Reframing early warning for Nipah virus in Bangladesh: A shift from detection to anticipation

Abstract

Nipah virus continues to pose a recurrent zoonotic threat in Bangladesh. The sporadic spillover events are associated with high case fatality and limited opportunities for clinical intervention. Despite nearly two decades of surveillance response, early warning systems remain reactive, relying heavily on laboratory confirmation and case accumulation. This Perspective argues that early warning has been conceptually misframed as outbreak detection, rather than risk anticipation. Drawing on the epidemiological characteristics of Nipah virus and Bangladesh's current surveillance architecture, this study highlights key structural constraints delaying signal recognition. These include community-level blind spots, diagnostic uncertainty, and fragmented cross-sectoral surveillance. This article also outlines priority shifts that emphasize anticipatory risk assessment, operational One Health integration, context-sensitive alert thresholds, and a direct linkage between early signals and preparedness actions. Reframing early warning in this way is essential to improve readiness for the Nipah virus and other rare, high-impact zoonotic threats.