What are the prevention measures for Nipah virus infection?

Nipah Virus Prevention

Preventing Nipah virus infection requires strict avoidance of fruit bat exposure, contaminated food sources, infected animals, and rigorous infection control measures including airborne precautions with N-95 respirators for all suspected cases, as person-to-person transmission occurs in approximately 50% of cases. 1, 2

Primary Prevention: Avoiding Zoonotic Transmission

Fruit Bat Exposure Prevention

• Avoid consumption of raw date palm sap, which is the primary transmission route in Bangladesh and India, as bats contaminate the sap with saliva and urine during feeding. 3, 4
• Do not consume fruits that show evidence of bat bites or bat saliva contamination. 5, 3
• Avoid outdoor activities near bat habitats, particularly Pteropus fruit bat roosting sites in endemic regions (South and Southeast Asia). 1, 2

Animal Contact Precautions

• Pig farmers represent the highest occupational risk group—avoid direct contact with sick pigs showing neurological or respiratory symptoms, as demonstrated in the 1999 Malaysia outbreak. 1, 2
• Avoid contact with cattle, goats, and other domestic animals showing signs of illness in endemic areas, as these can serve as intermediate hosts. 3, 6
• Do not handle dead animals or animal carcasses without proper protective equipment in endemic regions. 1

Food Safety Measures

• Avoid raw or undercooked meat from potentially infected animals in endemic areas. 5
• Wash all fruits and vegetables thoroughly before consumption, particularly in endemic regions. 6
• Do not share food sources that may be accessible to fruit bats. 1

Healthcare Worker Protection

Mandatory Infection Control Measures

• Use airborne precautions with N-95 respirators, gowns, aprons, and face shields for all suspected or confirmed cases, as healthcare workers face extremely high risk with person-to-person transmission occurring in approximately 50% of cases. 1, 2, 7
• Implement strict isolation protocols immediately upon suspicion of Nipah virus infection. 1, 2
• Avoid non-invasive ventilation or high-flow nasal oxygen in uncontrolled settings due to aerosolization risk that increases staff exposure. 1, 7

Environmental Decontamination

• Decontaminate all surfaces and equipment that may have contacted infected patients, as viable virus on healthcare workers' mobile phones and hospital equipment can cause nosocomial transmission. 2
• Consider wrapping mobile phones in disposable specimen bags when caring for suspected cases. 2

Community-Level Prevention

Travel Precautions

• Travelers to endemic regions (Bangladesh, India, Malaysia, Singapore, Philippines) should avoid rural areas with pig farming or fruit bat populations. 1, 5
• Do not visit bat caves or areas with large fruit bat colonies. 1
• Avoid contact with sick individuals in endemic areas during known outbreaks. 3, 4

Outbreak Response

• Implement immediate contact tracing and quarantine of exposed individuals, as human-to-human transmission is a major driver of outbreaks. 3, 6
• Reduce family members' and friends' exposure to infected patients' saliva through strict isolation and use of personal protective equipment. 3
• Maintain high clinical suspicion in travelers returning from South/Southeast Asia with fever and encephalitis. 1, 7

Critical Pitfalls to Avoid

• Do not delay implementation of airborne precautions while awaiting diagnostic confirmation—the high mortality rate (40-75%) and frequent person-to-person transmission demand immediate action. 1, 2
• Never use standard droplet precautions alone; airborne precautions with N-95 respirators are mandatory. 1, 2
• Do not allow unprotected family members to provide direct care to suspected or confirmed cases, as this is a major transmission route. 3, 4
• Avoid prolonged non-invasive ventilation trials that increase staff exposure during emergency intubation. 1, 7

Current Limitations

• No FDA-approved vaccine or specific antiviral treatment exists, making prevention the only effective strategy. 1, 2, 8
• Ribavirin has limited evidence for efficacy and is not a substitute for prevention measures. 1, 7
• A One Health approach integrating human, animal, and environmental health surveillance is necessary for long-term control. 5, 6