Post-acute sequelae after Nipah virus infection: a systematic review and meta-analysis

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: statistic. This review was registered with PROSPERO CRD42024616198. Findings: = 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. Funding: None.