{"doi":"10.1093/infdis/jiaa078","title":"Twenty Years of Nipah Virus Research: Where Do We Go From Here?","abstract":"Twenty years ago, the world had only just discovered Nipah virus, a new zoonotic paramyxovirus closely related to Hendra virus. A concurrent disease outbreak in pigs and humans in Malaysia led to the discovery of this virus in 1999 [1]. Through the intermediate host involved in this outbreak—domestic pigs—the outbreak spread to Singapore, resulting in a total of 276 reported cases with 106 deaths; the outbreak ended with the culling of more than 1 000 000 pigs [1, 2]. Nipah virus has caused fewer than 700 diagnosed human cases in the 20 years since its discovery, and, so far, outbreaks have been contained within a few chains of transmission. However, Nipah virus is among the most lethal viruses currently known. Because of this, even isolated cases can enormously impact families, healthcare workers, communities, and healthcare systems. Moreover, the potential involvement of intermediate, agricultural hosts can have significant economic consequences. In this study, we summarize the major scientific advances in Nipah virus epidemiology and biology made in the past 20 years to identify important gaps in our knowledge that must be filled to effectively prevent Nipah virus infections and deaths. Over the past 20 years, our understanding of the epidemiology of Nipah virus has grown substantially, thanks to increased capacity and efforts to identify and study human Nipah virus infections. The development of diagnostics tests after the outbreak in Malaysia offered a significant leap in our capability to identify cases. In 2001, just 1 year after the development of these tests, 2 outbreaks of Nipah virus occurred in India and Bangladesh, almost simultaneously [3, 4]. The geographical range of detected human cases of Nipah virus infection has continued to grow with outbreaks identified in the Philippines in 2014 and in Kerala, India, in 2018 [5, 6]. Scientists and public health officials quickly learned that Nipah virus had the ability to spread from person to person [3, 7]. Outbreaks on the Indian subcontinent were smaller in size than the outbreak in Malaysia, but they have been continuously reported, almost yearly, since 2001, suggesting that the virus may have been infecting humans for many years, undetected. Although the case fatality rate of Nipah virus infections in Malaysia was high, it has been even higher in South Asia, at approximately 70%. After outbreaks in 2001, 2003, 2004, and 2005, Bangladesh established targeted, hospital-based surveillance in 2006 (1) to identify and proactively respond to outbreaks of Nipah virus and (2) to identify isolated cases so that the mechanism of viral spillover from bats to humans could be identified. As a result, we know that multiple Nipah virus spillover events occur there each year (Nikolay et al, this supplement), primarily through human consumption of raw or fermented date palm sap contaminated with the urine or saliva of infected fruit bats [8]. Effective interventions to interrupt transmission have been developed but are not routinely used [9, 10]. Since 2015, the World Health Organization has listed Nipah virus as one of the most dangerous emerging viruses, due in large part to its capacity to transmit from person to person [11]. Although only ~10% of Nipah patients transmit the virus to others, transmission is highly heterogeneous and super-spreaders have infected dozens of people [12]. Close caregivers, typically family members but also sometimes healthcare workers, are at highest risk for infection, which most likely occurs through contact with infectious respiratory secretions from the patient [12]. Prevention of human-to-human transmission through quick diagnosis and infection prevention measures are among the best prevention strategies currently available. Animal models have been developed that reasonably recapitulate human disease as it is currently understood, providing valuable insights into pathogenesis and creating necessary platforms to test the efficacy of potential ther","journal":"The Journal of Infectious Diseases","year":2020,"id":97093,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":33,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9396,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":345004,"name":"Christina F. Spiropoulou","orcid":"0000-0001-8406-3161","position":1,"is_corresponding":false},{"id":106696,"name":"Emmie de Wit","orcid":"0000-0002-9763-7758","position":2,"is_corresponding":false},{"id":328825,"name":"Emily S. Gurley","orcid":"0000-0002-8648-9403","position":0,"is_corresponding":true}],"reference_count":30,"raw_metadata":null,"created_at":"2026-07-18T22:35:34.520494Z","pmid":"32392321","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}