Prioritizing surveillance of Nipah virus in India

The 2018 outbreak of Nipah virus in Kerala, India, highlights the need for global surveillance of henipaviruses in bats, which are the reservoir hosts for this and other viruses. Nipah virus, an emerging paramyxovirus in the genus Henipavirus, causes severe disease and stuttering chains of transmission in humans and is considered a potential pandemic threat. In May 2018, an outbreak of Nipah virus began in Kerala, > 1800 km from the sites of previous outbreaks in eastern India in 2001 and 2007. Twenty-three people were infected and 21 people died (16 deaths and 18 cases were laboratory confirmed). Initial surveillance focused on insectivorous bats (Megaderma spasma), whereas follow-up surveys within Kerala found evidence of Nipah virus in fruit bats (Pteropus medius). P. medius is the confirmed host in Bangladesh and is now a confirmed host in India. However, other bat species may also serve as reservoir hosts of henipaviruses. To inform surveillance of Nipah virus in bats, we reviewed and analyzed the published records of Nipah virus surveillance globally. We applied a trait-based machine learning approach to a subset of species that occur in Asia, Australia, and Oceana. In addition to seven species in Kerala that were previously identified as Nipah virus seropositive, we identified at least four bat species that, on the basis of trait similarity with known Nipah virus-seropositive species, have a relatively high likelihood of exposure to Nipah or Nipah-like viruses in India. These machine-learning approaches provide the first step in the sequence of studies required to assess the risk of Nipah virus spillover in India. Nipah virus surveillance not only within Kerala but also elsewhere in India would benefit from a research pipeline that included surveys of known and predicted reservoirs for serological evidence of past infection with Nipah virus (or cross reacting henipaviruses). Serosurveys should then be followed by longitudinal spatial and temporal studies to detect shedding and isolate virus from species with evidence of infection. Ecological studies will then be required to understand the dynamics governing prevalence and shedding in bats and the contacts that could pose a risk to public health. Author summary Nipah virus is an emerging zoonotic virus that spills over from bats to humans causing severe disease and chains of transmission in humans. In May 2018, in Kerala, India, Nipah virus infected 23 people, killing 21. We reviewed and analyzed published records of Nipah virus surveillance in bats and identified eleven species that occur in India and have had evidence of henipavirus infection or exposure. However, almost all of these bat species were sampled outside of India. Using a trait-based machine learning approach, we identified at least four additional Indian bat species that are likely to have been exposed to Nipah virus or cross-reacting henipaviruses. We suggest surveillance of these species as well as studies on the ecological dynamics of Nipah virus and epidemiology of spillover transmission to humans. This work will help prioritize a research agenda for responding to the recent outbreak of Nipah virus in Kerala, India and elsewhere.