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

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. 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. We conducted a systematic review 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 up to November 17, 2025. We included 8 articles, and extracted prevalence for 34 potential neurological, psychiatric or non-specific post-acute sequelae. The pooled prevalence of total residual neurological deficits was 24% (95% CI 9-49) among total survivors of Nipah infection, and 45% (95% CI 11-85) among the subset of survivors with acute Nipah encephalitis (5 articles). In the single controlled study, total residual neurological deficits, fatigue and daytime somnolence were significantly more prevalent in Nipah infection survivors than population-based controls. We estimated that 10% (95% CI 4-20) of Nipah infection survivors also experience late-onset or relapsing neurological symptoms after initial recovery. These findings demonstrate a substantial long-term disease burden following Nipah virus infection, which should be accounted for in mathematical modelling studies. However, the estimates are mainly based on data from the Malaysia/Singapore outbreak and may not be generalisable to the Bangladeshi and Indian setting, where current outbreaks occur and are caused by a different viral strain. Further limitations relate to subjective outcome assessment and heterogeneous populations of total Nipah infection survivors, which could have biased our estimates.