**Background:** Zoonotic diseases, which are infections transmitted from animals to humans, have caused numerous historical pandemics including the Spanish flu, Black Death, and the ongoing COVID-19 pandemic. The COVID-19 pandemic, caused by SARS-CoV-2, has overwhelmed healthcare systems globally, leading to neglect of other zoonotic infections such as Nipah virus, monkeypox, Langya virus, and others. India, being a predominantly agricultural country with high population density, deforestation, and urbanization, faces particular risk for zoonotic disease emergence. The paper aims to provide information about emerging zoonotic infections in India during the COVID-19 pandemic.
**Methods:** This is a narrative review article that synthesizes information from published literature on zoonotic diseases, with a focus on emerging viral infections in the context of the COVID-19 pandemic. The authors discuss the epidemiology, transmission, clinical features, and challenges of several zoonotic diseases including Nipah virus, COVID-19, Langya virus, monkeypox, scrub typhus, Zika virus, dengue, rabies, Japanese encephalitis, and Kyasanur Forest disease. They also review the One Health approach and strategies adopted by India during the pandemic.
**Key Results:** The paper reports that Nipah virus (NiV) outbreaks have occurred in India in 2001 (Siliguri, West Bengal), 2007 (Naidu district, West Bengal), 2018 (Kozhikode, Kerala), and September 2021 (Kozhikode, Kerala), with high fatality rates. The 2021 outbreak involved a 12-year-old boy who died from acute encephalitis. For COVID-19, the authors note that 55% of 425 early patients from Wuhan had linkage with Huanan Seafood Wholesale Market, and pangolins share 5/5 important amino-acids in the receptor binding domain with SARS-CoV-2. Langya virus (LayV) was identified in 35 patients in Chinese provinces between 2018-2021, with shrews as the likely natural reservoir. Monkeypox cases reached over 1500 cases from 43 nations by June 2022, with India reporting its first case on July 14, 2022, and 10 confirmed cases including one locally transmitted case. The paper also notes that in China, there was a substantial increase in zoonotic diseases like anthrax, brucellosis, leptospirosis, and hydatid disease from 2021 compared to 2020, possibly due to relaxation of nonpharmacological interventions. In the United States, Salmonella outbreaks linked to small turtles (87 illnesses, 32 hospitalizations, 1 death as of September 29, 2021) and bearded dragons (18 infections, 11 hospitalizations in November 2020) were reported during the pandemic.
**Clinical Implications:** The review underscores that zoonotic diseases pose a significant threat to public health, especially during pandemics when healthcare resources are diverted. The overlapping clinical features between COVID-19 and other zoonotic infections (e.g., fever, cough, respiratory symptoms) make diagnosis challenging. The lack of vaccines and specific therapeutics for many zoonotic viruses limits treatment to supportive care and prevention. The paper emphasizes the importance of the One Health approach, which involves collaboration between human health, animal health, and environmental sectors. India's strategies during COVID-19, including strengthening healthcare systems, public awareness campaigns, strict lockdowns, vaccination drives, and digital health initiatives, could serve as models for future pandemic preparedness. The authors recommend enhanced surveillance, animal health monitoring, safe food production, public education, and research funding for zoonotic disease prevention.