Primary prevention
Nipah virus (NiV) infection can be prevented by avoiding exposure to bats, consumption of raw date palm sap, and/or exposure to sick intermediate animals (such as pigs and horses) in endemic areas.[31] The use of bamboo skirts to prevent bats accessing date palm sap has been shown to effectively reduce contamination and is recommended for reducing transmission in Bangladesh.[32] Measures to limit exposure of pigs and horses to Pteropus bats may also prevent transmission.
Hendra virus (HeV) is acquired by humans through direct contact with the nasal secretions/body fluids of infected horses.[13] Awareness amongst equine veterinarians and those who work with horses in at-risk areas should be improved. Exposure to horses that are ill or possibly infected with HeV should be avoided and appropriate personal protective equipment used when contact is necessary.[13][33]
There is currently no licensed vaccine for humans for HeV or NiV. An HeV vaccine has been developed for horses (based on the G glycoprotein) and is licensed in Australia.[34] This aims to prevent infection in horses and thereby reduce the risk of transmission to humans.[34] There are indications that similar vaccine strategies may prove useful in NiV infection in future.[34][35]
Secondary prevention
Nipah virus (NiV) and Hendra virus (HeV) infections need to be reported to public health authorities as soon as they are suspected. Contact tracing of any active case by public health practitioners is vital.
NiV is known to be transmissible from human to human. Studies suggest that the most likely vehicles for transmission are saliva and respiratory secretions, although NiV RNA has also been identified in blood and urine.[28] Therefore, contacts of active cases and healthcare staff should wear personal protective equipment sufficient to prevent respiratory and contact spread. Strict infection control practices and barrier nursing should be utilised to prevent nosocomial transmission.[31]
Passive immunotherapy with human monoclonal antibodies specific for viral glycoproteins may have a role in post-exposure prophylaxis to henipaviruses. In particular, the monoclonal antibody m102.4 has proven efficacy in post-exposure treatment in animal studies for both HeV and NiV and has been used in humans with high-risk exposures to HeV in Australia on compassionate grounds.[34]
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