Molecular epidemiology and pathogenic mechanisms of the 2023 Nipah virus outbreak in Kerala, India
DOI:
https://doi.org/10.58445/rars.1115Keywords:
epidemiology, Nipah virus outbreak, Kerala, IndiaAbstract
The 2023 Nipah virus (NiV) outbreak in Kerala, India, was the largest known occurrence to date, with 30 confirmed cases and an alarming fatality rate of 40–75%. Approximately half of the cases involved human-to-human transmission, an unprecedented level for NiV outbreaks. The review provides a comprehensive analysis of the genomic characteristics, cellular tropism, replication dynamics, pathogenesis, and host immune responses associated with the 2023 Kerala outbreak strain. It identifies significant gaps and non-obvious limitations in the existing knowledge base, proposing future research trajectories to address these deficiencies. By elucidating the viral determinants and mechanisms underlying the strain's enhanced transmissibility, cell entry, replication fitness, and pathogenicity, this review aims to inform the development of effective countermeasures and robust preparedness strategies against Nipah virus outbreaks worldwide. It also discusses the implications of key mutations identified in the viral attachment, fusion, and polymerase proteins, which may have contributed to the strain's enhanced transmissibility, cell entry, and replication fitness. Additionally, it explores the expanded cell and tissue tropism observed during this outbreak, highlighting potential entry receptors and the role of viral proteins in mediating these interactions. The review delves into the replication cycle of the 2023 strain, examining viral protein functions and interactions with host factors that could influence viral kinetics. It also discusses the dysregulated host immune responses, cytokine storm, and immune evasion strategies employed by the virus, shedding light on the mechanisms underlying the severe pathogenesis. Finally, the review assesses potential therapeutic strategies, including existing antivirals, novel small-molecule inhibitors, monoclonal antibodies, and vaccine development efforts tailored to the 2023 strain. By providing a comprehensive understanding of this outbreak, the aim is to inform future preparedness efforts, guide the development of effective countermeasures, and ultimately mitigate the impact of Nipah virus outbreaks worldwide.
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Map was generated by using ArcGIS version 10.4.1 software (https://desktop.arcgis.com/en/quick-start-guides/10.4/arcgis-desktop-quick-start-guide.htm).
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