Current evidence on Nipah virus detection and implications for wastewater-based surveillance

Nipah virus (NiV) is a high-consequence zoonotic pathogen associated with severe neurological and respiratory disease, high case-fatality ratios (40-75%), and documented human-to-human transmission, including in healthcare settings. Current surveillance for NiV remains predominantly clinical and reactive, limiting the ability of infection prevention and control (IPC) programs to implement proportionate measures prior to healthcare exposure. Wastewater-based surveillance (WBS) has emerged as a complementary surveillance approach capable of detecting novel viral outbreaks, often before clinical case recognition. WBS has now been operationalized for multiple pathogens relevant to human health but the usefulness of WBS for tracking NiV outbreaks has not yet been demonstrated. As a result, this narrative review synthesizes evidence on NiV animal and human infections, transmission dynamics, viral shedding, molecular detection methods, and environmental considerations to evaluate the plausibility of WBS as an IPC-supporting surveillance approach. We distinguish biological feasibility (NiV shedding into wastewater), technical feasibility (recovery and quantification of NiV RNA from wastewater matrices), and operational feasibility (implementation within BSL-4 biosafety and infrastructure constraints). The available evidence indicates that NiV shedding in urine and respiratory secretions provide a biologically plausible route by which viral RNA could enter wastewater, particularly from hospital effluents. However, human fecal shedding remains unconfirmed and the recovery, persistence, and partitioning of NiV RNA in wastewater have not been characterized. WBS for NiV is therefore biologically plausible but not yet technically or operationally demonstrated. We suggest that targeted pilot studies and the development of independent, open-source RT-qPCR assays is required before NiV WBS could be considered for deployment.