Nipah virus (NiV) is a zoonotic paramyxovirus belonging to the genus Henipavirus, which infects Pteropus bat species in Southeast and South Asia. Since its discovery in the late 1990s in Malaysia, NiV has caused outbreaks in humans in Singapore, Bangladesh, India and the Philippines. The spillover pathway for the most recent NiV outbreak in 2023 in Kerala, India, remains speculative. NiV causes serious disease in infected humans, with a mean case-fatality rate of 70%, and no approved treatment or vaccines exist. Humans have been infected directly from bats through shared food or through infected bridging hosts, including pigs and horses, although other spillover pathways may exist. Here, we review the pathways of NiV spillover and transmission, highlighting areas needing further research. We emphasize the importance of collaborative and multidisciplinary efforts both in the laboratory and in the field, and the implementation of a One Health strategy to prevent future epidemics.
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