Henipaviruses

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Jun 2025

Last updated: 11 Aug 2022

Henipaviruses cause rare, but emerging, infection in the Asia-Pacific region.

Isolation and infection control measures should be put in place as soon as a case is suspected. Public health authorities should be informed as soon as a case is suspected.

Nipah and Hendra viruses cause encephalitis, although respiratory and influenza-like presentations are also common. Diagnosis is confirmed with serology or molecular testing.

Mainstay of treatment is supportive care.

Mortality rates are high; patients who survive may develop persistent fatigue, somnolence, and/or neurological impairment.

Definition

Henipaviruses are an important emerging cause of zoonotic disease in the Asia-Pacific region.[1][2][3] Two viruses in this genus infect humans: Hendra virus (HeV) and Nipah virus (NiV). The natural hosts of both viruses are fruit bats of the Pteropodidae family, Pteropus genus. They both cause severe disease in animals and humans.

HeV infection in humans varies from mild influenza-like illness to fatal respiratory or neurological disease.[2] NiV infection in humans ranges from asymptomatic infection to acute respiratory syndrome and fatal encephalitis.[1]

Nipah and henipaviral diseases have been added to the World Health Organization's R&D Blueprint list of epidemic threats that require urgent research and development action.[4]

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History and exam

Key diagnostic factors

presence of risk factors
fever

Full details

Other diagnostic factors

headache
dizziness
weakness/lethargy
vomiting
myalgia
non-productive cough
dyspnoea
altered mental status/reduced consciousness
meningism
seizures
focal neurological signs
tachycardia
hypertension

Full details

Risk factors

history of residence in or travel to endemic area
contact with known infected person
consumption of contaminated date palm products in endemic areas
contact with horses in endemic areas
contact with pigs in endemic areas
contact with bats or their secretions in endemic areas
diabetes
age >40 years
bioterrorism

Full details

Diagnostic investigations

1st investigations to order

serology
reverse transcription-polymerase chain reaction
FBC
LFTs
serum urea and electrolytes
clotting profiles
CXR
malaria thick and thin blood films
blood/urine cultures
cerebrospinal fluid analysis
cerebrospinal fluid polymerase chain reaction tests for other viral encephalitides

Full details

Investigations to consider

MRI brain
EEG
other serological assays
brain biopsy/autopsy

Full details

Treatment algorithm

ACUTE

symptomatic patients

Contributors

Authors

Christopher Cousins, MBChB (Hons), MRCP

Speciality Registrar in Infectious Diseases

Regional Infectious Diseases Unit

Manchester

Disclosures

CC declares that he has no competing interests.

Andrew Ustianowski, MB BS, FRCP, DTM&H, PhD

Consultant in Infectious Diseases and Tropical Medicine

Regional Infectious Diseases Unit

Manchester

Disclosures

AU declares that he has received speaker and/or advisory board fees for Biogen, Gilead, Janssen, Merck, Sanofi, UCB, and ViiV/GlaxoSmithKline (unrelated to henipaviruses).

Peer reviewers

Catherine Houlihan, MBChB, MRCP, PhD

Clinical lecturer

University College London

London

Disclosures

CH declares that she has no competing interests.

Alice Ruth Foxwell, BSc (Hons), MSc, PhD, MAE

Adjunct

National Centre for Epidemiology and Population Health

Australian National University

Canberra

Australia

Disclosures

ARF declares that she has no competing interests.

Steffen Geis, MD, MSc

Science Programme Manager

London School of Hygiene and Tropical Medicine

Karonga Prevention Study

Chilumba

Malawi

Disclosures

SG declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

World Health Organization. Nipah virus (NiV) infection. 2017 [internet publication].Full text

World Health Organization. Hendra virus (HeV) infection. 2017 [internet publication].Full text

Australian Government Department of Health. Hendra virus CDNA national guidelines for public health units. November 2016 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Japanese encephalitis (JeV)
- Herpes simplex encephalitis
- Bacterial meningitis
More Differentials
Guidelines
- Nipah virus: epidemiology, outbreaks and guidance
- Nipah virus disease guidelines
More Guidelines
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Henipaviruses

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

symptomatic patients

Contributors

Authors

Christopher Cousins, MBChB (Hons), MRCP

Disclosures

Andrew Ustianowski, MB BS, FRCP, DTM&H, PhD

Disclosures

Peer reviewers

Catherine Houlihan, MBChB, MRCP, PhD

Disclosures

Alice Ruth Foxwell, BSc (Hons), MSc, PhD, MAE

Disclosures

Steffen Geis, MD, MSc

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice