Nipah Virus – PCR and Serology

Conformément au Règlement de l’Ontario 671/92 de la Loi sur les services en français, les renseignements d’analyses de laboratoire liés à la présente page ne sont offerts qu’en anglais parce qu’ils sont de nature scientifique ou technique et destinés uniquement à l’usage des fournisseurs de soins de santé qualifiés et non aux membres du public.

IMPORTANT NOTE FOR SHIPPING/TRANSPORTATION:

This is a Risk Group 4 pathogen. In accordance with Transportation of Dangerous Goods Regulations, shipping clinical specimens suspected of Risk Group 4 pathogens require Category A packaging (section 2.36) and an Emergency Response Assistance Plan (ERAP) (section 7.2(1)(g)).

Background
This page provides information on PCR and serology testing offered through Public Health Ontario (PHO) for Nipah Virus.

Nipah Virus is a single-stranded negative-sense RNA virus that belongs to the Paramyxoviridae family¹
Nipah Virus is a zoonotic virus, it can be transmitted from animals to humans via direct contact or through contaminated food. Human to human transmission can occur through respiratory secretions, close physical interaction, or contact with saliva.

Testing for Nipah Virus is performed at the National Microbiology Laboratory (NML) in Winnipeg. Specimens received by PHO will be forwarded to the NML.

Updates

Updates to reflect MOH special pathogens pathway

* Copie d'impression non contrôlée. Valide uniquement le jour de l'impression : 01 mars 2026.

Testing Indications

A clinical risk assessment is necessary to support all Nipah virus test requests. Information on the individual’s signs/symptoms, travel and exposure history and consideration of alternative differential diagnoses will be required for testing-related discussions.

Testing for Nipah Virus may be considered for individuals with:

compatible clinical symptoms AND
relevant travel history (e.g., travel to endemic areas with active cases or outbreaks) AND/OR
relevant epidemiological exposures (e.g., contact with a confirmed positive case)

PCR is the preferred method to detect acute Nipah Virus infections.² Testing of asymptomatic individuals is not recommended.

All specimens for Nipah Virus testing require shipment to PHO under the Emergency Response Assistance Plan (ERAP)³ regardless of patient’s clinical status and reason for testing.

Before collecting or submitting a sample, contact PHO’s Laboratory Customer Service Centre at 416-235-6556/1-877-604-4567 or the After-Hours Emergency Duty Officer at 416-605-3113.

Submitters must ensure that a Transportation of Dangerous Goods (TDG) certified individual is available to arrange shipment of the specimens. PHO’s laboratory will assist with facilitating the ERAP process during shipment.

Acceptance/Rejection Criteria

Specimens will not be tested without prior notification and consultation with a PHO Microbiologist.

IMPORTANT INSTRUCTIONS (READ BEFORE PROCEEDING)

If a Nipah virus infection is suspected, consult your institution’s internal protocols for special pathogens (e.g. VHF) and follow to the Ministry of Health’s Notification Pathway for Special Pathogens.

Testing for Nipah virus requires the involvement of a PHO Microbiologist. A PHO Microbiologist is available through PHO’s Customer Service Centre at:

416-235-6556/1-877-604-4567 during normal business hours OR
416-605-3113 after-hours

Specimens for Nipah virus testing should not be shipped to PHO until the testing plan has been agreed upon by PHO and the appropriate consultations, indicated above, have occurred.

Specimen Collection and Handling

Specimen Requirements

Test Requested	Required Requisition(s)	Specimen Type	Minimum Volume	Collection Kit
Nipah Virus PCR	General Test Requisition	Serum or plasma	1.5mL serum or blood	Red top, Serum Separator Tubes (SST), EDTA, heparin or citrate
Nipah Virus PCR	General Test Requisition	CSF, other body fluids	0.5mL minimum	Sterile 1.5-2.0 mL screw cap tubes
Nipah Virus PCR	General Test Requisition	Tissues		Fresh frozen, formalin fixed or paraffin-embedded
Nipah Virus serology	General Test Requisition	Serum	0.5 ml serum or blood	Red top or Serum Separator Tubes (SST)

Submission and Collection Notes

Do not submit samples to PHO prior to notifying PHO’s Customer Service. PHO will then provide the submitter with additional directions before proceeding. Testing for Nipah Virus must be discussed with a PHO Microbiologist prior to sample submission.

Clearly label the specimen container(s) with the patient’s first and last name, date of collection, and one other unique identifier such as the patient’s date of birth or Health Card Number. For additional information see Criteria for Acceptance of Patient Specimens. Failure to provide this information may result in rejection or testing delay.

Each specimen must be submitted with a separate PHO General Test Requisition, with all required fields completed

It is MANDATORY to provide the clinical information, relevant travel(s), and relevant exposure risk factors. Test requests that are submitted without the appropriate mandatory information will be subject to cancellation.

If additional infectious disease testing is required (e.g. malaria), Nipah virus tests must be submitted using a separate tube of blood. Notify laboratory staff, both at your local microbiology laboratory and PHO that the patient is under investigation for Nipah Virus.

Due to potential biosafety risks, PHO will not aliquot or perform other testing until Nipah Virus has been ruled out by the National Microbiology Laboratory (NML).

Malaria testing can be performed at PHO from specimens from individuals suspected of Nipah virus infection, where applicable.

Timing of Specimen Collection

Collect specimens as soon as possible after a PHO Microbiologist has agreed to testing and following a discussion with the relevant testing partners, stakeholders and ministry.
Specimens collected at least 72 hours from the onset of symptoms are preferred due to variability in viral load during the early stages of infection.³

Limitations

Haemolysed, icteric, lipemic or microbial contaminated sera or plasma are not recommended for testing.

Storage and Transport

Specimens must be packaged and transported according to Transportation of Dangerous Goods Act/Regulations for Category A pathogens (UN2814 packaging) and require initiation of ERAP. Contact PHO’s Laboratory Customer Service Centre to request assistance in shipping these types of samples.

For serum separator tubes: centrifugation of serum tubes is not required and should be avoided.
Place each specimen type in an individual biohazard bag and seal.
Insert the corresponding requisition in the pocket on the outside of each sealed biohazard bag.

All specimens submitted for molecular testing should be stored at 2-8°C following collection and shipped to PHO on ice packs. If a delay in transport to PHO is anticipated (more than 72 hours), specimens should be frozen (at -80°C if possible) and shipped on dry ice. Avoid freezing whole blood samples.

Requisitions and Kit Ordering

Test Frequency and Turnaround Time (TAT)

Testing is performed only upon request.

These are Referred Out Tests. Specimens are referred to the NML in Winnipeg. The TAT for testing will be determined at the time of submission.

Test Methods

Nipah Virus PCR is a validated assay performed at NML. This is the preferred method to detect Nipah virus infection in acutely ill individuals.³

Nipah Virus serology is performed at the NML using Enzyme Linked Immunosorbent Assay (ELISA) and is a non-routine, investigational test. This method is best suited for detecting antibodies in individuals later in the disease course.^3-5

Refer to NML- Guide to Services for further information.

Interpretation

All results should be interpreted in the context of the specific clinical scenario. Testing for other potential pathogens should be considered, where applicable.

The presence of Nipah virus RNA detected by PCR, or antibodies detected via serological methods may suggest a recent or past infection.

Reporting

The reporting plan will be communicated to stakeholders at the time of testing.

Results are reported to the physician, authorized health care provider (General O. Reg 45/22, s.18) or submitter as indicated on the requisition.

References

Public. Pathogen Safety Data Sheets: Infectious Substances – Nipah virus - Canada.ca [Internet]. Canada.ca. 2018 [cited 2026 Jan 30]. Available from: https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/nipah-virus.html#ref
World Health Organization. Nipah virus [Internet]. Who.int. World Health Organization: WHO; 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/nipah-virus
Hassan MZ, Khader Ibrahim S, Harriss E, Horby P, Olliaro et al. Interpreting the natural history and pathogenesis of Nipah virus disease through clinical data, to inform clinical trial design: a systematic review. Lancet Microbe [Internet]. 2026 [cited 2026 Feb 5];101295. Available from: https://doi.org/10.1016/j.lanmic.2025.101295
Mazzola LT and Cirino CK. 2019. Diagnostics for Nipah virus: a zoonotic pathogen endemic to Southeast Asia. BMJ Global Health [Internet]. 2019 [cited 2026 Feb 5];4(Suppl 2);e001118. Available from: https://doi.org/10.1136/bmjgh-2018-001118
Satter SM, Sultana S, Choudury SS, Aquib WR, Rahman DI, Chowdhury M, et al. Insights into the acute phase of Nipah virus infection: Clinical features, viral detection, and humoral immune response. Int J Infect Dis [Internet].