Welcome to Public Health On Call, a podcast from the Johns Hopkins Bloomberg School of Public Health,

where we bring evidence, experience, and perspective to make sense of today's leading health challenges.

If you have questions or ideas for us, please send an email to public health question at jh.edu.

That's public health question at jhhu.edu for future podcast episodes.

This is Lindsay Smith Rogers.

NEPA virus is in the news again, this time with an outbreak in Kerala, India.

Johns Hopkins epidemiologist Emily Gurley returns to the podcast to talk with me about the deadly

zoonotic virus, which spreads from bats to humans and her work investigating NEPA spillover events.

We also talk about how lessons from studying NEPA's complex transmission

can give us clues to finding and preventing other spillover events and even pandemics. Let's listen.

Emily Gurley, thank you so much for coming back on public health on call. Today we're going to

talk about NEPA and your work studying this

virus. So can you tell us a little bit about how the virus presents clinically?

Sure. Happy to be here and talk about NEPA. NEPA is a concern in part because of how severe

the clinical presentation is. There has been some evidence of asymptomatic or mild infections,

but most people who have NEPA develop severe disease, including encephalitis, which is swelling

of the brain, brain stem, or severe respiratory symptoms, including difficulty breathing, or both. And the case fatality is very high.

And the first recognized outbreak in Malaysia, the case fatality was around 40%. Subsequently,

and outbreaks in South Asia, it's been closer to 75%. Although there is some difference between

case fatality among patients who are infected from bats, it's a bat borne virus, and those infected person to

person. If you're infected from another NEPA patient, their chances of survival

are usually a bit better, usually about 50% survival. But just because you survive doesn't mean

...