Enhancing preparation for large Nipah outbreaks beyond Bangladesh: Preventing a tragedy like Ebola in West Africa.

The Nipah virus has been transmitted from person-to-person via close contact in non-urban parts of India (including Kerala May 2018), Bangladesh, and the Philippines. It can cause encephalitis and pneumonia, and has a high case fatality rate. Nipah is a One Health zoonotic infectious disease linked to fruit bats, and sometimes pigs or horses. We advocate anticipating and preparing for urban and larger rural outbreaks of Nipah. Immediate enhanced preparations would include standardized guidance on infection prevention and control, and personal protective equipment, from the World Health Organization (WHO) on their OpenWHO website and 2018 "Managing Epidemics" handbook, along with adding best clinical practices by experts in countries with multiple outbreaks such as Bangladesh and India. Longer-term enhanced preparations include accelerating development of field diagnostics, antiviral drugs, immune-based therapies, and vaccines. WHO-coordinated multi-partner protocols to test investigational treatments, diagnostics, and vaccines are needed, by analogy to such protocols for Ebola during the unanticipated pan-epidemic in Guinea, Liberia, and Sierra Leone. Anticipating and preparing now for urban and rural Nipah outbreaks in nations with no experience with Nipah will help avoid the potential for what the United Nations 2016 report on Ebola in West Africa called a "preventable tragedy".

One health education for future physicians in the pan-epidemic "Age of Humans".

We propose the term "pan-epidemic Anthropocene" to refer to multifocal infectious disease epidemics related to human-caused (anthropogenic) forces such as urbanization, globalization, industrialization and the growing populations of humans and animals. The integrated framework of One Health (human, animal, and environmental health) helps both to understand why epidemics occur when and where they do, and also how to respond, mitigate, and sometimes prevent them. We suggest a collaborative mechanism for increasing One Health in medical education to create a synergy of strengths between the growing number of contributing One Health organizations in the US and internationally.