due to: Geographic location Contact with fruit bats or items contaminated by fruit bats Contact with pigs or animals that could come into contact with fruit bats Work in a healthcare setting or as a caregiver for people infected with NiV Method The recent outbreak resulted in nearly three hundred human cases and more than one hundred deaths and caused substantial economic impact as more than one million pigs were killed to help control the outbreak. This study was designed in the immediate aftermath of this outbreak, in order to elucidate the awareness of common public regarding the risks and preventative measures. After institutional approval, a self-assessment questionnaire was designed de novo to capture information regarding the respondent’s knowledge on Nipah Virus, its symptoms, high risk groups, the modalities of spread, importance of personal hygiene and safety measures to prevent the spread of the disease. The respondents were selected from the public telephone directory and the selected respondents were contacted requesting to provide with their email addresses. Informed consent was also obtained from the participants. The link for the electronic questionnaire and consent was emailed to the respondents who were requested to fill the answers electronically. An initial pilot study was undertaken with ten respondents; the questionnaire and its components were discussed with these respondents to determine if they found any aspect of the questionnaire to be difficult. After minor revisions, the final questionnaire was used for the survey. The questionnaire consisted of 15 questions including demographic information such as gender and age, if the patient had been infected in the past, questions on the awareness of Nipah Virus including the possible causative organism, transmission, signs and symptoms, high risk groups, methods of preventing, vaccine availability, treatment of Nipah Virus, seriousness of the illness, common causes of death due to Nipah Virus and if common public need to be worried about this disease. The respondents were asked to choose the appropriate answers. Many questions pertaining to the respondent’s knowledge about different aspects of prevention and treatment of Nipah Virus had choices as statements rather than open ended questions; many responses were either yes, no or don’t know, while response for the question regarding the fear of the disease was in a 5-point Likert scale with a range of ‘strongly agree’ to ‘strongly disagree’. Statistical Package for Social Sciences software analysed all the responses – version 21. Findings From the above diagram majority of the participants belong to the age group of 20 to 30 years. That clearly shows that the younger generation have more interest in community awareness activities. Eighty percent of respondents were aware of the Nipah virus. Twenty percent had never heard of it. A significant majority of respondents have at least heard of the Nipah virus, reflecting successful information dissemination—due to media coverage during recent outbreaks. However, the 20% unfamiliarity highlights gaps in targeted health communication, especially in school-based or rural education. From the diagram 3, it shows that fifty percent (50%) correctly identified fruit bats (Pteropus species) as the primary natural reservoir and thirty percent (30%) mentioned pigs as a source. Twenty percent were either unsure or gave incorrect answers. Half of the respondents possess accurate knowledge of the zoonotic origin, suggesting reasonable exposure to correct biological facts. However, confusion about the role of pigs (secondary hosts in past outbreaks) shows the need for clarity between primary reservoirs and amplifying hosts. Direct animal-to-human transmission (e.g., through bats, pigs): Most common response (94 %). Knowledge of transmission modes is good, especially regarding zoonotic and food-borne routes. However, misconceptions persist—especially regarding non-relevant vectors like mosquitoes. This indicates a lack of comprehensive epidemiological understanding, which is crucial for outbreak prevention. The above diagram predicts the knowledge of the public on the signs and symptoms of Nipah virus. Fever, headache, cough, and respiratory symptoms were widely recognized. Only a minority mentioned itching, rashes, and drowsiness, which are hallmarks of severe Nipah infection. Avoiding raw date palm sap (a known risk factor in Bangladesh and India), Avoiding contact with bats and sick animals, Practicing good hygiene. A few also mentioned wearing masks and avoiding crowded places—influenced by COVID-19 protocols. The public has a sound understanding of preventive strategies, especially those related to environmental and dietary behaviors. This shows that prior health campaigns may have influenced broader behavioral awareness, although some confusion between respiratory virus protocols (e.g., COVID-19) and zoonotic-specific prevention was observed. Discussion The findings of the study reveal a high level of general awareness regarding the Nipah virus (NiV), with 80% of respondents indicating familiarity with the disease. This high awareness may be attributed to recent outbreaks and media coverage, especially in regions like Kerala, India, which have experienced multiple Nipah outbreaks (Arunkumar et al., 2019 ; Ang et.al ,2018, WHO, 2023). Despite this awareness, deeper understanding remains inconsistent. While most participants correctly identified fruit bats as the primary natural reservoir, fewer were aware of the full range of transmission modes—including the consumption of raw date palm sap and human-to-human contact (Luby, 2013 ; CDC, 2022). The study also highlights gaps in symptom recognition. Although respondents commonly identified fever and respiratory symptoms, awareness of neurological manifestations such as encephalitis and seizures were limited. This reflects findings from prior research which emphasizes that while NiV initially mimics common viral infections, its most severe and fatal outcomes involve the central nervous system (Ang et al., 2018 ). Encouragingly, a majority of participants expressed a willingness to follow public health guidelines and take preventive measures, such as avoiding raw sap and animal contact. This positive health-seeking behavior is essential, especially given the lack of specific treatments or vaccines for NiV (Broder et al., 2013 , Chadha, et.al, 2006). However, the study also revealed a heavy reliance on social and mass media for information, with minimal input from educational institutions or healthcare professionals. This underscores the need for improved school-based education and healthcare-led outreach to combat misinformation and ensure accurate, consistent messaging (Field et al., 2012 , Johnson & Hariharan, 2017). The Nipah virus remains a significant public health threat due to its high fatality rate, potential for human-to-human transmission, and lack of targeted treatment. Preventive strategies focusing on surveillance, rapid response, and community education are crucial (Chatterjee, 2018 , Menachery, & Graham. 2020). There is a critical need for investment in vaccine development, diagnostics, and intersectoral collaboration to mitigate future outbreaks and build resilient health systems. Conclusion The findings reveal a well-informed public with positive attitudes toward disease prevention, though some knowledge gaps and misconceptions remain—especially about the severity and neurological impact of the virus, and non-relevant transmission modes like mosquitoes. The reliance on social media over structured education suggests a need for targeted, evidence-based outreach programs using both digital and institutional channels. With tailored interventions, this audience could serve as effective agents of health communication, especially during outbreak scenarios. While general awareness of the Nipah virus is high, targeted educational interventions are necessary to address critical gaps in understanding transmission, symptoms, and evidence-based prevention strategies. Declarations Disclosure of potential conflicts of interest: The authors declare that they have no conflict of interest. Funding: This study did not receive any funding Acknowledgments: The authors gratefully acknowledge the generosity of those respondents who responded to the questionnaire for this study References Ang, B. S. P., Lim, T. C. C., & Wang, L. (2018). Nipah virus infection. Clinical Microbiology Reviews, 31 (2), e00087-17. https://doi.org/10.1128/CMR.00087-17 Arunkumar, G., Chandni, R., Mourya, D. T., et al. (2019). Outbreak investigation of Nipah virus disease in Kerala, India, 2018. The Journal of Infectious Diseases, 219 (12), 1867–1878. https://doi.org/10.1093/infdis/jiy612 Broder, C. C., Xu, K., Nikolov, D. B., Zhu, Z., Dimitrov, D. S., Middleton, D., ... & Wang, L. F. (2013). A treatment for and vaccine against the deadly Hendra and Nipah viruses. Antiviral Research, 100 (1), 8–13. https://doi.org/10.1016/j.antiviral.2013.06.011 Centers for Disease Control and Prevention. (2022). Nipah virus (NiV) infection . https://www.cdc.gov/vhf/nipah/index.html Chadha, M. S., Comer, J. A., Lowe, L., Rota, P. A., Rollin, P. E., Bellini, W. J., ... & Mishra, A. C. (2006). Nipah virus-associated encephalitis outbreak, Siliguri, India. Emerging Infectious Diseases, 12 (2), 235–240. https://doi.org/10.3201/eid1202.051247 Chatterjee, P. (2018). India scrambles to contain Nipah virus outbreak. The Lancet, 391 (10136), 2070. https://doi.org/10.1016/S0140-6736(18)31252-2 Ching, P. K. G., de los Reyes, V. C., Sucaldito, M. N., et al. (2015). Outbreak of henipavirus infection, Philippines, 2014. Emerging Infectious Diseases, 21 (2), 328–331. https://doi.org/10.3201/eid2102.141433 De Wit, E., Munster, V. J., Metwally, S. A., Feldmann, H., & Prescott, J. (2012). The need for a Nipah virus vaccine: Epidemiology, pathogenesis, and current status of vaccine development. Current Topics in Microbiology and Immunology, 359 , 159–173. https://doi.org/10.1007/82_2012_210 Epstein, J. H., et al. (2020). Nipah virus dynamics in bats and implications for spillovers. Nature Communications, 11 (1), 1–9. https://doi.org/10.1038/s41467-020-18306-6 Field, H., Crameri, G., Kung, N. Y., Wang, L. F., & Epstein, J. H. (2012). Ecological aspects of Hendra virus and Nipah virus. Current Topics in Microbiology and Immunology, 359 , 153–187. https://doi.org/10.1007/82_2012_208 Geisbert, T. W., & Broder, C. C. (2010). Developing countermeasures for Nipah virus and other henipaviruses. U.S. Army Medical Research Institute of Infectious Diseases Bulletin, 38 (1), 1–6. https://pubmed.ncbi.nlm.nih.gov/20508622 Johnson, E.J., Hariharan, S. Public health awareness: knowledge, attitude and behaviour of the general public on health risks during the H1N1 influenza pandemic. J Public Health 25, 333–337 (2017). https://doi.org/10.1007/s10389-017-0790-7 Johnson, E.J., Rodrigues, V. (2016). Primary Health Care: Expectations and Tasks for Public Health in Trinidad and Tobago. J Community Health 41, 645–649 https://doi.org/10.1007/s10900-015-0140-z Kulkarni, D. D., Tosh, C., Venkatesh, G., & Kumar, D. S. (2013). Nipah virus infection: Current scenario. Indian Journal of Virology, 24 (3), 398–408. https://doi.org/10.1007/s13337-013-0159-2 Lo Presti, A., Cella, E., Giovanetti, M., et al. (2016). Origin and evolution of Nipah virus. Journal of Medical Virology, 88 (3), 380–388. https://doi.org/10.1002/jmv.24335 Lo, M. K., & Rota, P. A. (2008). The emergence of Nipah virus, a highly pathogenic paramyxovirus. Journal of Clinical Virology, 43 (4), 396–400. https://doi.org/10.1016/j.jcv.2008.08.007 Luby, S. P. (2013). The pandemic potential of Nipah virus. Antiviral Research, 100 (1), 38–43. https://doi.org/10.1016/j.antiviral.2013.07.011 Menachery, V. D., & Graham, R. L. (2020). The importance of Nipah virus surveillance. Nature Reviews Microbiology, 18 (2), 67–68. https://doi.org/10.1038/s41579-019-0323-3 Plourde AR, Bloch EM. (2016) A literature review of Zika virus: Emerg Infect Dis . 2016 Volume 22, Number 7, http://dx.doi.org/10.3201/eid2207.151990 Rahman, M. A., Hossain, M. J., Sultana, S., et al. (2012). Date palm sap linked to Nipah virus outbreak in Bangladesh. Emerging Infectious Diseases, 18 (2), 210–216. https://doi.org/10.3201/eid1802.111081 Tan, C. T., & Wong, K. T. (2003). Nipah encephalitis outbreak in Malaysia. Annals of the Academy of Medicine, Singapore, 32 (1), 112–117. https://pubmed.ncbi.nlm.nih.gov/12797641 World Health Organization. (2023). Nipah virus . https://www.who.int/news-room/fact- sheets/detail/nipah-virus Additional Declarations The authors declare no competing interests. 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Threat”\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNipah virus (NiV) was first discovered in 1999 following an outbreak of disease in pigs and people in Malaysia and Singapore (Tan, et.al. 2003). The recent outbreak resulted in nearly three hundred human cases and more than one hundred deaths and caused substantial economic impact as more than one million pigs were killed to help control the outbreak. While there have been no other known outbreaks of NiV in Malaysia and Singapore since 1999, outbreaks have been recorded almost annually in some parts of Asia since then\u0026mdash;primarily in Bangladesh and India. The virus has been shown to spread from person-to-person in these outbreaks, raising concerns about the potential for NiV to cause a global pandemic.\u003c/p\u003e\n\u003ch3\u003eWhat is Nipa Virus?\u003c/h3\u003e\n\u003cp\u003eNiV is a member of the family Paramyxoviridae, genus Henipavirus. It is a zoonotic virus, meaning that it initially spreads between animals and people. The animal host reservoir for NiV is the fruit bat (genus Pteropus), also known as the flying fox. Given that NiV is genetically related to Hendra virus, another henipavirus known to be carried by bats, bat species were quickly singled out for investigation and flying foxes were subsequently identified as the reservoir (Geisbert \u0026amp; Broder. 2010, Lo Presti, et.al.2016). Infected fruit bats can spread the disease to people or other animals, such as pigs. People can become infected if they have close contact with an infected animal or its body fluids (such as saliva or urine)\u0026mdash;this initial spread from an animal to a person is known as a spillover event. Once it spreads to people, person-to-person spread of NiV can also occur. The symptoms of NiV infection range from mild to severe, with death occurring in 40\u0026ndash;70% of those infected in documented outbreaks between 1998 and 2018. (CDC, 2023).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSymptoms of Nipa Virus infection\u003c/h2\u003e \u003cp\u003eNipah virus (NiV) can spread to people from the direct contact with infected animals, such as bats or pigs, or their body fluids (such as blood, urine or saliva), consuming food products that have been contaminated by body fluids of infected animals (such as palm sap or fruit contaminated by an infected bat), and close contact with a person infected with NiV or their body fluids (including nasal or respiratory droplets, urine, or blood).\u003c/p\u003e \u003cp\u003eIn the first known NiV outbreak, people were probably infected through close contact with infected pigs (Field, et.al, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Epstein, et.al, 2020). The NiV strain identified in that outbreak appeared to have been transmitted initially from bats to pigs, with subsequent spread within pig populations. Then people who worked closely with infected pigs began falling ill. No person-to-person transmission was reported in that outbreak. However, person-to-person spread of NiV is regularly reported in Bangladesh and India (Rahman, et. al.2012). This is most commonly seen in the families and caregivers of NiV-infected patients, and in healthcare settings. Transmission also occurs from exposure to food products that have been contaminated by infected animals, including consumption of raw date palm sap or fruit that has been contaminated with saliva or urine from infected bats. Some cases of NiV infection have also been reported among people who climb trees where bats often roost.\u003c/p\u003e \u003cp\u003eInfection with Nipah virus (NiV) can cause mild to severe disease, including swelling of the brain (encephalitis) and potentially death (Ching, et al, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Symptoms typically appear in 4\u0026ndash;14 days following exposure to the virus. The illness initially presents as 3\u0026ndash;14 days of fever and headache, and often includes signs of respiratory illness, such as cough, sore throat, and difficulty breathing. A phase of brain swelling (encephalitis) may follow, where symptoms can include drowsiness, disorientation, and mental confusion, which can rapidly progress to coma within 24\u0026ndash;48 hours. Death may occur in 40\u0026ndash;75% of cases. Long-term side effects in survivors of Nipah virus infection have been noted, including persistent convulsions and personality changes. Infections that lead to symptoms and sometimes death much later after exposure (known as dormant or latent infections) have also been reported months and even years after exposure. Nipah virus (NiV) infection can be diagnosed during illness or after recovery. Different tests are available to diagnose NiV infection. During early stages of the illness, laboratory testing can be conducted using real time polymerase chain reaction (RT-PCR) from throat and nasal swabs, cerebrospinal fluid, urine, and blood. Later in the course of illness and after recovery, testing for antibodies is conducted using an enzyme-linked immunosorbent assay (ELISA).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eWhat is the treatment for Nipa infection?\u003c/h3\u003e\n\u003cp\u003eCurrently there are no licensed treatments available for Nipah virus (NiV) infection. Treatment is limited to supportive care, including rest, hydration, and treatment of symptoms as they occur. There are, however, immunotherapeutic treatments (monoclonal antibody therapies) that are currently under development and evaluation for treatment of NiV infections. One such monoclonal antibody, m102.4, has completed phase 1 clinical trials and has been used on a compassionate use basis. In addition, the antiviral treatment remdesivir has been effective in nonhuman primates when given as post-exposure prophylaxis and may be complementary to immunotherapeutic treatments. The drug ribavirin was used to treat a small number of patients in the initial Malaysian NiV outbreak, but its efficacy in people is unclear.\u003c/p\u003e\n\u003ch3\u003ePrevention\u003c/h3\u003e\n\u003cp\u003eIn areas where Nipah virus (NiV) outbreaks have occurred (Bangladesh, Malaysia, India, and Singapore), people should practice handwashing regularly with soap and water, avoid contact with sick bats or pigs, avoid areas where bats are known to root. (Kulkarni, et.al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Avoid eating or drinking products that could be contaminated by bats, such as raw date palm sap, raw fruit, or fruit that is found on the ground, avoid contact with the blood or body fluids of any person known to be infected with NiV. Because NiV can be spread from person-to-person, standard infection control practices and proper barrier nursing techniques are important in preventing hospital-acquired infections (nosocomial transmission) in settings where a patient has confirmed or suspected NiV infection. Other geographic locations may be at risk for NiV outbreaks in the future, such as regions where flying foxes (bat genus \u003cem\u003ePteropus\u003c/em\u003e) live. These bats are currently found in Cambodia, Indonesia, Madagascar, the Philippines, and Thailand. People living in or visiting these areas should consider taking the same precautions as those living in areas where outbreaks have already occurred. In addition to steps that individuals can take to lower their risk for NiV infection, it will be critical for scientists, researchers, and communities to continue learning about NiV to prevent future outbreaks. Broader prevention efforts include:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIncreasing surveillance of animals and people in areas where NiV is known to exist.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIncreasing research on the ecology of fruit bats to understand where they live and how they spread the virus to other animals and people.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEvaluation of novel technologies or methods to minimize spread of the virus within bat populations.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImproving tools to detect the virus early in communities and livestock.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReinforcing protocols for healthcare settings on standard infection control practices to prevent person-to-person spread (Johnson \u0026amp; Rodrigues. 2016).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRaising awareness about the signs, symptoms, and risk of NiV among populations at higher risk due to:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eGeographic location\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eContact with fruit bats or items contaminated by fruit bats\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eContact with pigs or animals that could come into contact with fruit bats\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWork in a healthcare setting or as a caregiver for people infected with NiV\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe recent outbreak resulted in nearly three hundred human cases and more than one hundred deaths and caused substantial economic impact as more than one million pigs were killed to help control the outbreak. This study was designed in the immediate aftermath of this outbreak, in order to elucidate the awareness of common public regarding the risks and preventative measures. After institutional approval, a self-assessment questionnaire was designed de novo to capture information regarding the respondent\u0026rsquo;s knowledge on Nipah Virus, its symptoms, high risk groups, the modalities of spread, importance of personal hygiene and safety measures to prevent the spread of the disease. The respondents were selected from the public telephone directory and the selected respondents were contacted requesting to provide with their email addresses. Informed consent was also obtained from the participants. The link for the electronic questionnaire and consent was emailed to the respondents who were requested to fill the answers electronically.\u003c/p\u003e \u003cp\u003eAn initial pilot study was undertaken with ten respondents; the questionnaire and its components were discussed with these respondents to determine if they found any aspect of the questionnaire to be difficult. After minor revisions, the final questionnaire was used for the survey. The questionnaire consisted of 15 questions including demographic information such as gender and age, if the patient had been infected in the past, questions on the awareness of Nipah Virus including the possible causative organism, transmission, signs and symptoms, high risk groups, methods of preventing, vaccine availability, treatment of Nipah Virus, seriousness of the illness, common causes of death due to Nipah Virus and if common public need to be worried about this disease. The respondents were asked to choose the appropriate answers. Many questions pertaining to the respondent\u0026rsquo;s knowledge about different aspects of prevention and treatment of Nipah Virus had choices as statements rather than open ended questions; many responses were either yes, no or don\u0026rsquo;t know, while response for the question regarding the fear of the disease was in a 5-point Likert scale with a range of \u0026lsquo;strongly agree\u0026rsquo; to \u0026lsquo;strongly disagree\u0026rsquo;. Statistical Package for Social Sciences software analysed all the responses \u0026ndash; version 21.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eFrom the above diagram majority of the participants belong to the age group of 20 to 30 years. That clearly shows that the younger generation have more interest in community awareness activities.\u003c/p\u003e\n\u003cp\u003eEighty percent of respondents were aware of the Nipah virus. Twenty percent had never heard of it. A significant majority of respondents have at least heard of the Nipah virus, reflecting successful information dissemination\u0026mdash;due to media coverage during recent outbreaks. However, the 20% unfamiliarity highlights gaps in targeted health communication, especially in school-based or rural education.\u003c/p\u003e\n\u003cp\u003eFrom the diagram 3, it shows that fifty percent (50%) correctly identified fruit bats (Pteropus species) as the primary natural reservoir and thirty percent (30%) mentioned pigs as a source. Twenty percent were either unsure or gave incorrect answers. Half of the respondents possess accurate knowledge of the zoonotic origin, suggesting reasonable exposure to correct biological facts. However, confusion about the role of pigs (secondary hosts in past outbreaks) shows the need for clarity between primary reservoirs and amplifying hosts.\u003c/p\u003e\n\u003cp\u003eDirect animal-to-human transmission (e.g., through bats, pigs): Most common response (94 %). Knowledge of transmission modes is good, especially regarding zoonotic and food-borne routes. However, misconceptions persist\u0026mdash;especially regarding non-relevant vectors like mosquitoes. This indicates a lack of comprehensive epidemiological understanding, which is crucial for outbreak prevention.\u003c/p\u003e\n\u003cp\u003eThe above diagram predicts the knowledge of the public on the signs and symptoms of Nipah virus. Fever, headache, cough, and respiratory symptoms were widely recognized. Only a minority mentioned itching, rashes, and drowsiness, which are hallmarks of severe Nipah infection.\u003c/p\u003e\n\u003cp\u003eAvoiding raw date palm sap (a known risk factor in Bangladesh and India), Avoiding contact with bats and sick animals, Practicing good hygiene. A few also mentioned wearing masks and avoiding crowded places\u0026mdash;influenced by COVID-19 protocols. The public has a sound understanding of preventive strategies, especially those related to environmental and dietary behaviors. This shows that prior health campaigns may have influenced broader behavioral awareness, although some confusion between respiratory virus protocols (e.g., COVID-19) and zoonotic-specific prevention was observed.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of the study reveal a high level of general awareness regarding the Nipah virus (NiV), with 80% of respondents indicating familiarity with the disease. This high awareness may be attributed to recent outbreaks and media coverage, especially in regions like Kerala, India, which have experienced multiple Nipah outbreaks (Arunkumar et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Ang et.al ,2018, WHO, 2023). Despite this awareness, deeper understanding remains inconsistent. While most participants correctly identified fruit bats as the primary natural reservoir, fewer were aware of the full range of transmission modes\u0026mdash;including the consumption of raw date palm sap and human-to-human contact (Luby, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; CDC, 2022). The study also highlights gaps in symptom recognition. Although respondents commonly identified fever and respiratory symptoms, awareness of neurological manifestations such as encephalitis and seizures were limited. This reflects findings from prior research which emphasizes that while NiV initially mimics common viral infections, its most severe and fatal outcomes involve the central nervous system (Ang et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Encouragingly, a majority of participants expressed a willingness to follow public health guidelines and take preventive measures, such as avoiding raw sap and animal contact. This positive health-seeking behavior is essential, especially given the lack of specific treatments or vaccines for NiV (Broder et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, Chadha, et.al, 2006). However, the study also revealed a heavy reliance on social and mass media for information, with minimal input from educational institutions or healthcare professionals. This underscores the need for improved school-based education and healthcare-led outreach to combat misinformation and ensure accurate, consistent messaging (Field et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, Johnson \u0026amp; Hariharan, 2017). The Nipah virus remains a significant public health threat due to its high fatality rate, potential for human-to-human transmission, and lack of targeted treatment. Preventive strategies focusing on surveillance, rapid response, and community education are crucial (Chatterjee, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Menachery, \u0026amp; Graham. 2020). There is a critical need for investment in vaccine development, diagnostics, and intersectoral collaboration to mitigate future outbreaks and build resilient health systems.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings reveal a well-informed public with positive attitudes toward disease prevention, though some knowledge gaps and misconceptions remain\u0026mdash;especially about the severity and neurological impact of the virus, and non-relevant transmission modes like mosquitoes. The reliance on social media over structured education suggests a need for targeted, evidence-based outreach programs using both digital and institutional channels. With tailored interventions, this audience could serve as effective agents of health communication, especially during outbreak scenarios. While general awareness of the Nipah virus is high, targeted educational interventions are necessary to address critical gaps in understanding transmission, symptoms, and evidence-based prevention strategies.\u003c/p\u003e"},{"header":"Declarations","content":" \u003ch2\u003eDisclosure of potential conflicts of interest:\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study did not receive any funding\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eThe authors gratefully acknowledge the generosity of those respondents who responded to the questionnaire for this study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAng, B. S. P., Lim, T. C. C., \u0026amp; Wang, L. (2018). Nipah virus infection. \u003cem\u003eClinical Microbiology\u0026nbsp;\u003c/em\u003e\u003cem\u003eReviews, 31\u003c/em\u003e(2), e00087-17. https://doi.org/10.1128/CMR.00087-17\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eArunkumar, G., Chandni, R., Mourya, D. T., et al. (2019). Outbreak investigation of Nipah virus disease in Kerala, India, 2018. \u003cem\u003eThe Journal of Infectious Diseases, 219\u003c/em\u003e(12), 1867\u0026ndash;1878. https://doi.org/10.1093/infdis/jiy612\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBroder, C. C., Xu, K., Nikolov, D. B., Zhu, Z., Dimitrov, D. S., Middleton, D., ... \u0026amp; Wang, L. F. (2013). A treatment for and vaccine against the deadly Hendra and Nipah viruses. \u003cem\u003eAntiviral Research, 100\u003c/em\u003e(1), 8\u0026ndash;13. https://doi.org/10.1016/j.antiviral.2013.06.011\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCenters for Disease Control and Prevention. (2022). \u003cem\u003eNipah virus (NiV) infection\u003c/em\u003e. https://www.cdc.gov/vhf/nipah/index.html\u003c/li\u003e\n \u003cli\u003eChadha, M. S., Comer, J. A., Lowe, L., Rota, P. A., Rollin, P. E., Bellini, W. J., ... \u0026amp; Mishra, A. C. (2006). Nipah virus-associated encephalitis outbreak, Siliguri, India. \u003cem\u003eEmerging Infectious Diseases, 12\u003c/em\u003e(2), 235\u0026ndash;240. https://doi.org/10.3201/eid1202.051247\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChatterjee, P. (2018). India scrambles to contain Nipah virus outbreak. \u003cem\u003eThe Lancet, 391\u003c/em\u003e(10136), 2070. https://doi.org/10.1016/S0140-6736(18)31252-2\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChing, P. K. G., de los Reyes, V. C., Sucaldito, M. N., et al. (2015). Outbreak of henipavirus infection, Philippines, 2014. \u003cem\u003eEmerging Infectious Diseases, 21\u003c/em\u003e(2), 328\u0026ndash;331. https://doi.org/10.3201/eid2102.141433\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDe Wit, E., Munster, V. J., Metwally, S. A., Feldmann, H., \u0026amp; Prescott, J. (2012). The need for a Nipah virus vaccine: Epidemiology, pathogenesis, and current status of vaccine development. \u003cem\u003eCurrent Topics in Microbiology and Immunology, 359\u003c/em\u003e, 159\u0026ndash;173. https://doi.org/10.1007/82_2012_210\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEpstein, J. H., et al. (2020). Nipah virus dynamics in bats and implications for spillovers. \u003cem\u003eNature\u003c/em\u003e\u003cem\u003e\u0026nbsp;Communications, 11\u003c/em\u003e(1), 1\u0026ndash;9. https://doi.org/10.1038/s41467-020-18306-6\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eField, H., Crameri, G., Kung, N. Y., Wang, L. F., \u0026amp; Epstein, J. H. (2012). Ecological aspects of \u0026nbsp;Hendra virus and Nipah virus. \u003cem\u003eCurrent Topics in Microbiology and Immunology, 359\u003c/em\u003e, 153\u0026ndash;187. https://doi.org/10.1007/82_2012_208\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGeisbert, T. W., \u0026amp; Broder, C. C. (2010). Developing countermeasures for Nipah virus and other henipaviruses. \u003cem\u003eU.S. Army Medical Research Institute of Infectious Diseases Bulletin, 38\u003c/em\u003e(1), 1\u0026ndash;6. \u003cu\u003ehttps://pubmed.ncbi.nlm.nih.gov/20508622\u003c/u\u003e\u003c/li\u003e\n \u003cli\u003eJohnson, E.J., Hariharan, S. Public health awareness: knowledge, attitude and behaviour of the general public on health risks during the H1N1 influenza pandemic. \u003cem\u003eJ Public Health\u003c/em\u003e 25, 333\u0026ndash;337 (2017). https://doi.org/10.1007/s10389-017-0790-7\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJohnson, E.J., Rodrigues, V. (2016). \u0026nbsp;Primary Health Care: Expectations and Tasks for Public Health in Trinidad and Tobago. \u003cem\u003eJ Community Health\u003c/em\u003e 41, 645\u0026ndash;649 https://doi.org/10.1007/s10900-015-0140-z\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKulkarni, D. D., Tosh, C., Venkatesh, G., \u0026amp; Kumar, D. S. (2013). Nipah virus infection: Current scenario. \u003cem\u003eIndian Journal of Virology, 24\u003c/em\u003e(3), 398\u0026ndash;408. https://doi.org/10.1007/s13337-013-0159-2\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLo Presti, A., Cella, E., Giovanetti, M., et al. (2016). Origin and evolution of Nipah virus. \u003cem\u003eJournal of Medical Virology, 88\u003c/em\u003e(3), 380\u0026ndash;388. https://doi.org/10.1002/jmv.24335\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLo, M. K., \u0026amp; Rota, P. A. (2008). The emergence of Nipah virus, a highly pathogenic paramyxovirus. \u003cem\u003eJournal of Clinical Virology, 43\u003c/em\u003e(4), 396\u0026ndash;400. https://doi.org/10.1016/j.jcv.2008.08.007\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLuby, S. P. (2013). The pandemic potential of Nipah virus. \u003cem\u003eAntiviral Research, 100\u003c/em\u003e(1), 38\u0026ndash;43. https://doi.org/10.1016/j.antiviral.2013.07.011\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMenachery, V. D., \u0026amp; Graham, R. L. (2020). The importance of Nipah virus surveillance. \u003cem\u003eNature\u003c/em\u003e\u003cem\u003e\u0026nbsp;Reviews Microbiology, 18\u003c/em\u003e(2), 67\u0026ndash;68. https://doi.org/10.1038/s41579-019-0323-3\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePlourde AR, Bloch EM. (2016) A literature review of Zika virus: \u003cem\u003eEmerg Infect Dis\u003c/em\u003e. 2016 \u0026nbsp;Volume 22, Number 7, http://dx.doi.org/10.3201/eid2207.151990\u003c/li\u003e\n \u003cli\u003eRahman, M. A., Hossain, M. J., Sultana, S., et al. (2012). Date palm sap linked to Nipah virus outbreak in Bangladesh. \u003cem\u003eEmerging Infectious Diseases, 18\u003c/em\u003e(2), 210\u0026ndash;216. https://doi.org/10.3201/eid1802.111081\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTan, C. T., \u0026amp; Wong, K. T. (2003). Nipah encephalitis outbreak in Malaysia. \u003cem\u003eAnnals of the\u0026nbsp;\u003c/em\u003e\u003cem\u003eAcademy of Medicine, Singapore, 32\u003c/em\u003e(1), 112\u0026ndash;117. https://pubmed.ncbi.nlm.nih.gov/12797641\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2023). \u003cem\u003eNipah virus\u003c/em\u003e. https://www.who.int/news-room/fact- sheets/detail/nipah-virus\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"N/A","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Public health awareness, Nipa Virus, health information, knowledge and attitude, prevention","lastPublishedDoi":"10.21203/rs.3.rs-6721001/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6721001/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNipah virus (NiV) was first discovered in 1999 following an outbreak of disease in pigs and people in Malaysia and Singapore. The recent outbreak resulted in nearly three hundred human cases and more than one hundred deaths and caused substantial economic impact as more than one million pigs were killed to help control the outbreak. Providing health information during disease outbreaks is a fundamental component of outbreak control strategies. This study aimed to identify the importance of providing information that increases community health awareness on personal hygiene, safety measures and reduce fear of the spread of disease15-item questionnaire was designed de novo and emailed to the selected public after telephone contact. The response choices were never open ended, either \u0026lsquo;yes\u0026rsquo; or \u0026lsquo;no\u0026rsquo; or \u0026lsquo;do not know,\u0026rsquo; while one response was in a Likert scale of 1\u0026ndash;5. Of the one hundred emailed questionnaires, eighty-four were returned eligible to be included for analysis (84% response rate). Majority of the responders were of the female gender (74%). Overall, only 48% of the responders knew the causative organism of the illness, while they were divided in their opinion regarding the mode of transmission of the disease.\u003c/p\u003e","manuscriptTitle":"Unmasking Nipah Virus: Public knowledge and Attitude Towards a Growing “Health Threat”","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 09:14:38","doi":"10.21203/rs.3.rs-6721001/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"89ae993a-eef7-4f05-b91e-d71c555e6e3d","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48973218,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2025-05-26T09:14:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 09:14:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6721001","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6721001","identity":"rs-6721001","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}