Nepal's vulnerability to Nipah virus transmission: an urgent call for preparedness.

The confirmation of two Nipah virus (NiV) infections among healthcare workers in West Bengal, India, in December 2025 highlights the ongoing regional threat of this highly contagious zoonotic pathogen and the risk of nosocomial transmission before clinical suspicion. Increasing reports of human-to-human transmission in South Asia call for stronger preparedness efforts in neighboring countries. Nepal is particularly vulnerable due to its open border with India, high population mobility, ecological suitability for Petropus bat reservoirs, mixed livestock farming, limited surveillance, and diagnostic capacity. The absence of reported cases likely reflects underdetection rather than the absence of risk. Current gaps include weak infection prevention and control, limited laboratory readiness, minimal wildlife and livestock surveillance, and inadequate cross-border coordination. We propose priority actions based on the One Health approach, including bat roost mapping, cross-border information sharing, targeted community risk communication, strengthening tertiary hospitals and laboratory capacity, enhanced veterinary surveillance, and the development of a national outbreak preparedness and response plan for future potential NiV or other emerging pathogen outbreaks.