#19,225
Five months ago, in the wake of a nosocomial Nipah outbreak among healthcare workers in Bengal State, India - we reviewed the history and growing concerns over this bat borne henipavirus (see A Brief History of the Nipah Virus).
Nipah, which is carried by fruit bats in Southeast Asia and the Indian Subcontinent (see map above), was first identified in the late 1990s following a large outbreak in Malaysia spread first from bat(s) to pigs - and then from pigs to humans - eventually infecting at least 265 people, killing 105 (see Lessons from the Nipah virus outbreak in Malaysia).
Limited human-to-human transmission has been occasionally documented, as in India in 2018 (see Nipah Transmission In Kerala Outbreak) where we saw apparent robust household and nosocomial transmission of the virus.
While most outbreaks have remained small, in July of 2018, in IJID: Enhancing Preparation For Large Nipah Outbreaks Beyond Bangladesh, we looked at an article that appeared in the International Journal of Infectious Diseases, that discussed the potential of the Nipah virus producing a large urban epidemic, similar to what we saw in West Africa with Ebola in 2014.
Late last week the WHO published a DON report on a recent case in Kozhikode district, Kerala State, India. Notably, this patient was symptomatic for roughly 10 days before being hospitalized, resulting in more than 100 close contacts who are now under monitoring.
First, a brief excerpt from a much longer WHO report.
25 June 2026
Situation at a glance
On 11 June 2026, the Kerala State Health Department confirmed one laboratory confirmed case of Nipah virus (NiV) infection in Kozhikode district, Kerala State, India. The case is an adult male who developed symptoms on 30 May 2026 and was hospitalized on 10 June 2026. He presented with neurological manifestations and at the time of reporting is on ventilatory support in an intensive care unit (ICU).
As of 18 June 2026, a total of 104 contacts had been identified and were under monitoring, including health and care workers, with no reported secondary cases to date. NiV is a zoonotic disease transmitted to humans through infected animals, or through consumption of fruits or fruit products, such as raw date palm juice contaminated with the saliva, urine, or excreta of infected bats, as well as close contact with infected individuals. The current event involves a single confirmed case, with no secondary transmission identified to date. Public health measures are in place, including isolation, contact tracing, and enhanced surveillance. However, as the source of infection has not yet been identified and given the known presence of animal reservoirs, additional cases cannot be excluded.
(SNIP)
The current event involves a single confirmed case with no evidence of secondary transmission as of 23 June 2026. The case has been isolated, and public health measures, including contact tracing, enhanced surveillance, and strengthened infection prevention and control in healthcare settings, have been rapidly implemented. The event appears to be geographically limited, with no evidence of international spread reported.
However, as the source of infection has not yet been identified and given the presence of known animal reservoirs and ongoing seasonal risk, additional cases, including sporadic zoonotic spillover, cannot be excluded.
This event represents the second notification of NiV infection in India in 2026, following the earlier two epidemiologically linked cases reported in West Bengal state in January 2026. There is an ongoing moderate sub-national risk, driven by recurrent zoonotic spillover, limited clinical specificity during the early stages of disease, and the absence of licensed vaccines or specific therapeutics, with potential for transmission among close contacts and in healthcare settings. At the regional and global levels, the risk remains low, given the absence of cross-border or international spread and the geographically contained nature of the outbreak.
Coincidentally, on the very same day (June 25th), a narrative review on Nipah, lessons from the COVID pandemic and pandemic preparedness, appeared in the Journal Infectious Diseases.
While this narrative is framed around the Nipah Virus, the authors clearly intend their work to include other high consequence infectious diseases. They write:
Unlike conventional narrative approaches, this framework (Fig. 1) emphasizes the dynamic interaction between past pandemic experiences and future preparedness needs, positioning NiV not as an isolated threat but as a critical test case for global readiness in the era of emerging “Disease X” scenarios. By linking systemic lessons, identified gaps, and targeted interventions, the framework provides a coherent and scalable model for strengthening pandemic preparedness across diverse settings.
And as bad as it was, COVID is not the worst case scenario.
This is a long-read, so I've only posted the abstract. Follow the link to read it in its entirety. I'll have a bit more after the break.
Nipah virus and the lessons of COVID-19: Are we prepared for the next pandemic threat?
Sharmake Gaiye Bashir a, Ilyas Abdullahi khalif b, Yusuf Abdullahi Hubow b, Ahmed Mohamed Omar b, Narura Omar Mohamed b, Ayan Abdullahi Mohammed b, Hibo hassan Mohamed b, Nour Ahmed Dahir b, Aniso Mohamed Abdi b, Abas Nor Abdi b, Yakub Burhan Abdullahi b c, Mohamed Sharif Abdi b c, Naima Ibrahim Ahmed b c, Yusuf Hared Abdi b c, Ahmed Abdinasir Abdulle ba
Available online 25 June 2026.
https://doi.org/10.1016/j.imj.2026.100269Get rights and content
Under a Creative Commons license
Highlights
- Nipah virus represents a high-fatality zoonotic pathogen with credible pandemic potential and limited global preparedness.
- Lessons from COVID-19 reveal persistent gaps in surveillance, diagnostics, governance, and equitable access to countermeasures.
- Integrated One Health surveillance at human–animal–environment interfaces remains weak and under-operationalized.
- Absence of licensed vaccines or specific antivirals leaves health systems vulnerable to rapid Nipah virus escalation.
Abstract
- Translating COVID-19 innovations into sustained, equitable preparedness is critical to prevent future “Disease X” scenarios.
The coronavirus disease 2019 (COVID-19) pandemic has exposed profound and persistent weaknesses in global preparedness, including fragmented surveillance systems, governance failures, inequitable access to countermeasures, and erosion of public trust. Although SARS-CoV-2 has dominated global attention, other high-consequence zoonotic pathogens with pandemic potential have remained comparatively neglected.
Among these, the Nipah virus (NiV) represents a particularly serious threat, characterized by high case-fatality rates, zoonotic spillover from wildlife reservoirs, documented human-to-human transmission, and the absence of licensed vaccines or specific antiviral therapies. This narrative review synthesizes and contextualizes existing evidence on the NiV through the lens of lessons learned during the COVID-19 pandemic.
Drawing on epidemiological data, outbreak experience, and global health policy literature, this review examines the key dimensions of preparedness, including surveillance and diagnostics, laboratory and health-system capacity, vaccine and therapeutic development, emergency governance, ethical decision-making, and the operationalization of One Health approaches, with particular attention to low- and middle-income and fragile settings.
The review highlights that despite scientific advances achieved during COVID-19, preparedness for the NiV remains limited and uneven. Persistent gaps in integrated surveillance at human–animal–environment interfaces, constrained laboratory capacity, insufficient investment in countermeasures, fragmented governance, and enduring global inequities threaten timely detection and containment.
As we discussed 18 months ago in The Wrong Pandemic Lessons Learned - governments today seem to be less well prepared to deal with another global health crisis than they were a decade ago (see From Here To Impunity).The NiV should therefore be understood not as an isolated regional concern, but as a warning signal for future “Disease X” scenarios, underscoring the urgent need to translate COVID-19 lessons into sustained, equitable, and multisectoral pandemic preparedness.
Health Agencies like the WHO, PAHO, ECDC issue frequent pleas and reminders to member states to share data, but local economic and political considerations often take precedence.
The all-too-common thread across the hundreds of epidemiological studies we've looked at on this blog is that more robust surveillance, testing, and sharing of data are essential (see here, here, here, here, here, here, and here), yet, progress continues at a glacial pace.
Although this review offers actionable steps that - if taken now - could help mitigate the effects of the next pandemic, it remains a tough sell to financially strapped governments.
But somehow I remain hopeful. If not for the next pandemic, perhaps for the pandemic-after-next.
