In 1998, a mysterious and deadly illness emerged among pig farmers in Malaysia, later identified as the Nipah virus (NiV), a bat-borne zoonotic pathogen from the Henipavirus genus. It caused severe respiratory illness and encephalitis, claiming over 100 lives and decimating the pig farming industry.The virus reappeared in Singapore in 1999. Over time, it was clear that the outbreaks weren’t isolated events. NiV had entrenched itself across regions with certain ecological and socio-cultural conditions, particularly in South and Southeast Asia.Today, NiV is considered one of the World Health Organization's priority diseases for research and development due to its high case fatality rate (up to 100% in some outbreaks), human-to-human transmissibility, and pandemic potential.25 Years, 754 Cases, 435 DeathsAs of May 2024, there have been 754 confirmed human Nipah cases reported across five countries—Malaysia, Singapore, Bangladesh, India, and the Philippines—with 435 deaths, averaging a staggering case fatality rate (CFR) of 58%.The most affected countries are:Bangladesh: 341 cases, 241 deaths (CFR 71%)India: 102 cases, 74 deaths (CFR 73%)Malaysia: 283 cases, 109 deaths (CFR 39%)Philippines: 17 cases, 9 deaths (CFR 53%)Singapore: 11 cases, 1 death (CFR 9%)Unlike Malaysia and the Philippines, where the virus spread through intermediate hosts like pigs or horses, cases in Bangladesh and India have been directly linked to bat-to-human transmission—primarily through the consumption of raw date palm sap contaminated by infected fruit bats.Why Does Nipah Still Exist?Fruit Bats Are Permanent ReservoirsNipah virus resides in Pteropus fruit bats, which are widely distributed across Asia, the Pacific Islands, and even parts of Africa. These bats are natural carriers and do not show symptoms of the disease, making them difficult to monitor or control. NiV RNA and antibodies have been found in bats in at least 15 countries, including India, Cambodia, Indonesia, and Ghana.Human Habits Enable SpilloverIn regions like Bangladesh, seasonal practices such as collecting fresh date palm sap—a delicacy also consumed raw—provide a direct interface between humans and bat secretions. The virus can contaminate sap through bat saliva or urine.Moreover, in the Philippines, outbreaks were traced to the butchering and consumption of sick horses. These recurring interactions with potential intermediary hosts keep the door open for viral spillover.Human-to-Human TransmissionAlthough not as contagious as influenza or COVID-19, human-to-human transmission of NiV has been confirmed in Bangladesh and India. Some outbreaks have shown vertical transmission (mother to child) and transmission among caregivers and family members.This capability increases the risk of community spread, particularly in regions with delayed detection or inadequate isolation infrastructure.No Vaccine, No CureDespite being on the global priority pathogen list, there is no licensed vaccine or specific treatment for Nipah. Management remains supportive, relying on early diagnosis and intensive care. In resource-constrained regions, especially rural South Asia, this becomes a daunting challenge.Bangladesh and India: The Epicenters of Ongoing RiskSince 2001, both Bangladesh and India have reported almost every year either isolated or clustered cases of Nipah virus, particularly in Kerala and West Bengal (India) and multiple districts in Bangladesh.Notably, 2023 saw Bangladesh’s highest ever reported NiV cases and deaths. In 2024, the country reported two cases—both of which were fatal, marking a 100% CFR for the year.Efforts in both countries have been ramped up. Surveillance now includes:Testing date palm sap for contaminationEducating communities to avoid raw consumptionQuarantining suspected casesExpanding diagnostic labs and outbreak response teamsStill, challenges remain due to cultural habits, lack of rapid testing in rural areas, and public fatigue around health advisories.The Risk of a Wider SpreadThough human NiV cases have so far been reported only in Asia, the potential for global spread exists. Several factors fuel this concern:Genetic adaptability: The virus has shown potential for genetic reassortment, raising fears of a more transmissible strain.Broad geographic distribution: NiV-carrying bats exist far beyond the current outbreak zones.Environmental change: Deforestation, land-use changes, and climate shifts are bringing bats closer to human habitats.Global travel and trade: A delayed diagnosis in one international traveler could enable the virus to spread outside endemic zones.What Needs to Be Done?A Global “One Health” ApproachThe study by Sakirul Khan et al. emphasizes the urgent need for multisectoral collaboration—involving human health, veterinary, and environmental sciences—to monitor and prevent outbreaks. A “One World, One Health” model is key.Steps must include:Strengthening high-containment laboratories in risk zonesContinuous monitoring of viral genetic changesDeveloping and testing vaccines and antiviral therapiesInvesting in bat ecology research and habitat protectionCommunity engagement and behavioral change strategies