What precautions should be taken to avoid transmission of Nipah virus?

Preventing Nipah Virus Transmission

To prevent Nipah virus transmission, implement strict airborne precautions with N-95 respirators, face shields, gowns, and aprons for all suspected or confirmed cases, combined with rigorous contact tracing and immediate isolation, as person-to-person transmission occurs in approximately 50% of cases. 1

Primary Transmission Routes

Nipah virus spreads through three main pathways that require targeted prevention strategies:

• Bat-to-human transmission occurs primarily through consumption of raw date palm sap contaminated by bat saliva or urine 2
• Animal-to-human transmission happens when domestic animals (cattle, pigs, goats) consume food contaminated with bat excreta and subsequently infect humans 2
• Person-to-person transmission accounts for approximately half of all recognized cases in Bangladesh, occurring through close contact with infected patients' saliva 1, 2

Healthcare Worker Protection

Healthcare workers must use comprehensive airborne precautions when caring for any suspected or confirmed Nipah case:

• Wear N-95 respirators (not just surgical masks), gowns, aprons, and face shields at all times during patient care 1
• Maintain strict hand hygiene with alcohol-based hand rub before and after each patient encounter 3
• Prepare for early intubation rather than prolonged non-invasive ventilation trials, as emergency intubation during respiratory failure puts staff at unnecessary risk 1
• If non-invasive ventilation is attempted in carefully selected mild cases, it must occur only in ICU settings with strict airborne precautions and proper interface fitting 1

Community-Level Prevention

Preventing bat-to-human transmission requires specific behavioral modifications:

• Avoid consumption of raw date palm sap, which is the primary vehicle for bat-to-human transmission in Bangladesh 2
• Prevent bat access to date palm sap collection sites 2
• Avoid contact with sick domestic animals, particularly those showing neurological or respiratory symptoms 2

Contact Tracing and Isolation

Rapid identification and isolation of contacts is essential for outbreak containment:

• Implement immediate rigorous contact tracing for all confirmed cases, as a single hospitalized patient can generate 98 contacts in a healthcare setting alone 4
• Isolate all close contacts precautionarily, particularly family members and friends exposed to infected patients' saliva 2
• Maintain daily contact lists to facilitate rapid tracing if exposure occurs 4

High-Risk Populations Requiring Enhanced Precautions

Certain groups require heightened protective measures:

• Children aged <5 years are at particularly high risk and require close supervision to avoid animal contact and contaminated environments 3
• Pregnant women, immunocompromised individuals, and older adults need closer monitoring and should avoid any potential exposure 3

Critical Pitfalls to Avoid

Do not delay implementing airborne precautions while awaiting laboratory confirmation—clinical suspicion alone warrants full protective measures given the 50% person-to-person transmission rate 1

Do not rely solely on droplet precautions (surgical masks)—Nipah requires airborne precautions with N-95 respirators due to its transmission characteristics 1

Do not discharge patients without comprehensive follow-up plans, as neurological sequelae may emerge later even after apparent recovery 1

Do not attempt prolonged non-invasive ventilation in deteriorating patients—this delays definitive airway management and increases staff exposure risk during emergency intubation 1

Environmental Decontamination

When cleaning areas potentially contaminated by infected patients or animals:

• Wear rubber, latex, vinyl, or nitrile gloves during all cleaning activities 3, 5
• Spray all potentially contaminated surfaces with disinfectant or chlorine solution (1:10 bleach solution) before cleaning 3, 5
• Avoid sweeping or vacuuming until surfaces are thoroughly disinfected to prevent aerosol generation 3, 5
• Disinfect gloves before removal and perform thorough hand hygiene after glove removal 3