Nipah Virus (NiV) in Focus: Molecular Insights Into Pathogenesis, Transmission Dynamics, and Evolving Epidemiology From Malaysia to Recent Indian Outbreaks

ABSTRACT

Since the emergence of the Nipah virus (NiV) in Malaysia in 1998, it has returned multiple times and continues to pose a significant threat to global public health. It is characterised by high mortality and fatality rates and increasing evidence of human‐to‐human transmission. The epidemiological pattern of NiV has shifted considerably over the past 2 decades, from transmission primarily associated with infected pigs to repeated spillover events linked to Pteropus fruit bats, contaminated food sources, and close human contact. NiV infection is marked by severe respiratory involvement, immune dysregulation, acute encephalitis and widespread endothelial damage contributing to rapid clinical deterioration and poor outcomes. The World Health Organisation classified the Nipah virus as a priority pathogen with high mortality and pandemic potential, with recognised outbreaks showing case fatalities ranging from 40% to 100%. The virus has been detected in the Indian subcontinent and is carried by fruit bats. Recent outbreaks reported in India through 2026 have further highlighted the ongoing threat posed by the virus and the challenges of outbreak containment in densely populated regions. Current advances in serological and Molecular diagnostics have improved early detection; however, therapeutic options remain limited, and no licenced vaccine is currently available for human use. Ongoing therapeutics research involving monoclonal antibodies, recombinant vaccines, and antiviral agent platforms continues to expand the prospects for future prevention and disease control. Outbreaks must be prevented by prompt diagnosis and the application of infection control measures. However, the lack of knowledge regarding the pathophysiology, clinical features, and current treatment of Nipah virus disease makes it difficult to design such trials. The current advances summarised herein strengthen the scientific foundation for improved diagnostic platforms, antiviral interventions, vaccine development, and integrated One Health surveillance approaches targeting Nipah Virus.