Research progress in the evolutionary characteristics and prevention and control of Nipah virus

doi:10.3969/j.issn.1674-8115.2026.06.002

Abstract

Abstract:

Nipah virus (NiV) is a highly lethal single-stranded negative-sense RNA virus designated by the World Health Organization (WHO) as a priority pathogen for pandemic preparedness. NiV has fruit bats as its natural reservoir and can infect humans through direct contact, consumption of contaminated food, and person-to-person transmission, causing severe diseases such as acute encephalitis and acute respiratory distress syndrome, with case fatality rates ranging from 40% to 75%. Based on whole-genome sequence homology and geographical distribution patterns, NiV has differentiated into two major genetic lineages, NiV-Malaysia (NiV-M) and NiV-Bangladesh (NiV-B). NiV-M is primarily transmitted via intermediate hosts (pigs and horses) and outbreaks can be controlled through culling of infected intermediate hosts, whereas NiV-B can directly spill over from fruit bat reservoirs to humans, exhibits greater person-to-person transmissibility, and shows endemic transmission characteristics. Current NiV outbreak prevention and control efforts face multiple challenges, including persistent viral genome evolution, lack of lineage-discriminating capability of diagnostic assays, and the absence of licensed human vaccines. This review systematically summarizes the evolutionary characteristics of NiV, its cross-species transmission patterns, recent advances in vaccine and antiviral drug development, analyzes the impact of viral evolution on surveillance strategies, and provides recommendations for optimizing prevention and control strategies from a pandemic preparedness perspective.

Key words: Nipah virus (NiV), genomic evolution, cross-species transmission, surveillance

CLC Number:

R183

Jin Dawei, Zhang Xinxin, Wan Zilin, Guo Jinzheng, Ren Lili. Research progress in the evolutionary characteristics and prevention and control of Nipah virus[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(6): 705-712.

Figures/Tables 5

TrendMD

References 57

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Country	Year	Case/n	Case fatality rate/%	Lineage	Primary transmission route	Main clinical feature
Malaysia	1998—1999	283	40	NiV-M	Pig→Human	Fever, acute encephalitis, impaired consciousness
Singapore	1999	11	9	NiV-M	Pig→Human	Acute encephalitis, mild respiratory involvement
Bangladesh	2001—present	≥348	77 (adjusted)	NiV-B (BD1/BD2)^[8,13]	Consumption of raw date palm sap, person-to-person transmission, nosocomial transmission	ARDS-predominant disease
India	2001—present	≈140	78 (adjusted)	NiV-B	Consumption of raw date palm sap, person-to-person transmission, nosocomial transmission	ARDS combined with encephalitis
Philippines	2014	17	53	NiV-M	Horse→Human	Encephalitis with respiratory symptoms

Country	Year	Case/n	Case fatality rate/%	Lineage	Primary transmission route	Main clinical feature
Malaysia	1998—1999	283	40	NiV-M	Pig→Human	Fever, acute encephalitis, impaired consciousness
Singapore	1999	11	9	NiV-M	Pig→Human	Acute encephalitis, mild respiratory involvement
Bangladesh	2001—present	≥348	77 (adjusted)	NiV-B (BD1/BD2)^[8,13]	Consumption of raw date palm sap, person-to-person transmission, nosocomial transmission	ARDS-predominant disease
India	2001—present	≈140	78 (adjusted)	NiV-B	Consumption of raw date palm sap, person-to-person transmission, nosocomial transmission	ARDS combined with encephalitis
Philippines	2014	17	53	NiV-M	Horse→Human	Encephalitis with respiratory symptoms

Vaccine vector	Candidate vaccine	Target antigen	Animal model	Immunization schedule (dose, route, frequency)	Clinical trial stage	Reference
rVSV viral vector	rVSV-∆G-EBOV GP/NiV G	NiV G	African green monkey	10⁷PFU, IM, single dose	Phase Ⅰ completed	[38]
	rVSV expressing NiV G	NiV G	Hamster	10⁵PFU, IM, single dose	Not yet initiated	[39]
	rVSV-ΔG-NiVB/G	NiV G, F	Ferret	10⁷PFU, IM, single dose	Not yet initiated	[40]
	Replication-deficient VSV	NiV G	Syrian golden hamster	10⁶PFU, IM, single dose	Not yet initiated	[41]
Adenoviral vector	ChAdOx1 Nipah B	NiV G	Syrian golden hamster	10⁸PFU, IM, single dose	Phase Ⅱ ongoing	[42]
Nucleic acid vaccine	mRNA-1215	NiV M, F, G	Mouse	IM, two doses	Phase Ⅰ completed	[43]
Subunit vaccine	HeV-sG-V	HeV sG	African green monkey	50‒100 μg, IM, two doses	Phase Ⅰ ongoing	[44]
Other	NiV-VLPs	NiV M, F, G	Syrian golden hamster	20 μg, IM, three doses	Not yet initiated	[45]
	Canarypox virus vector	NiV G, F	Pig	10⁸PFU, IM, two doses	Not yet initiated	[46]
	Measles virus vector	NiV G	African green monkey/Hamster	10⁵TCID₅₀, SC/IP, two doses	Not yet initiated	[47]
	Newcastle disease virus vector	NiV G, F	Mouse/Pig	10⁸‒10⁹EID₅₀, IM, single dose	Not yet initiated	[48]

Vaccine vector	Candidate vaccine	Target antigen	Animal model	Immunization schedule (dose, route, frequency)	Clinical trial stage	Reference
rVSV viral vector	rVSV-∆G-EBOV GP/NiV G	NiV G	African green monkey	10⁷PFU, IM, single dose	Phase Ⅰ completed	[38]
	rVSV expressing NiV G	NiV G	Hamster	10⁵PFU, IM, single dose	Not yet initiated	[39]
	rVSV-ΔG-NiVB/G	NiV G, F	Ferret	10⁷PFU, IM, single dose	Not yet initiated	[40]
	Replication-deficient VSV	NiV G	Syrian golden hamster	10⁶PFU, IM, single dose	Not yet initiated	[41]
Adenoviral vector	ChAdOx1 Nipah B	NiV G	Syrian golden hamster	10⁸PFU, IM, single dose	Phase Ⅱ ongoing	[42]
Nucleic acid vaccine	mRNA-1215	NiV M, F, G	Mouse	IM, two doses	Phase Ⅰ completed	[43]
Subunit vaccine	HeV-sG-V	HeV sG	African green monkey	50‒100 μg, IM, two doses	Phase Ⅰ ongoing	[44]
Other	NiV-VLPs	NiV M, F, G	Syrian golden hamster	20 μg, IM, three doses	Not yet initiated	[45]
	Canarypox virus vector	NiV G, F	Pig	10⁸PFU, IM, two doses	Not yet initiated	[46]
	Measles virus vector	NiV G	African green monkey/Hamster	10⁵TCID₅₀, SC/IP, two doses	Not yet initiated	[47]
	Newcastle disease virus vector	NiV G, F	Mouse/Pig	10⁸‒10⁹EID₅₀, IM, single dose	Not yet initiated	[48]

Category	Drug	Mechanism of action	Animal model	Clinical trial stage	Reference
Monoclonal antibodies	m102.4	Targets the binding site of viral G glycoprotein with Ephrin B2/B3 receptor on host epithelial cells	Non-human primates	Phase Ⅰ completed	[50]
Monoclonal antibodies	h5B3.1	Inhibits conformational change of NiV-F	Ferret	Not yet initiated	[51]
Nucleotides and nucleoside analogues	Remdesivir	Competitively binds viral RNA-dependent RNA polymerase (RdRp), inhibits RdRp activity	African green monkey	Not yet initiated	[52]
	Favipiravir	Competitively binds RdRp site, blocks viral genome replication	Hamster	Not yet initiated	[53]
	Ribavirin	Broad-spectrum inhibitior of viral RNA synthesis	African green monkey	Not yet initiated	[54]
	VV116	Targets RdRp	Syrian golden hamster	Not yet initiated	[55]
	4'-fluorouridine	Broad-spectrum anti-RNA virus, inhibits RdRp and terminates viral RNA chain synthesis	Syrian golden hamster	Not yet initiated	[56]
Fusion inhibitory peptides	Cholesterol-tagged fusion inhibitory peptide	Alters F protein conformation, inhibits viral entry into host cells	African green monkey/hamster	Not yet initiated	[57]