Nipah virus: pathogenesis, genome, diagnosis, and treatment

Abstract

The highly infectious Nipah virus (NiV) is classified under the Paramyxoviridae family and is categorized under the genus Henipavirus. NiV spreads to humans through zoonotic transmission from reservoir host bats and other intermediate hosts. It is highly contagious and has a high case fatality rate (CFR) of ~ 40-80%. Only sporadic outbreaks have been reported so far, but like SARS-CoV2, NiV has a high pandemic potential and has been put on the World Health Organization (WHO) priority pathogen list. Currently, no clinically approved antivirals, immunotherapy, or vaccines are available to tackle NiV infection, thereby necessitating further research into its life cycle, transmission, and pathogenesis. This detailed review outlines the origin and spread of the Nipah virus, its modes of transmission, risk factors, its genome, key proteins, pathogenesis, and clinical features. We also discuss different diagnostic approaches and ongoing research to develop therapies ranging from antibodies to vaccines. KEY POINTS: •Pandemic preparedness for emerging and re-emerging viruses. •Novel approaches for diagnostics and therapeutics for Nipah viruse. •Global threat from biosafety level 4 pathogens. •Animal models for Nipah virus research.

Keywords: Anti-viral drugs; Clinical trials; Henipavirus; Nipah virus; Vaccines; Viral encephalitis; Viral outbreaks; WHO.

Fig. 1

Epidemiological trends of Nipah virus (NiV) outbreaks illustrating confirmed cases (orange), deaths (blue), and case fatality rates (CFR) (grey). A Country-wise distribution of NiV cases and deaths, with the CFR demonstrating variability in virus infectivity across nations. B Year-wise trends in Bangladesh, highlighting recurrent outbreaks since 2001, with variations in case numbers and CFR over the years. C Year-wise deaths over confirmed cases data for India, emphasizing notable outbreaks in Kerala (2001, 2018, and 2023), where CFR has remained high despite improved surveillance and healthcare responses. The graphs combinedly demonstrate the impact of NiV, showing global as well as regional differences in epidemiological dynamics and disease outcomes

Fig. 2

Global distribution of Nipah virus (NiV) outbreaks, highlighting cumulative deaths over confirmed cases. The map illustrates affected countries, including Malaysia, Bangladesh, India, Singapore, and the Philippines, with outbreak hotspots marked according to the reported number of cases and fatalities. The color intensity represents the severity of outbreaks, with the highest number of cases recorded to date. Regions with repeated outbreaks in India (Kerala and West Bengal) have been highlighted in blue

Fig. 3

Timeline of Nipah virus (NiV) outbreaks from 1998 to 2024. The figure illustrates key outbreaks, highlighting their geographic locations, case fatality rates, and major transmission routes. The first recorded outbreak in Malaysia (1998–1999) involved pig-to-human transmission, whereas subsequent outbreaks, particularly in Bangladesh and India, were linked to direct bat-to-human or human-to-human transmission. Notable events include the recurrent outbreaks in Bangladesh since 2001, the Kerala outbreaks in India (2018, 2019, and 2023), and recent cases in 2024

Fig. 4

Illustration of the complex dynamics of Nipah virus transmission in various animal models. The intricate interactions involved in the virus's transmission among different species are graphically depicted

Fig. 5

Representation of the structure and proteins of the Nipah virus. Comprehensive illustration of the virus's molecular structure provides an unobstructed view of its structural elements. All the important structural elements and proteins of the Nipah virus are shown

Fig. 6

Representation of the Nipah virus life cycle, including all important phases from entry to exit in host cells. Graphical illustrations of how the virus enters the cell, replicates, and leaves the cell are shown

Fig. 7

Illustration of the diagnosis of Nipah virus using a variety of techniques. A variety of virus detection methods and their visual description are shown, e.g., SHERLOCK Assay, Lateral flow assay, ELISA, PCR, and Live Virus Neutralization Assay

Fig. 8

Different treatment approaches for Nipah virus infection. Representation of the complexity of various possible methods to prevent the virus infection including immunotherapies, nano-therapies, and antiviral drugs