Situation at a glance
On 11 June 2026, the Kerala State Health Department confirmed one laboratory confirmed case of Nipah virus (NiV) infection in Kozhikode district, Kerala State, India.
The case is an adult male who developed symptoms on 30 May 2026 and was hospitalized on 10 June 2026.
He presented with neurological manifestations and at the time of reporting is on ventilatory support in an intensive care unit (ICU).
As of 18 June 2026, a total of 104 contacts had been identified and were under monitoring, including health and care workers, with no reported secondary cases to date.
NiV is a zoonotic disease transmitted to humans through infected animals, or through consumption of fruits or fruit products, such as raw date palm juice contaminated with the saliva, urine, or excreta of infected bats, as well as close contact with infected individuals.
The current event involves a single confirmed case, with no secondary transmission identified to date.
Public health measures are in place, including isolation, contact tracing, and enhanced surveillance.
However, as the source of infection has not yet been identified and given the known presence of animal reservoirs, additional cases cannot be excluded.
Description of the situation
On 11 June 2026, WHO was informed of a laboratory-confirmed case of Nipah virus infection reported in Kozhikode district, Kerala State.
Initial positive results were obtained through PCR testing at local laboratories and were subsequently confirmed by RT‑PCR at the National Institute of Virology, Pune.
The case is an adult male resident of Kozhikode district. He developed symptoms on 30 May 2026 and was admitted to hospital on 10 June 2026. The clinical presentation was primarily neurological, without reported respiratory symptoms prior to intubation. The patient is on ventilatory support in the ICU.
Following confirmation of the case, extensive contact tracing was initiated. As of 18 June 2026, a total of 104 contacts had been identified, including four very high-risk, 14 high-risk, and 86 low-risk contacts. Among these, 45 are health and care workers. All contacts are under active monitoring with regular follow-up, and no secondary cases have been reported to date.
This event follows a pattern of recurrent Nipah virus outbreaks in Kerala, including in Kozhikode district, since the first outbreak was reported in 2018. Additional outbreaks occurred in 2019, 2021, 2023, 2025, and 2026 according to the NCDC Communicable Disease Alert.
Epidemiology
NiV infection is a zoonotic disease transmitted to humans through infected animals (such as bats), or fruit or fruit products contaminated with saliva, urine, and excreta of infected bats.
Fruit bats or flying foxes (Pteropus species) are the natural hosts for the virus.
It can also be transmitted directly from person to person through close contact with an infected person.
The incubation period ranges from 3 to 14 days. In some rare cases, an incubation period of up to 45 days has been reported.
Laboratory diagnosis of a patient with a clinical history of NiV infection can be made during the acute and convalescent phases of the disease by using a combination of tests.
The main tests used are RT-PCR from bodily fluids and antibody detection via ELISA.
Human infections range from asymptomatic infection to acute respiratory infection (mild, severe), neurological symptoms, and fatal encephalitis (brain swelling).
Infected people initially develop symptoms including fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis (brain swelling). Some people can also experience atypical pneumonia and severe respiratory complications, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.
The case fatality ratio (CFR) in outbreaks across Bangladesh, India, Malaysia, and Singapore range from 40% to 75%, depending on local capabilities for early detection and clinical management.
Intensive supportive care is recommended to treat severe respiratory and neurologic complications.
There are currently no licensed medicines or vaccines specific for NiV infection.
Henipavirus nipahense (Nipah virus) is considered a priority pathogen for the accelerated development of medical countermeasures (MCMs) to respond to epidemics and pandemics as part of the WHO R&D Blueprint for Epidemics.
Further information about NiV infection can be found here.
Public health response
National and State authorities have implemented a range of coordinated response measures, including surveillance, case management, contact tracing, risk communication, and One Health investigations.
Immediate initiation of response measures upon preliminary positive laboratory results prior to national confirmation. Ongoing monitoring and coordination by State and Central health authorities, including the activation of Rapid Response Teams and coordination meetings at district level.
Deployment of central expert teams: a National Centre for Disease Control (NCDC) team and an Indian Council of Medical Research (ICMR) expert team both visited Kozhikode on 13 June 2026 to evaluate the situation and provide technical support for ongoing response activities.
Establishment of a State High-Power Committee for Epidemic Control: the Kerala State Health Department has constituted a multi-sectoral expert committee to study recurrent seasonal outbreaks in Kerala and develop evidence-based preventive recommendations. Membership includes government and private-sector clinicians, One Health experts, representatives from Animal Husbandry, Food Safety, Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH), and local government bodies.
Identification and monitoring of 104 contacts, with twice-daily follow-up.
Establishment of isolation wards and dedicated quarantine facilities at Kozhikode Government Medical College Hospital. Provision and stockpiling of personal protective equipment (PPE) and essential medical supplies.
Establishment of a control room for risk communication and public queries.
Systematic community surveillance: door-to-door surveys completed across all 320 households (1047 residents) in Ramanattukara Municipality Division 5. No Nipah-compatible symptoms were identified among surveyed residents.
Psychosocial support: a district mental health programme is providing psychological support to contacts under quarantine, with 125 contacts reached by 18 June 2026.
One Health and environmental investigation: Animal Husbandry Department conducted specimen collection within a 5 km radius of the epicentre, including bat specimens (collected with Forest Department assistance) and faecal samples from bat roosting sites along with samples from other animals. All samples have been dispatched to the National Institute of High Security Animal Diseases (NIHSAD), Bhopal, for Nipah virus testing; results are pending.
WHO continues to monitor the evolving situation and support risk assessment and coordination efforts as needed.
WHO risk assessment
Nipah virus (NiV) (Henipavirus nipahense) is a rare zoonotic pathogen with a high case fatality rate (40–75%) and no licensed vaccine or specific antiviral treatment.
Its natural reservoirs are fruit bats (Pteropus spp.), which are widely distributed across India, South and Southeast Asia, and parts of Oceania.
Transmission to humans can occur through direct contact with infected animals, including bats and domestic animals, via contaminated food products such as raw date palm sap, or through close and prolonged contact with infected individuals, particularly in healthcare settings.
Since its first identification in 1998, NiV outbreaks have been reported in Bangladesh, India, Malaysia, the Philippines, and Singapore.
In India, outbreaks have been recurrent but relatively limited in scale, with the highest numbers reported in 2001 (66 cases) and 2018 (18 cases).
Over the past five years, approximately a dozen confirmed cases have been reported, all in Kerala State. Kerala has experienced NiV events since 2018 and has established surveillance systems, laboratory capacity, and rapid response mechanisms, including Rapid Response Teams at central and state levels. Ecological conditions, including those in districts such as Kozhikode, support fruit bat populations, facilitating repeated spillover events. Seasonal patterns are observed and locally, April to September is recognized as a Nipah high‑alert period.
The current event involves a single confirmed case with no evidence of secondary transmission as of 23 June 2026. The case has been isolated, and public health measures, including contact tracing, enhanced surveillance, and strengthened infection prevention and control in healthcare settings, have been rapidly implemented. The event appears to be geographically limited, with no evidence of international spread reported.
However, as the source of infection has not yet been identified and given the presence of known animal reservoirs and ongoing seasonal risk, additional cases, including sporadic zoonotic spillover, cannot be excluded.
This event represents the second notification of NiV infection in India in 2026, following the earlier two epidemiologically linked cases reported in West Bengal state in January 2026. There is an ongoing moderate sub-national risk, driven by recurrent zoonotic spillover, limited clinical specificity during the early stages of disease, and the absence of licensed vaccines or specific therapeutics, with potential for transmission among close contacts and in healthcare settings.
At the regional and global levels, the risk remains low, given the absence of cross-border or international spread and the geographically contained nature of the outbreak.
WHO advice
In the absence of a licensed vaccine or specific therapeutic treatment for Nipah virus disease, reducing or preventing infection in people relies on raising awareness of the risk factors.
This includes providing guidance on and reinforcing risk communication messages about the measures that people can take to reduce exposure to the Nipah virus.
Patient management should focus on delivering timely supportive care, supported by an effective laboratory system and adequate infection prevention and control measures in health facilities.
Intensive supportive care is recommended for treatment of severe respiratory and neurologic complications.
Public health educational messages should focus on:
° Reducing the risk of bat-to-human transmission
Efforts to prevent transmission should first focus on decreasing bat access to date palm sap and other fresh food products.
Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption.
Fruits with signs of bat bites should be discarded.
Areas where bats are known to roost should be avoided.
° Reducing the risk of human-to-human transmission.
Close unprotected physical contact with NiV-infected people should be avoided.
Regular hand washing should be carried out after caring for or visiting sick people along other preventive measures.
People experiencing Nipah-like symptoms should be referred to a health facility, as early supportive care is key in the absence of treatment.
Contact tracing and monitoring are also key to mitigate human-to-human transmission.
° Controlling infection in health care settings
Health and care workers caring for patients with suspected or confirmed infection, or handling specimens from them, should always implement standard precautions for infection prevention and control at all times, for all patients.
When caring for patients with suspected or confirmed NiV, WHO advises the use of contact and droplet precautions including a well-fitting medical mask, eye protection, a fluid-resistant gown, and examination gloves.
Airborne precautions should be implemented during aerosol-generating procedures, including placing the patient in an airborne-infection isolation room and the use of a fit-tested filtering facepiece respirator instead of a medical mask.
Suspected or confirmed cases of NiV should be placed in a single-patient room.
Samples taken from people and animals with suspected NiV infection should be handled by trained staff working in suitably equipped laboratories.
Based on the currently available information, WHO does not recommend any travel and/or trade restrictions.
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Source:
Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON609
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