The Nipah virus threat in India: Epidemiological trends, risk drivers, and lessons for pandemic preparedness

Nipah virus (NiV), a WHO-priority zoonotic pathogen, poses a recurrent public health threat in India. Since its initial detection in 2001, India has encountered multiple NiV spillover events, including repeated outbreaks in Kerala and recent cases reported in West Bengal in 2026. Although the pig-amplified epidemic in Malaysia (1998-1999) and the seasonal outbreaks associated with NiV-contaminated date palm sap consumption in Bangladesh are extensively documented, India represents a unique and relatively understudied epidemiological setting. NiV outbreaks in India are primarily linked to the NiV-Bangladesh clade and are marked by direct spillover transmission from bats to humans, elevated case-fatality rates, clustered emergence, and effective household/nosocomial transmission without an intermediate amplifying host. Spillover risk is influenced by region-specific ecological and socio-economic factors, including contamination of peri-domestic fruit, proximity of bat roosts to human settlements, deforestation, and urban expansion. To date, no treatment or vaccine is available for humans or animals. This review synthesizes evidence from India spanning 2001 to 2026. It integrates aspects of epidemiology, bat reservoir ecology, viral genomics, clinical manifestations, surveillance experiences, and health system responses, while contrasting India's transmission dynamics with those observed in Malaysia and Bangladesh. Furthermore, we explore India's current preparedness and response strategies, highlighting the critical shift from reactive outbreak control to a proactive, integrated "One Health" framework. The strategy to strengthen integrated surveillance, contact tracing, isolation, and quarantine of suspected and confirmed cases, advance India-developed vaccines and therapeutics, and address the root ecological drivers of zoonotic emergence is essential for national and global health security.