The Infection Prevention and Control challenges are many when faced with a novel viral infection. In July 2008, an outbreak of HeV infection among 5 horses (with predominantly neurological symptoms) and 2 clinic workers occurred in a Brisbane Bay-side veterinary clinic. Both workers presented with influenza-like illnesses (ILI) and subsequent encephalitis (one fatal) after an incubation period of 9-16 days, to the Princess Alexandra Hospital.

HeV is a recently described paramyxovirus, the natural reservoir of which is fruit bats of the genus Pteropus. Transmission from bats to horses and horses to humans has been documented. No transmission from bats to humans or humans to humans has been documented. Nine previous HeV infection outbreaks involving 29 horses and 4 humans had been recognised. Previous equine cases suffered predominantly respiratory signs. Human cases included two survivors with self-limited ILIs and two fatalities: one with multi-organ failure and another with initial aseptic meningitis followed by fatal encephalitis 13 months later.

There were multiple challenges associated with the management of cases and contacts associated with the outbreak in July 2008. The management of patients with HeV required additional support from the infection control team by way of expert advice on infection prevention and control due to the uncertainty and concern expressed by staff. The challenges in managing these patients included extensive multidisciplinary education, encompassing personal protective equipment and disease transmission, appropriate patient placement within the facility, and clarification of concerns by clinical and support staff. Education and support was also extended to the families of those unwell, and colleagues that had been exposed during their work practices. As a result of the extensive media interest in this outbreak our resources were also extended to the general community.

The evolving equine clinical manifestations, the inevitable and increasing interactions between the host fruit bat species and horses, and the absence of therapies or vaccines will continue to present major challenges to the medical, nursing, public health and veterinary communities. The suboptimal use of standard precautions in veterinary medicine is an area for further investigation and education, and is crucial to the preventative management of zoonotic infections. New and emerging infectious diseases will continue to confront Infection Control Practitioners; many decisions regarding the treatment and prevention of these will need to be made on the basis of incomplete scientific evidence, but based on our sound knowledge of basic infection control principles.