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 the testing for Nipah Virus offered through Public Health Ontario (PHO).

Nipah Virus is a zoonotic RNA virus that has caused outbreaks in parts of South and Southeast Asia. It can be transmitted from animals to humans in at-risk locations via direct contact or through ingestion of contaminated items (e.g. date palm sap). ^1,2
Refer to PHO’s Focus On: Nipah Virus Infection for additional information on Nipah virus epidemiology and clinical presentation.

Nipah virus testing is performed at the National Microbiology Laboratory (NML) and requires consultation with the Ministry of Health, PHO and other provincial health system partners. Specimens for Nipah virus testing should not be submitted to PHO until the appropriate consultations, indicated above, have occurred.

* Copie d'impression non contrôlée. Valide uniquement le jour de l'impression : 10 juin 2026.

Testing Indications

Testing for Nipah virus may be considered for individuals with:

compatible clinical signs/symptoms of infection AND
recent travel to or residence in areas with active transmission or ongoing outbreaks AND
relevant exposures (e.g., ingestion of date palm sap)

Molecular testing by PCR is the preferred method to detect acute Nipah virus infection within 14 days of symptom onset.³ Serology testing is not routinely recommended but may be considered for individuals suspected of Nipah virus infection later in the disease course.

Testing of individuals with no signs or symptoms of infection is not recommended.

Acceptance/Rejection Criteria

Specimens that are submitted to PHO for Nipah virus testing where the appropriate notifications described in the Notification Pathway for Special Pathogens have not been followed are subject to cancellation.

IMPORTANT INSTRUCTIONS (READ BEFORE PROCEEDING)

If you suspect an individual has a Nipah virus infection, consult the Ministry of Health Notification Pathway for Special Pathogens which outlines the provincial algorithm for managing special pathogens, which includes Nipah virus.

It is recommended that a clinical risk assessment be conducted prior to initiating this process to assess the likelihood of infection with Nipah virus. The information gathered through this assessment will inform subsequent coordination calls with provincial health system partners and subject matter experts, following consultation with the Ministry, and will support decision-making on testing, in accordance with the Notification Pathway for Special Pathogens.

Specimen Collection and Handling

Specimen Requirements

Test Requested	Required Requisition(s)	Specimen Type	Minimum Volume	Collection Kit
Nipah Virus PCR	General Test Requisition	Whole blood or serum	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	N/A	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

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.

Malaria testing can be performed at PHO alongside Nipah virus testing. If requested, submit a second, separate EDTA blood tube in the same package that is to be submitted to PHO[

Specimen types not listed above (e.g. swabs of the respiratory tract) are not validated for Nipah virus testing; however, they may be considered on a case-by-case basis.

Timing of Specimen Collection

Specimens for Nipah virus testing should be collected only after the decision to proceed with testing has been discussed at the provincial health systems partners coordination call.
Appropriate infection prevention and control measures should be in place and a local risk assessment completed.

Limitations

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

Storage and Transport

Federal shipping and transportation regulations, including the requirement to activate an Emergency Response Assistance Plan (ERAP), must be followed when handling or transporting specimens for VHF testing. All specimens must be shipped in compliance with the Transportation of Dangerous Goods Act.

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.

Specimens submitted for PCR 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 and centrifugation of serum separator tubes.

Special Instructions

See Submission and Collection notes

Requisitions and Kit Ordering

Test Frequency and Turnaround Time (TAT)

Testing for Nipah virus is performed only after discussion at the provincial health systems partners coordination call.

These are Referred Out Tests. Specimens are referred to the NML. The TAT for testing will be established 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

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].