Kerala, which has a strong public health system in southern India, is yet again facing the threat of Nipah virus—a deadly, bat-spread zoonotic illness with high mortality rates. Two fresh cases in Malappuram and Palakkad have led the authorities to issue an alert in three districts: Malappuram, Palakkad, and Kozhikode. The swift mobilization of health resources and containment measures attest both to the seriousness of the threat as well as lessons gleaned from past outbreaks.This return of the virus, with a high fatality rate and a zoonotic mode of transmission, has renewed debate around viral spillovers, ecological disturbance, and the tenuous equilibrium between human activity and wildlife interaction.The first official case is that of a 38-year-old Malappuram woman, who was tested positive at the country's top virology lab, the National Institute of Virology (NIV) in Pune. The woman, who first reported fever almost three weeks ago, visited three different healthcare centers, including a local clinic. The woman is now undergoing intensive care at Perinthalmanna's private hospital.The second case, unfortunately, is that of a child from Palakkad who died due to the infection. Postmortem examination revealed Nipah virus to be the killer. Clinical history and contact history of the child are being evaluated as health officials scramble to determine the spread of the outbreak.As a precautionary measure, three districts—Kozhikode, Malappuram, and Palakkad—have been put in high alert. Kerala Health Minister Veena George confirmed that contact tracing and containment procedures are already underway. The samples of both the cases have also been sent to the National Institute of Virology for reconfirmation.345 people have been identified in the contact network as per Minister George—211 from Malappuram, 91 from Palakkad, and 43 from Kozhikode.A travel history map of the Palakkad patient was released, enabling the authorities to step up containment and isolation measures. In a first-ever initiative, 26 specialist response committees have been deployed in every affected district. These consist of task forces for epidemiological surveillance, hospital readiness, public communication, and coordination with law enforcement.Police forces have also been asked to work closely with the health apparatus to facilitate smooth implementation of movement restrictions, testing, and quarantine measures, if the situation demands.District Collectors have been authorized to declare containment zones as a precaution, with teams to implement lockdowns at micro levels based on risk assessment.Nipah virus infection poses a daunting diagnostic challenge. Early presentation—fever, headache, sore throat, and respiratory distress—is indistinguishable from that of routine viral infections such as influenza. Severe illness can quickly evolve into encephalitis, seizures, and coma within 24 to 48 hours. Incubation is 4 to 14 days but can be up to 45 days, making it difficult to trace and contain transmission.Kerala has enforced strict surveillance measures. All contacts are risk-stratified: high-risk contacts (who had contact with body fluids or spent extended hours with a confirmed case) are home quarantined with active monitoring for 21 days, and symptomatic contacts are placed in specialized isolation facilities right away.Nipah virus first appeared in Kerala in 2018, and since then the state has suffered five outbreaks, claiming 22 lives and leaving only seven alive. The virus is mainly spread from fruit bats (Pteropus species) to humans, though it can also be spread through food contact or human-to-human transmission. Kerala's distinctive ecology—highly populated forests, large bat presence, and frequent human-wildlife interaction—is especially susceptible to spillover events.A new study in PLOS Global Public Health discovered that four out of six Nipah outbreaks in Kerala since 2018 occurred during El Niño years and the time of fruit ripening (May–September), highlighting the influence of environmental determinants on outbreak patterns. Deforestation, habitat destruction, and climate variability are suspected to enhance the risk of bat-to-human transmission.This is not the first time Kerala has fought against Nipah. The state has already encountered five outbreaks since 2018. Among the 29 reported cases, 22 ended in deaths, with seven individuals surviving the infection.The Nipah virus, which was first detected in 1999 in an outbreak among pig farmers in Malaysia, is a zoonotic virus. The natural reservoir in India is the Pteropus fruit bat or Indian flying fox. Humans get infected through direct contact with bats, their secretions, or intermediate hosts like domesticated animals.What makes Nipah particularly sinister is the 40% to 75% mortality rate and the fact that it is hard to detect in its early stages because of its resemblance to typical viral fevers. The initial symptoms are fever, headache, and muscle aches, which may progress rapidly to encephalitis (inflammation of the brain), respiratory failure, and death. There is no cure or vaccine as yet, making control and prevention the only feasible measures.Nipah outbreaks in Kerala have in the past caused mass panic and, in some instances, destructive social practices. Misinformation and panic have during past outbreaks resulted in stigmatization of patients and their relatives and avoidance of health facilities. Health officials are thus putting efforts into open communication and public sensitization against fear, as well as promoting collaboration with measures of containment.Nipah has a case fatality rate of 40% to 75%, ranking among the most lethal known viral infections. Survivors can have long-term neurological sequelae, such as chronic convulsions and personality disturbances. The high death rate and severity of disease emphasize the need for prompt detection and vigorous containment.Global Lessons and the One Health ApproachKerala's most recent outbreak highlights anew the value of the One Health strategy—an intersectoral, collaborative strategy that acknowledges the interrelatedness of human, animal, and environmental health.Experts are urging steady investments in bat surveillance, conservation of the environment, and genomic monitoring for rising pathogens. Conservation of bat habitats and reduction of human exposure through safer agriculture practices and food handling standards might decrease future threats.Globally, Nipah virus is a canary in the coal mine. With increasing climate change, deforestation, and urbanization, the risk of zoonotic viruses emerging and spreading is bound to rise exponentially.