Post-acute sequelae after Nipah virus infection: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Zhang, Tiantian
Wei, Qingshuang
Schmit, Nora
Type
Journal Article
Abstract
Background Nipah virus was first detected in the 1998-1999 Malaysia outbreak and remains a significant public health concern due to its high epidemic potential and recurrent outbreaks in South Asia. Incidence patterns of post-acute sequelae, characterised by persistence or delayed onset after the acute phase of an infection, are not well documented after infectious disease outbreaks. We aimed to address this knowledge gap.
Methods We conducted a systematic review and meta-analysis on the prevalence, incidence, duration, and characteristics of post-acute sequelae in survivors of Nipah virus infection. We searched PubMed and Web of Science for studies published in English between database inception and Nov 17, 2025. Articles were eligible for inclusion if they were peer-reviewed and reported primary data on post-acute sequelae in survivors of Nipah virus infection. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. We conducted random-effects meta-analysis for all outcomes reported in at least two studies, and assessed heterogeneity qualitatively and using the I2 statistic. This review was registered with PROSPERO CRD42024616198. Findings Our search identified 1,091 articles after deduplication, of which eight were eligible for inclusion in the systematic review and six in the meta-analysis. Study populations included hospitalised Nipah encephalitis survivors and total survivors of Nipah virus infection in three and five articles, respectively. Only one study included a healthy control group. Three articles were of high, four of moderate and one of low quality. We extracted prevalence for potential
neurological, psychiatric or non-specific post-acute sequelae. The pooled prevalence of total residual neurological deficits was 24% (95% CI 9-49; I2=0%) among total survivors of Nipah infection (3 studies; 80 participants), and 45% (95% CI 11-85; I2=64%) among the subset of survivors with acute Nipah encephalitis (3 studies; 87 participants). Publication bias could not be 34
meaningfully assessed due to the small number of studies in the meta-analysis. In the single controlled study, total residual neurological deficits, fatigue and daytime somnolence were significantly more prevalent in Nipah infection survivors than household controls. We estimated that 10% (95% CI 4-20; I2=0%) of Nipah infection survivors experience late-onset or relapsing neurological symptoms after initial recovery (3 studies; 291 participants). Interpretation These findings demonstrate a substantial long-term disease burden following Nipah virus infection, which should be accounted for in mathematical modelling studies. However, estimates were based on very limited data mainly from the Malaysia/Singapore outbreak. Additional limitations relate to subjective outcome assessment and heterogeneous populations of total Nipah infection survivors, which could have biased our estimates or affected their generalisability. Further research is needed in the Bangladeshi and Indian setting, where current outbreaks occur and are caused by a different viral strain.
Methods We conducted a systematic review and meta-analysis on the prevalence, incidence, duration, and characteristics of post-acute sequelae in survivors of Nipah virus infection. We searched PubMed and Web of Science for studies published in English between database inception and Nov 17, 2025. Articles were eligible for inclusion if they were peer-reviewed and reported primary data on post-acute sequelae in survivors of Nipah virus infection. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. We conducted random-effects meta-analysis for all outcomes reported in at least two studies, and assessed heterogeneity qualitatively and using the I2 statistic. This review was registered with PROSPERO CRD42024616198. Findings Our search identified 1,091 articles after deduplication, of which eight were eligible for inclusion in the systematic review and six in the meta-analysis. Study populations included hospitalised Nipah encephalitis survivors and total survivors of Nipah virus infection in three and five articles, respectively. Only one study included a healthy control group. Three articles were of high, four of moderate and one of low quality. We extracted prevalence for potential
neurological, psychiatric or non-specific post-acute sequelae. The pooled prevalence of total residual neurological deficits was 24% (95% CI 9-49; I2=0%) among total survivors of Nipah infection (3 studies; 80 participants), and 45% (95% CI 11-85; I2=64%) among the subset of survivors with acute Nipah encephalitis (3 studies; 87 participants). Publication bias could not be 34
meaningfully assessed due to the small number of studies in the meta-analysis. In the single controlled study, total residual neurological deficits, fatigue and daytime somnolence were significantly more prevalent in Nipah infection survivors than household controls. We estimated that 10% (95% CI 4-20; I2=0%) of Nipah infection survivors experience late-onset or relapsing neurological symptoms after initial recovery (3 studies; 291 participants). Interpretation These findings demonstrate a substantial long-term disease burden following Nipah virus infection, which should be accounted for in mathematical modelling studies. However, estimates were based on very limited data mainly from the Malaysia/Singapore outbreak. Additional limitations relate to subjective outcome assessment and heterogeneous populations of total Nipah infection survivors, which could have biased our estimates or affected their generalisability. Further research is needed in the Bangladeshi and Indian setting, where current outbreaks occur and are caused by a different viral strain.
Date Issued
2026-04-01
Date Acceptance
2026-03-24
Citation
EClinicalMedicine, 2026, 94 (1)
ISSN
2589-5370
Publisher
Elsevier
Journal / Book Title
EClinicalMedicine
Volume
94
Issue
1
Copyright Statement
© 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
License URL
Subjects
Nipah virus
Epidemics
Emerging infectious diseases
Disease sequelae
Epidemiological parameters
Publication Status
Published
Article Number
103878
Date Publish Online
2026-04-09