Abstract
<title>Abstract</title> <p>Background Nipah virus (NiV) is a high-mortality zoonotic pathogen prioritized by WHO, with no licensed vaccines or specific antivirals. Medical students represent frontline future health workforce, yet robust NiV knowledge-attitude-practice (KAP) data among medical students in non-endemic Chinese regions remain scarce. This study aimed to assess NiV-related knowledge, attitudes and independent associated factors among medical students in Southwest China, and provide evidence for One Health-oriented medical education reform. Methods A cross-sectional questionnaire survey was conducted in February 2026 at Chongqing Three Gorges Medical College. Sociodemographic, physical fitness, NiV knowledge (16-item scale) and attitude (10-item Likert scale) data were collected. Cronbach’s α, KMO and Bartlett’s test were used for psychometric evaluation. Chi-square test, independent t-test, Spearman correlation and binary logistic regression were applied for statistical analysis. A total of 7355 questionnaires were distributed, and 6178 valid responses were included for final analysis. Results The knowledge and attitude scales exhibited excellent reliability and construct validity (Cronbach’s α = 0.779 and 0.937, both KMO > 0.94). Median knowledge score was 26 (IQR 24–28), with 66.5% students having adequate NiV knowledge; median attitude score was 47 (IQR 40–50), and 52.2% held positive prevention attitudes. Knowledge was positively correlated with attitudes (rₛ=0.141, P < 0.001). Multivariate regression showed female sex (OR = 1.655) was a positive predictor of adequate knowledge, while second-year students had lower odds of good knowledge (OR = 0.819). Positive attitudes were independently predicted by adequate NiV knowledge (OR = 1.790), whereas second-year, non-medical and ethnic minority students were less likely to hold positive attitudes. Only 12.43% participants had never heard of NiV; news and social media were dominant information sources, with authoritative professional materials rarely accessed. Severe misconceptions existed: merely 27.90% correctly recognized no approved NiV vaccines or targeted antiviral treatments available. Conclusions Medical students in non-endemic Southwest China possessed moderate NiV knowledge and generally positive attitudes, but critical clinical misconceptions and over-reliance on unregulated social media information channels were prominent. Targeted curriculum integration of NiV and priority zoonoses, standardized authoritative health communication and equity-focused education for vulnerable student subgroups are urgently needed to strengthen regional and global One Health pandemic preparedness.</p>