Global and regional mortality statistics of nipah virus from 1994 to 2023: a comprehensive systematic review and meta-analysis

Abstract

The mortality rate of Nipah virus (NiV) can vary in different regions, and its pattern across timelines has yet to be assessed. The primary objective is to perform a comparative analysis of mortality rates across different timelines and countries. Articles reporting NiV mortality from inception to November 2023 were analyzed in PubMed, Ovid Embase, Scopus, and Web of Science databases. A meta-analysis utilizing random-effects models determined the mortality rate secondary to NiV complications. The initial search strategy yielded 1213 records, of which 36 articles met the inclusion criteria, comprising 2736 NiV patients. The Global mortality rate of the Nipah virus in the 2014-2023 decade was 80.1% (CI: 68.7-88.1%), indicating a significant 24% increase compared to the preceding decade (2004-2013) with a mortality rate of 54.1% (CI: 35.5-71.6%). Among the countries analyzed for overall mortality from 1994-2023, India experienced the highest mortality rate at 82.7% (CI: 74.6-88.6%), followed by Bangladesh at 62.1% (CI: 45.6-76.2%), Philippines at 52.9% (CI: 30-74.5%), Malaysia at 28.9% (CI: 21.4-37.9%), and Singapore at 21% (CI: 8-45%). Subgroup analysis revealed that India consistently had the highest mortality rate for the past two decades (91.7% and 89.3%). The primary complication leading to mortality was encephalitis, accounting for 95% of cases. This systematic review and meta-analysis revealed a noteworthy surge in NiV mortality rates, particularly in the current decade (2014-2023). The escalation, with India reporting a concerning level of mortality of 89.3-91.7% in the past decades, signifies a pressing public health challenge.

Keywords: Mortality rate; case fatality rate; global death rate; henipavirus; nipah virus.

Figure 1.

PRISMA flowchart illustrating study selection.

Figure 2.

Annual and decade mortality rate trend for Nipah virus (1994–2023).

Figure 3.

Forest plot illustrating the global decade-wise NiV mortality rate in [a] 1994–2003, [b] 2004–2013, and [c] 2014–2023.

Figure 4.

Forest plot illustrating the regional-specific NiV mortality rates in [a] Bangladesh, [b] Malaysia, [c] India, [d]Singapore, and [e] Philippines.

Figure 5.

Multivariate Meta-regression analysis scatterplot for age and sex.