Sustaining Kerala's Progress against the Nipah virus: Operational strategies for long-term preparedness face to a recurrent zoonotic threat.

BACKGROUND: Nipah virus (NiV), a highly pathogenic zoonotic henipavirus with case fatality rates ranging from 40 to 75%, remains a recurrent public health threat in Kerala, India. Despite rapid containment of previous outbreaks, repeated spillover events underscore persistent ecological and systemic vulnerabilities. METHODS: We conducted a narrative policy and systems analysis integrating outbreak investigations, national laboratory guidelines, ecological evidence, and recent global research priorities (2020-2026)n the objectives being to identify structural preparedness gaps and to propose operationally feasible enhancements. RESULTS: Five strategic domains were identified: (1) optimization of diagnostic systems through a tiered hybrid laboratory model; (2) expansion of integrated One Health surveillance beyond bat reservoirs to livestock and ecological interfaces; (3) uniform health system preparedness across all tiers of care; (4) targeted digital outbreak intelligence systems adapted to localized transmission dynamics; and (5) spillover prevention strategies addressing human-animal interfaces. For each axis, resource implications, feasibility constraints, and implementation barriers are discussed. CONCLUSION: Sustainable NiV preparedness in Kerala requires calibrated investment in diagnostic decentralization, cross-sectoral surveillance integration, workforce strengthening, and targeted digital augmentation. System-level interventions may serve as a template for other NiV-endemic regions facing recurrent zoonotic spillover.