Background: Nipah encephalitis outbreaks mostly involve multiple patients. We report a case of Nipah virus encephalitis (NVE), which had no documented secondary cases in spite of many having prolonged and close contact with the patient. Methods: A 21-year-old male was admitted with NVE on May 30, 2019. Before the confirmatory report, there was close contact with multiple healthcare workers (HCWs), defined as exposure for >1 hour to the patient or his immediate environment and/or exposure to body fluids. We conducted extensive contact tracing of all HCWs who had come into close contact with the proven NVE case from the time of admission to the time of discharge. This contact tracing included those who had nursed him before the diagnosis with usual standard precautions and those who had nursed him after the diagnosis with full PPE. These HCWs were reviewed daily for fever and respiratory symptoms. All those who developed these symptoms within the 3 weeks of exposure where tested for NEV with a throat swab using RT-PCR. This testing was conducted twice over 3 days to confirm negative results. For the close family contacts that were asymptomatic, both throat swab and serum for Nipah IgM were tested. Results: In total, 169 HCW contacts were identified at our hospital. Of these, 94 were at high risk according the predetermined criteria and others were low-risk contacts. Moreover, 7 HCWs developed fever and respiratory symptoms within the defined surveillance period; 5 had symptoms before the diagnosis (using only standard precautions) and 2 were in contact with full PPE after the diagnosis. All of these symptomatic contacts were tested for NEV (throat swab and serology), and all were negative. The family members of the patient (his mother and aunt) who had cared for him throughout his illness period of 12 days before the diagnosis were also tested and were seronegative for NEV. Conclusions: This NEV case had very low transmission capability; even close family members who cared for him for 12 days without any precautions and had exposure to urine (which was positive for NEV) did not contract the disease. The absence of overt respiratory involvement and young age of the affected patient could have contributed to low transmissibility both prior to hospitalization and during the hospitalization.

Funding: None

Disclosures: None