Nipah virus (Niv), a zoonotic paramyxovirus of the Henipaviral genus, continues to pose recurrent epidemic threats across South and Southeast Asia. Initially recognized in Malaysia (1998–99) and later established as endemic in Bangladesh and India, its high case-fatality rate (40–90%) and absence of licensed therapeutics make it a pathogen of pandemic concern. Recent outbreaks in Kerala during 2018, 2021, and 2023 reaffirm the need for an integrated One Health approach, cross-border surveillance, and accelerated therapeutic research.