Development of an early warning system for Nipah outbreak prevention: on-site inactivation, PCR surveillance and sequencing in Bangladesh

Background: Mobile laboratory diagnostic technologies for Nipah virus outbreak prevention, mitigation and response remain limited, despite the critical need for such capacities in remote, low-resource regions where most cases occur. We aim to address this gap by implementing a workflow that includes method development, laboratory validation, and field demonstration of a mobile Nipah virus complex diagnostic solution. Methods: We developed a flexible mobile laboratory workflow incorporating PCR capacity, a novel amplicon-based sequencing protocol, and a validated Nipah virus inactivation procedure. Following development and validation, we demonstrated the feasibility of this workflow through repeated field sampling of bat colonies in Nipah virus endemic regions of Bangladesh across multiple field campaigns. Findings: We demonstrated the feasibility of this system for early outbreak response and as a potential early warning tool prior to the emergence of human cases. We detected two urine samples from flying foxes that tested positive and performed full-scale on-site analysis, including qPCR diagnostics and NGS sequencing, within 24 hours. Interpretation: As highlighted in the present study, active surveillance enables outbreak prevention by identifying bat colonies that are actively shedding viruses in real time, even in rural settings. Also, this method can provide rapid, on-site sequence data to track and better understand the genomic diversity of Nipah virus in natural reservoirs during both outbreak and non-outbreak periods. In this study we aimed to establish the foundations of a standard procedure for safe and rapid field testing of Nipah virus in remote areas.