Long-term sequelae and functional outcomes in the largest cohort of Nipah virus survivors in Bangladesh

Background: Since 2001, Bangladesh has experienced recurrent outbreaks of Nipah virus (NiV) infection. While acute-phase manifestations are well documented, long-term clinical and functional sequelae poorly characterized. Methods: We conducted a cross-sectional assessment of 52 adult NiV survivors in Bangladesh between November 2021 and February 2022 to document the persistence, severity, and functional impact of post infection symptoms. Symptom history, clinical evaluation, and functional status were assessed using structured questionnaires and the Washington Group Extended Set on Functioning (WG-ES). Findings: All the survivors reported fever during acute illness, with frequent symptoms including headache (71%), severe weakness (67%), and altered mental status (44%). Following recovery, survivors reported a wide range of symptoms including sleep disturbance (58%), gait disturbance (54%), chronic fatigue (52%), memory and concentration difficulties (54%) and myoclonus (48%). Neurological, musculoskeletal, and respiratory symptoms persisted with varying severity and chronicity. Functional assessments revealed notable disability in several domains, particularly anxiety (48%), mobility (31%), and cognition (25%). Although post-infection symptoms were common, 65% of survivors met criteria for disability in at least one functional domain, and 48% had disabilities across multiple domains. Interpretation: These findings highlight the substantial and enduring burden experienced by NiV survivors in Bangladesh. The range and persistence of sequelae in this cohort appear broader than previously documented in Malaysia-Singapore survivor studies; however, methodological differences limit formal comparison. As the largest clinical and functional assessment of NiV survivors to date, this study provides essential evidence to inform long-term care strategies and underscores the need for survivor-focused rehabilitation and monitoring in outbreak-prone settings. Funding: This study was supported by the Coalition for Epidemic Preparedness Innovations (CEPI) (Grant No: GR-02160). The funding body had no role in the study design; data collection, management, analysis, or interpretation; writing of the manuscript; or the decision to submit the manuscript for publication. The views and conclusions expressed in this manuscript are those of the authors and should not be construed as representing the official viewpoints of CEPI or the U.S. Centers for Disease Control and Prevention.