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Henipavirus evidence gaps: a Rapid Research Needs Appraisal
Marieke de Swart1, Amen-Patrick Nwosu1, Sandrena Ruth Frischer1
1Policy and Practice Research Group, Pandemic Sciences Institute, University of Oxford, Oxford, UK.
Introduction:
Henipaviruses have been identified as priority pathogens by the WHO for research and development. We applied a rapid research needs appraisal (RRNA) review methodology to systematically identify existing henipavirus evidence on clinical characteristics, immune response, transmission, risk factors, medical countermeasures and associated social and behavioural factors, to inform research prioritisation, and strategies to strengthen our preparedness and response for henipaviruses to protect populations and improve outcomes.
Method:
We searched PubMed, Ovid Embase, Cochrane Library, Epistemonikos from 1974 to 15 May 2025 for studies focused on henipavirus infection including humans or human samples. Two reviewers screened studies and extracted data across predefined research domains without language restrictions. Data were analysed descriptively.
Results:
Of 106 records included, most focused on Nipah (82.1%, 87/106), followed by Hendra (17.9%, 19/106) and Langya virus (1.9%, 2/106) disease, set in Asia (82.1%, 87/106), Australia (17.9%, 19/106) and Europe (0.9%, 1/106). Most (96.2%, 102/106) were observational, 3.8% (4/106) interventional studies. Adults were included in 76.4% (81/106) studies, children in 32.1% (34/106); pregnant women in 0.9% (1/106). Studies focused on clinical characteristics (n=59), transmission (n=28), risk factors (n=16), social science (n=17), diagnostics (n=14), immune response (n=9), and therapeutics (n=4). Of the four interventional studies, two focused on medical countermeasures, including a non-randomised controlled Nipah ribavirin study and a phase I m102.4 antibody Nipah and Hendra treatment trial in adults. Two were social science studies: one a self-instruction prevention training module, the other a workshop on personal protective equipment. Human vaccine studies were lacking, but nine studies explored attitudes to vaccination of horses against Hendra virus.
Conclusion:
Our data highlight the limited evidence available and the lack of medical countermeasures for henipaviruses. The gaps in inclusion of high-risk populations (young children, pregnant women) are concerning. Our data show a need to identify effective medical countermeasures, supported by behavioural studies, and to invest in One Health studies to generate evidence to inform strategies to protect societies against the threat of henipaviruses.
