Nipah virus preparedness in a One Health framework: Implications for Europe.

Nipah virus (NiV) is a highly pathogenic zoonotic henipavirus associated with severe neurological and respiratory disease and a high case fatality rate. Although outbreaks have remained geographically limited, recurrent events in South and Southeast Asia highlight the persistent risk posed by NiV and the potential global consequences of delayed detection and response. In non-endemic regions such as Europe, preparedness presents distinct challenges due to the rarity of cases, stringent biosafety requirements, and reliance on specialised diagnostic and clinical capacities that may degrade without routine use. This narrative review synthesises evidence from peer-reviewed literature and international public health agency reports on NiV biology, epidemiology, diagnostics, treatment, and preparedness, with a particular focus on operational implications for Europe within a One Health framework. We examine determinants of zoonotic spillover and limited human-to-human transmission, outline constraints across the diagnostic pathway including specimen handling and biosafety requirements and summarise current approaches to clinical management and investigational medical countermeasures. Attention is given to how these factors inform risk assessment, diagnostic readiness, and clinical recognition in non-endemic health systems. Preparedness for NiV should be conceptualised as a continuous process of biomonitoring and response rather than an episodic emergency activity. Integrated surveillance across human, animal, and environmental domains is essential for early identification of spillover signals and proportionate public health action. For Europe, sustained preparedness depends on maintaining functional capacity across laboratory networks, clinical services, and public health systems, supported by cross-border coordination and the systematic integration of One Health intelligence.