Nipah Virus kills two in Kerala State, India.

Two deaths caused by Nipah Virus have been confirmed in Kerala State, India, in an outbreak in Malappuram and Palakkad districts, that began in April 2025, according to a press release issued by the World Health Organization on 6 August 2025.

The first patient, a woman from Malappuram District presented at a hospital in the same district with fever, cough, and respiratory distress on 25 April 2025. She was admitted to the hospital, and then transferred to an intensive care unit on 2 May after developing acute encephalitis, where she is still being treated. The woman was diagnosed with Nipah Virus on 6 May after samples were sent to Calicut Medical College for testing, with the diagnosis being confirmed by a repeat of the test at the National Institute of Virology in Pune on 8 May.

The second patient, also a woman from Malappuram District first developed symptoms on 25 June, and unsuccessfully sought treatment at several healthcare institutions before being admitted to a multi-speciality hospital, where she died on 1 July. Tests subsequently confirmed she was infected with Nipah Virus.

The third patient, a woman from Palakkad District, developed symptoms on 25 June, and again sought treatment at several healthcare centres before being admitted to a multi-speciality hospital, where she remains in a critical condition on a ventilator. Tests confirmed that she was infected with Nipah Virus, making her the first ever confirmed case in Palakkad District.

The final patient, a man from Palakkad District, developed symptoms on 6 July and immediately sought treatment. He was admitted to a private hospital on 10 July, then transferred to a multi-speciality hospital on 11 July, where he died a day later. He too was confirmed by tests to have Nipah Virus, making him the second case in the district.

Nipah Virus infection, a zoonotic illness, is spread to Humans through contact with infected Animals such as Bats and Pigs. Additionally, direct contact with an infected individual can also lead to transmission, although this route is less common. Those affected by Nipah Virus infection may experience severe symptoms, including acute respiratory infection and fatal encephalitis. The only way to reduce or prevent infection in people is by raising awareness about the risk factors and preventive measures to protect themselves. Case management should focus on providing patients with supportive care measures and intensive support for severe respiratory and neurological complications.

Nipah Virus infection in Humans causes a range of clinical presentations including acute respiratory infection and fatal encephalitis.  The case-fatality rates in outbreaks across Bangladesh, India, Malaysia, and Singapore typically range from 40% to 100%. As of now, there are no available effective therapies or vaccines for this disease.

Electron micrographic image of Nipah Virus. Centers for Disease Control and Prevention.

Nipah Virus was first reported in Kerala State in 2018, since when there have been outbreaks every year. The first ever recorded case of Nipah Virus in India was reported in West Bengal in 2001. To date there have been 28 deaths caused by the Virus in Kerala, although 21 of these were in 2018, when local medical authorities were naïve to the disease. 

In the absence of a vaccine or licensed treatment available for Nipah Virus, the only way to reduce or prevent infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to Nipah Virus infection. Case management should focus on the delivery of supportive care measures to patients. Intensive supportive care is recommended to treat severe respiratory and neurological complications.

In order to reduce Bat-to-Human transmission, freshly collected Date Palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of Bat bites should be discarded. Areas where Bats are known to roost should be avoided. The risk of international transmission via fruit or fruit products (such as raw date palm juice) contaminated with urine or saliva from infected fruit Bats can be prevented by washing them thoroughly and peeling them before consumption.

Natural infection in domestic Animals has been described in farming Pigs, Horses, and domestic and feral Cats. Gloves and other protective clothing should be worn while handling sick Animals or their tissues and during slaughtering and culling procedures. As much as possible, people should avoid being in contact with infected Pigs. In endemic areas, when establishing new Pig farms, consideration should be given to the presence of Fruit Bats in the area and in general, Pig feed and Pig sheds should be protected against Bats when feasible. Samples taken from Animals with suspected Nipah Virus infection should be handled by trained staff working in suitably equipped laboratories.

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Four Human deaths from Rabies outbreak in Timor-Leste in May & June 2025.

Four Human deaths from Rabies have been confirmed in Timor-Leste (formerly East Timor) between 17 May and 17 June 2025, according to a bulletin issued by the World Health Orgnization on 24 July 2024. All four had been bitten by Dogs infected by the disease, and suffered syptoms including hydrophobia, photophobia, aggressiveness, convulsions, and hallucinations, and all four were subsequently confirmed as Rabies infections by Reverse Transcription Polymerase Chain Reaction testing at the National Health Laboratory.

The first fatality was an adult male from Ermera Municipality, who was bitten by a Dog in March 2025, and sought medical help on 15 May, subsequently dying in a hospital two days later. The second fatality, another adult male, this time from Oecusse Municipality, who was bitten by a Dog in June 20242, and arrived at a regional hospital with symptoms on 27 May 2024, subsequently dying on 30 May. The third case was another adult male, this time from Bobonaro Municipality, who arrived at a medical centre on 12 June 2025, having been bitten by a Dog 2-3 months earlier. This parient subsequently died on 13 June. The final case was a female child from Bobonaro Municipality, who was taken into medical care on 12 June 2025, having been bitten by a Dog about two months earlier. This patient subsequently died on 17 June. Two further Rabies fatalities were reported in Oecusse Municipality in 2024.

The outbreak appears to have begun in Dogs in Oecusse Municipality in March 2024, since when 103 Dogs have died from the disease in Oecusse and Bobonaro Municipalities, as well as two Goats, one each in Oecusse and Bobonaro, and a Pig in Bobinaro. Oecusse Municipality forms an enclave within Indonesia's East Nusa Tenggara Province, where Rabies is considered to be endemic and Human fatalities are frequently reported, with Bobonaro shares a border with the province. Ermera Municipality lacks a border with Indonesia, but borders Bobonaro.

The island of Timor showing the regions covered by Timor-Leste and East Nusa Tenggara Province. Google Maps.

The rising number of Rabies deaths in Timor-Leste suggests the disease is spreading across the its borders with Indonesia, pobably via infected Dogs, and becoming established within the smaller nation. The World Health Organization recomends that this is addressed through a combination of Dog vaccinations and education to raise public awareness of the disease. 

Between March 2024 and 15 June 2025, 1445 dog scratches and bites were reported in Timor-Leste, 41% of which were considered to by Catagoy III exposures, which is to say exposures in which the skin is broken and saliva from an Animal has come into contact with this break. World Health Organization guidelines recomend that in such cases the wound should be washed immediately and the patient should be given  immediate vaccination and administration of rabies immunoglobulin/monoclonal antibodies. Of the 1445 known Catagory III exposures in Timor-Leste in 2024 and 2025, only 66% began this course of vaccination and antibody administration, and only 18% completed the course.

Rabies is caused by Viruses of the genus Lyssavirus, a member of the Rhabdoviridae Family of negative-sense single-stranded RNA Viruses, which also includes pathogens attacking Fish, Insects and Plants. Rabies is spread through the saliva of infected animals, and causes hydrophobia (fear of water),  anxiety, insomnia, confusion, agitation, abnormal behaviour, paranoia, terror, and hallucinations, followed by paralysis, coma and death in Humans. Many animals (notably Dogs) become extremely aggressive at this stage and will bite anything that comes near them, helping to spread the disease. 

Transmission electron microscope image with numerous rabies virions (small, dark grey, rodlike particles) and Negri bodies (the larger pathognomonic cellular inclusions of rabies infection). Centers for Disease Control and Prevention/Wikimedia Commons.

In Humans, the disease typically has a gestation period of about three months, during which time the disease can be treated by repeated vaccination and doses of human rabies immunoglobulin, though if treatment is not begun within ten days of infection it is less likely to be successful, and once the patient starts to develop symptoms the disease is almost invariably fatal. Any wound thought to have been caused by an infected animal should be washed thoroughly under running water for at least five minutes, before being treated with alcohol or iodine, and immediate medical attention sought.

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Global number of Measles cases rose by 20% in 2023.

The number of Measles cases recorded worldwide rose by 20% in 2023 (compared to 2022), with 10.3 million cases recorded globally, according so a joint press release issued by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The main driver of this rise in cases is thought to be inadequate immunization coverage.

Two doses of Measles vaccine is sufficient to protect against infection with the disease, but 17% of children who should have received their first dose of the vaccine in 2023 are thought not to have done so (more than 22 million children), while 26% of children who should have received a second dose in 2023 did not do so. A vaccine coverage rate of 95% or higher for both vaccine doses is thought to be needed to prevent Measles spreading within a population.

Fifty seven countries are thought to have suffered Measles outbreaks due to gaps in vaccination coverage, a 60% rise on the 36 countries which suffered such outbreaks in 2022. The World Health Organization's African, Eastern Mediterranean, European, South-East Asia and Western Pacific regions were affected, with over half of outbreaks occurring in the African Region. Only the Americas Region was not affected by a Measles outbreak in 2023.

A doctor examines a girl with measles at the Republican Infectious Diseases Clinical Hospital, Bishkek city, Kyrgyzstan. Danil Usmanov/World Health Organization.

'Measles vaccine has saved more lives than any other vaccine in the past 50 years,' according to Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization. 'To save even more lives and stop this deadly virus from harming the most vulnerable, we must invest in immunization for every person, no matter where they live.'

Measles is a human disease caused by a Virus in the Paramyxovirus family. The Virus infects the respiratory tract, then spreads throughout the body. It can lead to major epidemics with significant morbidity and mortality, especially among vulnerable people. Among young and malnourished children, pregnant women, and immunocompromised individuals, including those with HIV, cancer or treated with immunosuppressives.

Thin-section transmission electron micrograph revealing the ultrastructural appearance of a single Viron, of the Measles Virus. The measles Virus is a Paramyxovirus, of the genus Morbillivirus. It is 100-200 nm in diameter, with a core of single-stranded RNA, and is closely related to the Rinderpest and Canine Distemper Viruses. Two membrane envelope proteins are important in pathogenesis. They are the F (fusion) protein, which is responsible for fusion of virus and host cell membranes, viral penetration, and hemolysis, and the H (hemagglutinin) protein, which is responsible for adsorption of virus to cells. Centers for Disease Control and Prevention/Wikimedia Commons.

It is estimated that 107 500 people died of Measles in 2023, most of them children below the age of five. This is an eight 8% drop in fatalities compared to 2022. The reason for this lower fatality rate in 2023, despite a higher infection rate, is thought to be that more cases of Measles were reported in 2023 in countries with generally better healthcare and childhood nutrition rates, where infected children are less likely to die. However, this is not all good news, as even where Measles is not fatal, it can cause a number of severe health problems, including blindness, pneumonia, and encephalitis (swelling of the brain, often leading to brain damage).

Measles is one of twenty life-threatening diseases which it was hoped could be eliminated through vaccination campaigns by 2030 under the remit of the Immunization Agenda 2030 program. In the first week of November 2024, Brazil was declared to be Measles-free, meaning that the disease had been eliminated in the Americas Region, and at least one nation in each of the other regions, with the exception of Africa, also having Measles-free status. However, the decline in vaccine-uptake, and the subsequent rise in Measles cases around the world, means that this project is now threatened.

The African and Eastern Mediterranean regions are thought to be in particular need of urgent and targeted interventions to ensure vaccine availability and uptake, particularly in conflict-affected and other vulnerable settings. Greater surveillance for cases is also needed in all regions, in order to facilitate prompt responses to outbreaks when they occur.

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Outbreak of Chandipura Virus causes at least 82 deaths in India.

Between 1 June and 15 August 2024, the Indian Ministry of Health and Family Welfare recorded 245 cases of suspected Chandipura Virus infection in Gujarat and Rajasthan states, with 45 districts affected and 82 known deaths, a case fatality rate of 33%, according to a press release issued by the World Health Organization on 23 August 2024. Sixty four of the cases have been confirmed as Chandipura Virus by either immunoglobulin M enzyme-linked immunosorbent assay or reverse transcription polymerase chain reaction, sixty one of these in Gujarat and three in Rajasthan. The number of new cases being reported has been declining since 19 July 2024.

Chandipura Virus, or Chandipura vesiculovirus, is endemic to western, central, and southern India, with sporadic outbreaks occurring across this region,  typically during the monsoon season. In 2023 an outbreak of the Virus in Andhra Pradesh led to 183 deaths among 329 reported cases, a case fatality rate of 55.6%. Other recent outbreaks have led to case fatality rates of between 56 and 75%. In Gujarat there appears to be a spike in cases every four-to-five years. 

Chandipura vesiculovirus is a negative-sense single-stranded RNA Virus in the family Rhabdoviridae. Like many Viruses in this family, it is a zoonotic disease which can be spread by a number of Arthropod vectors, including Sandflies, Mosquitoes, and Ticks, although its main vector appears to be the Sandfly, Phlebotomus papatasi. Notably, although Human infections with Chandipura vesiculovirus have been reported only from India, the Sandfly, Phlebotomus papatasi, has a much wider distribution, and the Virus has been extracted from Sandflies in Senegal, as well as a range of Mammals in Senegal, Nigeria, Bhutan, and Nepal, suggesting a much wider, undetected, range.

Transmission electron micrographs of primary Chandipura Virus isolates from culture. Rao et al. (2004).

Chandipura Virus infection can lead to the development of a febrile disease, predominantly in children under 15, which can lead rapidly to convulsions, coma, and in the worst cases, death. In children, where fatality occurs, it typically happens within 48-72 hours of the first symptoms being detected.

The Indian Ministry of Health and Social Welfare has deployed specialist teams to Gujarat State to help implement control measures, including fumigating dwellings with insecticide to control the vectors of the disease and an education campaign aimed at raising awareness of the Virus, symptoms, and preventive measures.

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Local transmission of Dengue Fever recorded in Iran for the first time.

The transmission of Dengue Fever within Iran has been demonstrated for the first time in June 2024, according to a press release issued by the World Health Organization on 22 July 2024. The Ministry of Health and Medical Education of Iran reported to cases of the disease had been confirmed by Polymerase Chain Reaction testing at the Pasteur Institute in Bandar Abbas, both in patients from the city of Bandar-Lengheh in Hormozgan Province who had never travelled outside of Iran, and who can therefore be confirmed to have acquired the infection within the country. By 17 July 2024 twelve cases had been confirmed in Bandar-Lengheh among people who had no history of travel outside the country.

This development is not entirely unexpected, as the number of imported cases within Iran has remained steady at about 20 per year between 2017 and 2023, and the Aedes aegypti and Aedes albopictus Mosquitoes, which act as vectors for the disease, are both present in Sistan and Balouchistan, Hormozgan, Bushehr, Khuzastan, and Gilan provinces. In 2024 the number of cases in the country has risen sharply, with 137 reported between 15 May and 10 July.

Dengue is a viral infection transmitted to humans through the bite of infected Mosquitoes and is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. The primary vectors that transmit the disease are Aedes aegypti Mosquitoes and, to a lesser extent, Aedes albopictus.  These mosquitoes are also vectors of Chikungunya, Yellow Fever and Zika viruses. Dengue is widespread throughout the tropics, with local variations in risk influenced by climate parameters as well as social and environmental factors.

Colour print of the Dengue Mosquito Aedes aegypti (then called Stegomyia fasciata, today also Stegomyia aegypti). To the left, the male, in the middle and on the right, the female. Above left, a flying pair in copula. Emil August Goeldi (1905)/Wikimedia Commons.

Infection with the Dengue Virus can cause a wide spectrum of disease. Ranging from subclinical disease (people may not know they are even infected) to severe flu-like symptoms in those infected. Although less common, some people develop Severe Dengue, which can be any number of complications associated with severe bleeding, organ impairment and/or plasma leakage. Severe Dengue has a higher risk of death when not managed appropriately. Severe Dengue was first recognised in the 1950s during Dengue epidemics in the Philippines and Thailand. Today, Severe Dengue affects most Asian and Latin American countries and has become a leading cause of hospitalisation and death among children and adults in these regions.

Dengue is caused by a Virus of the Flaviviridae family of positive-strand RNA Viruses and there are four distinct, but closely related, serotypes of the Virus that cause Dengue (Dengue Fever Virus-1, Dengue Fever Virus-2, Dengue Fever Virus-3 and Dengue Fever Virus-4). Recovery from infection is believed to provide lifelong immunity against that serotype. However, cross-immunity to the other serotypes after recovery is only partial, and temporary. Subsequent infections (secondary infection) by other serotypes increase the risk of developing Severe Dengue.

A transmission electron micrograph showing Dengue Virus virions (the cluster of dark dots near the centre). Centers for Disease Control and Prevention/Wikimedia Commons.

Dengue has distinct epidemiological patterns, associated with the four serotypes of the Virus. These can co-circulate within a region, and indeed many countries are hyper-endemic for all four serotypes. Dengue has an alarming impact on both human health and the global and national economies. Dengue Fever Virus is frequently transported from one place to another by infected travellers; when susceptible vectors are present in these new areas, there is the potential for local transmission to be established.

The incidence of Dengue has grown dramatically around the world in recent decades. A vast majority of cases are asymptomatic or mild and self-managed, and hence the actual numbers of dengue cases are under-reported. Many cases are also misdiagnosed as other febrile illnesses.

One modelling estimate indicates 390 million Dengue Virus infections per year, of which 96 million manifest clinically (with any severity of disease). Another study on the prevalence of dengue estimates that 3.9 billion people are at risk of infection with dengue viruses. Despite a risk of infection existing in 129 countries, 70% of the actual burden is in Asia.

The number of dengue cases reported to the World Health Organization increased over 8 fold over the last two decades, from 505 430 cases in 2000, to over 2.4 million in 2010, and 5.2 million in 2019. Reported deaths between the year 2000 and 2015 increased from 960 to 4032, affecting mostly younger age group. The total number of cases seemingly decreased during years 2020 and 2021, as well as for reported deaths. However, the COVID-19 pandemic might have also hampered case reporting in several countries.

The overall alarming increase in case numbers over the last two decades is partly explained by a change in national practices to record and report Dengue to the Ministries of Health, and to the World Health Organization. But it also represents government recognition of the burden, and therefore the pertinence to report Dengue disease burden.

Before 1970, only 9 countries had experienced Severe Dengue epidemics. The disease is now endemic in more than 100 countries in the World Health Organization regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific. The Americas, South-East Asia and Western Pacific regions are the most seriously affected, with Asia representing about 70% of the global burden of disease.

Not only is the number of cases increasing as the disease spreads to new areas including Europe, but explosive outbreaks are occurring. The threat of a possible outbreak of Dengue now exists in Europe; local transmission was reported for the first time in France and Croatia in 2010 and imported cases were detected in 3 other European countries. In 2012, an outbreak of Dengue on the Madeira islands of Portugal resulted in over 2000 cases and imported cases were detected in mainland Portugal and 10 other countries in Europe. Autochthonous cases are now observed on an annual basis in few European countries.

Iran forms part of the World Health Organization's Eastern Mediterranean Region, which is considered to be at high risk to Dengue Fever epidemics, with many countries having fragile healthcare systems due to conflict and political instability, while other countries where healthcare systems are considered to be stronger are sufferering increased rains due to climate change, leading to a proliferation of the Aedes aegypti and Aedes albopictus Mosquitoes which act as vectors for the disease. 

The countries of the World Health Organization's Eastern Mediterranean Region. Özturk et al. (2024).

Iran is particularly threatened by the presence of both types of Mosquito and a climate favourable to the spread of the disease, as well as a large numbers of visitors from countries where the disease is endemic. The discovery that the disease is being transmitted in the country at this time is particularly alarming as it comes shortly before the annual Arba'in Pilgrimage, which this year will take place in August, with potentially millions of Shiite Muslims from around the world visiting the Shrine of Husayn ibn Ali in the city of Karbala in central Iran.

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Outbreak of Hepatitis E in Ouaddai Province, Chad.

An outbreak of Hepatitis E has resulted in seven deaths and over 2000 people becoming sick in Ouaddai Province, Chad, according to a press release issued by the World Health Organization on 8 May 2024. The outbreak was first detected on 2 January 2024 when to cases of Acute Jaundice Syndrome were reported by medics from Médecins Sans Frontières who were operating a clinic at a temporary high school at a refugee camp in the Adré Health District of Ouaddai Province.

Between 2 January and 15 February 2024 the number of reported cases of Acute Jaundice Syndrome in Adré Health District rose to 113, of which 28 were confirmed as being Hepatitis E using rapid diagnostic test kits. On 19 February a case was reported at the Allasha Refugee Camp in the Hadjer-Hadid Health District, also Ouaddai Province.

Between 1 and 19 March 2024 forty blood samples taken from Acute Jaundice Syndrome sufferers in Ouaddai Province were sent to the Institute Pasteur of Dakar, Sénégal, where they were tested for Hepatitis E, Yellow Fever, Dengue, West Nile Fever, Zika, Chikungunya, Rift Valley Fever and Crimean-Congo Haemorrhagic Fever. Of these, 36 tested positive for Hepatitis E.

A refugee camp in eastern Chad in January 2024. Médecins Sans Frontières.

Between 2 January and 28 April 2024 a total of 2092 suspected cases of Hepatitis E were reported in Ouaddai Province, with seven fatalities. One hundred and three of these cases were members of the local conflict, while the remaining 1989 were refugees from the conflict in neighbouring Sudan, with the Lycée d'Adré, Aboutengué, and Metché refugee camps being particularly badly hit. 

Hepatitis E is caused by a single-stranded, nonenveloped, RNA Virus, and is usually a self-limiting infection, causing fever, nausea, loss of appetite, vomiting, jaundice, abdominal and joint pain and discolouration of the urine and stool, which typically passes within 2-6 weeks. However, in some cases the disease can cause acute liver failure (hepatitis) which is often fatal. Pregnant women are considered to be at particular risk from this disease, with a fatality rate of about 30%, compared to about 1% for the general population.

The Hepatitis E Virus. Centers for Disease Control and Prevention/Wikipedia.

Hepatitis E is spread through faeces and contaminated water, and thrives in unsanitary and crowded conditions. This makes it a particular problem in settings like refugee camps, where large numbers of people fleeing conflict situations arrive over short periods of time, overwhelming local sanitation systems. 

A queue of water containers at the Metché Refugee Camp in Ouaddai Province, Chad, where Médecins Sans Frontières is providing clean water. Médecins Sans Frontières.

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