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Hendra virus information for veterinarians
Hendra virus (HeV) is a disease that can produce life-threatening illness in horses and humans. It has claimed the lives of several people and more than 80 horses across Queensland and New South Wales since its discovery in 1994.
HeV has the potential to be a serious zoonotic disease, so rigorous biosecurity and safety measures are required. Public health and work health and safety issues must be considered.
Veterinarians must take stringent precautions to manage the level of risk when investigating potential HeV cases. Careful, safe work practices and the proper use of personal protective equipment (PPE) are required to manage potential exposure.
This guide provides information on implementing appropriate infection control procedures, safely managing HeV risks when investigating illness in horses, sampling and testing, and past HeV cases.
Assessing Hendra virus risk factors
Before making direct contact with a patient, an attending veterinarian should assess factors that may contribute to Hendra virus (HeV) spill-over and put steps in place to manage work health and safety obligations and human health risks.
Consider the possible combination of risk factors below when you decide on the risk management measures and actions you will take while dealing with equine patients, including providing sound advice to clients.
Always take the following into account:
- Consider standard work health and safety responsibilities and appropriate risk management strategies when dealing with sick horses. More information on this can be found in the Australian Veterinary Association's Guidelines for veterinary personal biosecurity and Workplace Health and Safety Queensland's information on work health and safety and diseases from animals.
- Horses have shown variable, and sometimes vague, clinical signs, particularly in the early phase of HeV infection. You should therefore conduct an assessment before you have direct contact with equine patients. Your risk assessment may evolve while attending the case as more information comes to hand.
- Vaccination of horses is the most effective way to help manage HeV disease. Vaccination of horses provides a public health and work health and safety benefit by reducing the risk of HeV transmission to humans and other susceptible animals. However, whenever HeV infection is suspected, even in vaccinated horses, appropriate biosecurity precautions including personal protective equipment (PPE) should be used as no vaccine can provide 100% guaranteed protection.
Factors to consider before making direct contact with the patient
Patient location
Proximity of flying fox roosts
You should consider HeV wherever horses and flying foxes are in proximity to each other. Known flying fox roosts in the locality have been demonstrated as an additive factor for HeV spill-over risk.
Keep in mind that flying fox roosts vary every year, both in the population and in the prevalence of HeV infection. Give greater consideration to roosts with black and/or spectacled flying foxes as they've been shown to be more likely to excrete HeV.
Find maps of flying-fox roost locations or an interactive flying fox web viewer.
The absence of noted flying fox activity does not remove the risk of HeV infection in horses. Smith CS, (unpublished data) found a statistically significant increase in the risk of equine cases within 7km of a known roost, however a 40km foraging 'footprint' was identified in another risk assessment study (Smith et al. 2014). However during the Bowen incident (2008-09) no roosts were mapped within 50km of the spill-over site (McFarlane et al. 2011).
History of the area
You should also take previous incidents in the area into consideration. Analysis of past events has identified areas with a higher prevalence of incidents. However, the interplay between the climate, location and the reservoir species should be taken into account, (i.e. these areas are most strongly correlated to species densities of black and spectacled flying-foxes) (Smith et al. 2014).
Find a summary of HeV incidents, including general locations.
Time of year
Don't use season as a risk criteria on its own. Seasonality has been identified in South East Queensland and northern New South Wales (NSW), but this winter peak is much less evident in other regions.
All regions sampled in Queensland (Field et al. 2015), show a similar background of 'endemic' infection. In the southern Queensland/northern NSW and central NSW regions, there has historically been a strong winter epidemic pattern.
One study did demonstrate an association with the dry season, May to October, with lower temperatures and rainfall (Mcfarlane et al. 2011). A more recent study (Martin et al. 2018) analysed risk based on latitude. It concluded there are 2 distinct regions:
- above latitude -22° (approximately in-line with Claireview, 220km north of Rockhampton), spill-over is not affected by seasons
- below latitude -22°, spill-over risk increases from April to October.
Patient factors
Vaccination history
Vaccination of horses is the most effective way to help manage HeV disease. Whenever HeV infection is suspected, even in vaccinated horses, appropriate biosecurity precautions including PPE should be used as no vaccine can provide 100% guaranteed protection.
Acute versus chronic presentation
HeV infection in horses typically causes an acute illness that is rapidly fatal.
Clinical signs
There are no pathognomonic signs that define HeV infection in horses. Horses infected with HeV have shown variable and sometimes vague clinical signs. There is a range of clinical signs recorded from confirmed cases.
Husbandry
There are a number of measures horse owners can take to reduce the risk of horses becoming infected. Attending veterinarians should also take these measures into consideration when assessing a case.
References
Field, H, Jordon, D, Edson, D, Morris, S, Melville, D and Parry-Jones K 2015, 'Spatiotemporal aspects of Hendra virus infection in pteroptid bats (flying foxes) in Eastern Australia', PLOS ONE 10(12): e0144055. https://doi.org/10.1371/journal.pone.0144055
Smith, C, Skelly, C, Kung, N, Roberts, B, Field, H 2014, 'Flying-foxes species density – a spatial risk factor for Hendra virus infection in horses in Eastern Australia', PLOS ONE 9(6): e999965. https://doi:10.1371/journal.pone.0099965
McFarlane, R, Becker, N, Field, H 2011, 'Investigation of the climatic and environmental context of Hendra Virus spillover events 1994-2010'. PLOS ONE 6(12): e28374. http://doi.org/10.1371/journal.pone.0028374
Martin, G, Yanez-Arenas, C, Plowright, R.K, Chen, C, Roberts, B, Skerratt, L.F 2018, 'Hendra Virus spillover is a bimodal system driven by climatic factors', EcoHealth. https://doi.org/10.1007/s10393-017-1309-y
Precautions to take when Hendra virus is suspected
Avoid contact with a sick horse that is showing clinical signs when Hendra virus (HeV) is a possible diagnosis. If you must have contact, assess and manage potential HeV risks. Adopt standard precautions and airborne precautions, and enhanced biosecurity.
Isolate the horse
Isolate the horse from humans, other horses and other animals. Put steps in place so that the public cannot access the horse. Keep non-essential people (including children) away from the horse.
Limit procedures
Consider limiting veterinary procedures to obtaining samples, providing immediate treatment and attending to the horse's welfare.
Avoid high-risk procedures that could result in a high level of exposure to the horse's blood, tissues, respiratory secretions and other body fluids.
Ensure sharps safety
Never recap a used needle, and consider using safety-engineered sharps, such as retractable blood collection systems, to minimise the risk of sharps injuries.
Manage the risk to others
Ensure the health and safety of any person who assists you with a veterinary assessment, procedure or treatment (e.g. the person holding the horse). Make sure that the person:
- is properly protected and supervised and follows infection control precautions
- wears appropriate personal protective equipment (PPE).
Consider using a trained veterinary professional (e.g. a veterinary nurse) to assist you instead of a non-veterinary person such as the horse owner.
If a potential HeV case needs ongoing treatment before test results are received, you should conduct a risk assessment to ensure the health and safety of the person administering the treatment.
Don't ask non-veterinary staff to administer invasive treatments, including giving injections, until HeV is excluded. Anyone who has close contact with the horse to administer a treatment should follow appropriate infection control precautions including wearing PPE, safe sharps handling and disposal, hand hygiene and decontamination of themselves and equipment.
You should also provide them with any information, instruction, training or supervision that is necessary to ensure their health and safety.
Manage accidental contamination
If there is accidental contamination with the horse's blood and/or body fluids or a needlestick (sharps) injury, take the following precautions:
- If blood, body fluids or excretions contaminates unprotected skin, or involves a cut or puncture wound, wash the area with soap and water as soon as possible.
- If the eyes are contaminated, gently but thoroughly rinse open eyes with water, or normal saline, for at least 30 seconds.
- If body fluids get in the mouth, spit it out and rinse the mouth with water several times.
- Seek medical advice about possible exposure to HeV.
Contact with an animal with confirmed HeV infection
An animal with confirmed HeV infection should be managed very carefully to prevent the transmission of infection to people and other susceptible animals.
Biosecurity Queensland will work in collaboration with the animal owners and relevant private veterinary practitioners, to implement actions to manage the incident.
These actions can include:
- stringent biosecurity and work health and safety measures to limit contact between potential sources of HeV and susceptible animals and humans
- controlling the movement of animals and objects that pose a risk of disease transmission
- epidemiological investigation, tracing and exposure assessment to assess the likelihood of the transmission of HeV to other susceptible animals
- laboratory testing of animals assessed as being close contact animals
- monitoring the health of animals assessed as being close contact animals
- ensuring communications and engagement informs and addresses the concerns and needs of industry and the community.
Read the Australian Veterinary Association's guidelines for veterinary personal biosecurity.
Unplanned contact with a suspect horse
A veterinary practice investigation procedure for HeV should address the risk of unplanned contact with a suspect horse.
You should compile a dedicated field kit for managing possible HeV cases (including PPE, cleaning agents, disinfectants, sampling equipment and waste disposal bags). This will provide veterinarians with ready access to the equipment needed to protect themselves and others against exposure in situations where there is no prior warning.
If HeV is suspected during routine work where no specific precautions have been taken
- Minimise exposure. Withdraw to a safe area and instruct others to do the same.
- Assess the degree of exposure and use soap and water to wash off contamination - shower if necessary and possible.
Before proceeding with the case:
- assess whether it's safe to re-enter the 'hot' area (i.e. the area where HeV contamination may be present) to sample the horse. Only continue with the investigation if it's safe and the PPE is adequate
- contact Biosecurity Queensland (13 25 23) for advice, as required.
Read more on infection control recommendations in Hendra virus infection prevention advice (PDF, 295KB).
Summary of Hendra virus incidents in horses
Hendra virus (HeV) was first isolated in 1994 in horses at a racing stable in Hendra, Brisbane.
The table below shows the location and date of each confirmed and possible HeV equine cases in Queensland and New South Wales, including clinical signs, observations in horses and other evidence.
Date | Location | Confirmed | Untested/ unresolved horses | Clinical signs and observations* | Other evidence |
---|---|---|---|---|---|
July 2023 | Newcastle | 1 | 0 | Inappetant, febrile, ataxia, depression, bilateral serous nasal discharge, injected membranes, unvaccinated for HeV. Some initial treatment provided but deteriorated and died 24 hours later | |
July 2022 | Mackay | 1 | 0 | Off food, trouble chewing food, staggering, disoriented and swollen muzzle | |
October 2021 | West Wallsend near Newcastle (NSW) | 1 | 0 | Neurological signs. Unvaccinated against HeV, euthanased after rapid health deterioration | This case was diagnosed as Hendra virus variant (HeV-g2) |
June 2020 | Murwillumbah (NSW) | 1 | 0 | Depressed and having difficulty breathing, euthanased after rapid health deterioration | |
June 2019 | Scone, Upper Hunter Valley (NSW) | 1 | 0 | Sudden onset of neurological signs and unresponsive, euthanased | |
September 2018 | Tweed Heads (NSW) | 1 | 0 | Depressed and not eating. Worse by the next morning, fever and staggering, euthanased | |
August 2017 | Lismore (NSW) | 1 | 0 | Observed unusually quiet and disorientated 1 day prior to showing clinical signs – fever, increased respiration, poor circulation, teeth grinding, euthanased after rapid health deterioration | |
August 2017 | Murwillumbah (NSW) | 1 | 0 | Lethargic and not eating properly, unsteady on its feet and unwilling to move, decreased gut sounds, elevated temperature and poor blood circulatory function | |
July 2017 | Lismore (NSW) | 1 | 0 | Off feed, wobbly of feet, lethargic, euthanased after health condition deteriorated | |
May 2017 | Gold Coast Hinterland | 1 | 0 | Depressed, inappetent, not walking, mild fever, elevated heart rate and respiratory ate, euthanased after rapid deterioration | |
December 2016 |
Casino (NSW) | 1 | 0 | Horse had been through a period of illness. Initial clinical signs observed included: failure to graze, nasal discharge, some ataxia, mild disorientation, weight loss and oral discomfort. Further behavioural abnormalities were seen prior to death | Initial samples collected at the start of illness tested negative for HeV PCR. Further samples collected a few weeks after horse became unwell again tested positive for HeV serology which showed the horse had mounted a strong immune response. Additional samples collected several days post death with 1 weak HeV PCR positive result |
September 2015 | Gympie | 1 | 0 | Acute disease onset with rapid deterioration over 24 hours. Depressed (obtruded) demeanour, injected/ congested gingival mucous membranes (darkened red/ purple change with darker periapical line and prolonged capillary refill time), tachycardia (75 beats/min), tachypnoea (60 breaths/min), normal rectal temperature (38.0°C), muscle fasciculations, head pressing and collapse, euthanised | This case was not diagnosed until 2021 where it was determined to have the Hendra virus variant (HeV-g2) |
September 2015 | Lismore (NSW) | 1 | 0 | Observed to be unwell, off food, before it collapsed | |
July 2015 | Atherton Tableland | 1 | 0 | Observed acutely ill 3 days before death. Ataxia, discharge, no respiratory distress | |
June 2015 | Murwillumbah (NSW) | 1 | 0 | Lethargy for 2-3 days before to death | |
July 2014 | Gladstone | 1 | 0 | Altered gait, off food, depressed, mild mucoid nasal discharge, died overnight | |
June 2014 | Murwillumbah (NSW) | 1 | 0 | Found in swamp unable to stand | |
June 2014 | Beenleigh | 1 | 0 | Off food, small amount of green nasal discharge turned bloody at later stage, ataxic, mild fever and toxic mucous membranes | |
March 2014 | Bundaberg | 1 | 0 | Off food, elevated respiratory rate, injected gums, frothy nasal discharge after death | |
July 2013 | Kempsey (NSW) | 1 | 0 | Observed seriously ill and failed to respond to antibiotics | |
July 2013 | Kempsey (NSW) | 1 | 0 | Ataxic, elevated heart rate, mild fever; neurological signs include loss of balance, staggering and laterally recumbent | |
July 2013 | Macksville (NSW) | 1 | 0 | Ataxic, weak, stumbling and rolling | |
July 2013 | Gold Coast Hinterland | 1 | 0 | Off feed, dull, lethargic, elevated respiratory rate and mild bilateral serous nasal discharge, deteriorated to collapse, intermittent convulsions and unresponsive state, euthanased | |
June 2013 | Brisbane Valley | 1 | 0 | Depressed, unsteady on feet, reluctant to move, elevated heart rate and muddy mucous membranes, deteriorated and euthanased | |
June 2013 | Macksville (NSW) | 1 | 0 | Observed normal in the early morning and found dead in the late afternoon | |
February 2013 | Atherton Tablelands | 1 | 0 | Slow moving, off food, ataxic. Found dead several days after the onset of clinical signs | |
January 2013 | Mackay | 1 | 0 | Slow moving, ataxic, absent blink reflex, found dead approximately 24 hours after clinical signs were first noticed | |
October 2012 | Ingham | 1 | 0 | Anorexia, slight bilateral nasal discharge, laboured respiration (respiratory rate 20), heart rate 60, lowered head, unsteady on feet, progression to recumbency | |
September 2012 | Port Douglas | 1 | 0 | Ataxic, high stepping (left side), death | |
July 2012 | Cairns | 1 | 0 | Inappetent, tremors, staggering, neurological signs worse on handling, slight nasal discharge, elevated heart rate, elevated respiratory rate, fever, delayed capillary refill time, congested conjunctival and oral mucous membranes, grinding teeth, penis protruding, muscle fasciculation, and blood from nose at death | |
July 2012 | Rockhampton | 3 | 0 | Horse 1: Ataxic, apparent blindness, droopy bottom lip and salivation Horse 2: Off food, reluctant to move, extended neck, muscle fasciculation, and increased respiratory effort Horse 3: Off food, dull demeanour, reluctant to move, hanging head, droopy bottom lip, ataxic, mild increase in respiratory effort, and pawing at ground | |
June 2012 | Mackay | 1 | 0 | Horse found moribund | |
May 2012 | Ingham | 1 | 0 | Fever, ataxic, circling, hanging head, dull demeanour | |
May 2012 | Rockhampton | 1 | 0 | Elevated respiratory rate, fever, bilateral frothy nasal discharge, muffled heart sounds, bilateral epistaxis at death | |
January 2012 | Townsville | 1 | 0 | Bilateral serous nasal discharge, blind, ataxic, sudden brief irritation, dull, fever, elevated heart rate, elevated respiratory rate, oral mucous membranes injected, capillary refill time greater than 4 seconds, clotting time 2 minutes, ileus, facial swelling | |
October 2011 | Beachmere | 2 | 1 | Horse 1: Unknown Horse 2: Ataxic, large distended bladder, decreased gut sounds, lethargic Horse 3: No clinical signs observed | A horse became acutely ill and was euthanased approximately 1 week before the first confirmed case. There were no samples available from this horse to be tested |
August 2011 | North Ballina (NSW) | 1 | 0 | Depressed, ataxic, wide-based stance. Found dead approximately 12 hours after onset of first signs | |
August 2011 | Gold Coast Hinterland | 1 | 0 | Gait problem, lethargic, fever | |
August 2011 | Mullumbimby (NSW) | 1 | 0 | Found dead. Observed normal by owners 15 hours previously | |
August 2011 | South Ballina (NSW) | 2 | 0 | Both horses (mare and foal) found dead. Absentee owner | |
August 2011 |
Ballina (NSW) | 1 | 0 | Slightly ataxic then recumbent 12 hours later, muscle twitching, unable to stand and euthanased 3 hours later | |
July 2011 | Mullumbimby (NSW) | 1 | 0 | Found dead. Observed normal by owners 18 hours previously | |
July 2011 | Chinchilla | 1 | 0 | Terminal nasal discharge, ataxic, recumbent, dull demeanour, respiratory signs | |
July 2011 | Boondall | 1 | 0 | Mild clear nasal discharge, acute onset ataxia, intermittent inappentance, lethargic fever | |
July 2011 | Hervey Bay | 1 | 0 | Attempting to stand but stumbling, dry faeces, fever, elevated heart rate, oral mucous membranes injected, capillary refill time less than 4 seconds | |
July 2011 | Lismore (NSW) | 1 | 0 | Found dead. Observed normal by owners 24 hours previously | |
July 2011 | Kuranda | 1 | 0 | Ataxic, disoriented, neck muscle fasciculation, circling, inappetent, recumbent, depressed | |
July 2011 | Macksville (NSW) | 1 | 0 | Sudden onset depression, blindness, head pressing, died 36 hours after first signs | |
July 2011 | Park Ridge | 1 | 0 | Incoordination, fever, very weak, progression to death overnight | |
June 2011 | Wollongbar (NSW) | 2 | 0 | Horse 1: Fever, congested mucous membranes, ataxic with wide-based stance, asymmetrical facial paralysis, blindness, euthanased | |
Horse 2: Depressed, fever, slightly ataxic, dyspnoea, copious amounts of nasal foam bilaterally after euthanasia | |||||
June 2011 | Logan | 1 | 0 | Ataxic, mild colic signs, fever, elevated heart rate, bloody ocular discharge | |
June 2011 | Boonah | 3 | 0 | Horse 1: Colic, recumbent, thrashing Horse 2: Twitching of muscles and eyes Horse 3: Slight nasal discharge, dull, depressed, fever, elevated heart rate | Test results confirmed the presence of antibodies to HeV in a dog on this property. It was reported that the dog did not show any clinical signs of illness. No HeV genetic material was detected in PCR tests of samples collected from the dog on 3 occasions over a 3 week period. This was the first reported case of HeV antibody detection in a dog outside of an experimental setting |
June 2011 | Beaudesert | 1 | 0 | Increased respiratory effort, hind limb incoordination, depressed, fever, congested oral mucous membranes with petechial haemorrhage, died | |
May 2010 | Tewantin | 1 | 0 | Twitching of mouth muscles, blindness, ataxic, seizures, inappetent, lethargic | |
September 2009 | Bowen | 2 | 0 | Horse 1: Shallow respiration, diaphragm twitching, muscle twitching, short stepping, reluctant to move, elevated heart rate, teeth grinding, head down, congested oral mucous membranes | A companion horse euthanased a month prior to the original confirmed case was also confirmed positive through laboratory testing |
Horse 2: Foam from mouth and nose, laterally recumbent with extensor rigidity, no gut sounds, fever, elevated heart rate, oral mucous membranes dry and congested, weak, jaw chomping, teeth grinding, rapid deterioration | |||||
July 2009 | Cawarral | 3 | 1 | Horse 1: Unknown Horse 2: Heavy breathing, nasal froth, fever, elevated heart rate, elevated respiratory rate, blood slow to clot, difficulty walking, collapsed, died Horse 3: Progressive neuromuscular spasms, incoordination, died Horse 4: Possible mild neurological signs—weaving, head pressing, ataxic on day of euthanasia | Strong epidemiological evidence exists for a horse which died 12 days prior to the first confirmed case. A veterinarian was confirmed positive for HeV infection after performing respiratory endoscopy on the horse. A second horse was confirmed as HeV positive on stored blood samples |
July 2008 | Proserpine | 3 | 1 | Horse 1: Unknown Horse 2: Some respiratory manifestation, head down, non-responsive, elevated heart rate, swollen muzzle, recumbent, red fluids from mouth, died Horse 3: Short neurological illness, ataxic, recumbent, horse appeared very stressed, trouble standing and walking Horse 4: High stepping, dull | One horse has an unresolved HeV status from this incident – a companion horse was found dead several days prior to the first confirmed case. Limited clinical history consistent with HeV infection was available. A necropsy was not performed. One of the 3 horses with a positive laboratory test was non-fatally infected and antibody-positive |
June 2008 | Redlands | 5 | 3 | Horses 1–3: Unknown Horse 4: Inappetent, depressed, maniacal/erratic behaviour Horse 5: Head tilt, ataxic, circling, inappetent, depressed, fever, recumbent periods Horse 6: Central neurological signs, severely ataxic, inappetent, depressed, recumbent, thrashing violently Horse 7: Depressed, deteriorated rapidly Horse 8: Febrile, depressed | Three horses have unresolved HeV status from this incident - all died at the veterinary clinic in the month before the first confirmed case with clinical signs consistent with possible HeV cases. Necropsies were not completed on the horses and only limited sub-standard laboratory samples were available for further testing with negative result for HeV |
July 2007 | Cairns | 1 | 0 | Nasal discharge, wet lung sounds, fever, elevated heart rate, elevated respiratory rate, terminal neurological signs | |
June 2007 | Peachester | 1 | 0 | Wide-based stance, rocking, relaxed penis, colic signs, inappetent, lethargic, depressed demeanour, elevated heart rate, recumbent and unable to rise | |
October 2006 | Murwillumbah (NSW) | 1 | 0 | Lethargic, ataxic, penile erection, disorientation, mandibular swelling, dyspnoea, fever, wide-based stance, high stepping gait, occasional tongue protrusion, coughing | |
June 2006 | Peachester | 1 | 0 | Opisthotonus, restlessness, vocalising (terminal), elevated heart rate, elevated respiratory rate, fever, markedly swollen lips, purple gums, died suddenly | |
December 2004 | Townsville | 1 | 0 | Depressed, fever, elevated heart rate and respiratory rate, brownish nasal discharge | |
October 2004 | Cairns | 0 | 1 | Restlessness, elevated heart rate, increased respiratory effort and profuse sweating, fever, blood-stained frothy secretions issuing from its nose | Strong epidemiological evidence exists for this horse. A veterinarian was confirmed serological positive for HeV after performing a necropsy on a horse that died suddenly with signs consistent with HeV. No samples from the horse were available for testing. The horse was the only identified potential source |
January 1999 | Cairns | 1 | 0 | Clinical signs to be confirmed* | |
September 1994 | Hendra, Brisbane | 7 | 13 | Clinical signs to be confirmed* | HeV was first identified and characterised as a result of this event. No diagnostic tests were available until after the event and not all horses were tested as samples were not retained from all horses. Strong epidemiological evidence exists for all horses involved to be considered as cases |
August 1994 | Mackay | 2 | 0 | Clinical signs to be confirmed* | These cases didn't become apparent until late 1995 when HeV infection was confirmed in a person from Mackay. Testing of stored samples from horses was undertaken in late 1995 |
Total | 89, all deceased | 20, all deceased |
*The clinical signs listed are taken from laboratory testing submission forms or media releases. Not all information for all cases was readily accessible to Biosecurity Queensland.
Hendra virus sampling, submission and testing
Warning: Safety of people is the primary consideration when investigating potential Hendra virus (HeV) cases in animals. If you are concerned about your health, you should:
- seek medical advice and contact your local GP
- contact your nearest Queensland Health Public Health Unit
- contact the Queensland Health 24-hour hotline on 13 HEALTH (13 43 25 84).
Apply the precautionary principle. An infected horse can excrete HeV in nasal or nasopharyngeal secretions for several days before the onset of clinical signs. A horse with severe clinical signs poses the greatest transmission risk to other horses and humans through a range of body fluids and excretions.
Take strict precautions for yourself, and anyone assisting you, when collecting samples for Hendra virus (HeV) testing. Only take samples if the risk of exposure to yourself and others can be adequately managed.
Samples may need to be taken from live and dead horses, so a veterinary assessment of the associated risks is required. Dead horses can be sampled adequately for HeV testing without conducting a complete necropsy, which is a very high risk activity - particularly on recently deceased animals.
It's the horse owner's responsibility to pay for transporting samples to Biosecurity Queensland's Biosecurity Sciences laboratory (BSL). Biosecurity Queensland will meet all laboratory testing costs to test samples for HeV in diagnostic cases (Note: charges apply for HeV health testing).
Private veterinary practitioners should make the final decision about whether to collect samples and submit them for laboratory testing and, where required, get advice from Biosecurity Queensland.
Taking samples for diagnosis
Preferred samples for diagnosis (from most preferred to least preferred) of suspect cases are:
- EDTA blood: ensure tubes are filled to reduce the risk of anticoagulant concentration interfering with test results.
- swabs: nasal, oral, rectal and vaginal. Note the following
- Nasal swabs may show infection earlier than blood or other clinical samples and together with EDTA blood is the minimum sample requirements for exclusion in diagnostic cases.
- Swabs should be transported in virus transport medium (VTM). A small amount of saline (1–2ml) can be used to prevent swabs from drying out if VTM is not available.
- A urine-soaked swab taken from the ground immediately after urination can also be helpful.
If whole blood in EDTA is not available, polymerase chain reaction (PCR) testing may be conducted on the blood clot.
Dead horses can be adequately sampled for HeV exclusion without conducting a complete necropsy. We recommend the following samples
- swabs (as above)
- blood clot obtained by cutting down onto the jugular vein
- submandibular lymph node (chilled).
Submitting a combination of EDTA blood, nasal, oral and rectal swabs should be sufficient for detecting HeV infection in a very high proportion of HeV-infected horses.
BSL doesn't undertake routine biochemistry/haematology testing. It's best to collect duplicate blood samples that you can keep safely and securely at your veterinary clinic for in-house or private laboratory testing, once HeV is excluded.
How to submit samples
HeV testing is conducted at the Biosecurity Sciences Laboratory (BSL) in Coopers Plains. Samples for HeV exclusion testing should be submitted directly to BSL as this will achieve the shortest turnaround times.
Specimen advice sheet
A fully completed specimen advice sheet (SAS) must accompany all submissions. If you want to receive diagnostic testing for HeV at no charge, you must include a full clinical history and vaccination status of the animal. Ensure that the SAS is packed on the outside of the samples and that it clearly indicates a request for HeV exclusion.
Cut-off and turn-around times
Typically, 1 round of HeV PCR laboratory testing is run each weekday at BSL, starting at 2pm. In most circumstances, samples received at BSL before this time will achieve a result on the same day. Samples received after this time will be tested the next business day.
Phone ahead to let BSL know if you intend to submit samples so arrangements can be made to facilitate testing, and so you can be contacted if the samples are not received by the cut-off time. It is essential that you provide a direct after-hours contact number on the SAS if you want to be notified of results by phone on the same day, as the results of testing are typically available around 5pm.
Packaging and transporting HeV exclusion samples
When submitting HeV exclusion samples:
- There are packaging requirements that must be met to transport biological samples by road and rail (surface) or air. The contents should have no chance of escaping from the package under normal conditions of transport.
- Everyone responsible for packaging and transporting biological samples must be appropriately trained and their competency assessed for the task that they are to perform. Training from an accredited provider is required for the packaging of some categories of samples.
- Some courier companies will provide a complete service (i.e. they will come to a veterinary practice, pack and dispatch the samples correctly). Veterinary practices should establish an account with their chosen courier service so that samples for HeV testing can be dispatched for testing without delay.
- For transport of all pathology samples and associated material by air or surface transport methods, the contents must be triple packaged in a primary receptacle, secondary packaging and outer packaging.
Contact BSL if you have any queries on sample submission.
Urgency of HeV testing for horses
Urgent testing for HeV diagnosis/exclusion may be conducted under certain circumstances.
If urgent testing is required during business hours, veterinarians should contact the Biosecurity Queensland duty pathologist at BSL to discuss the situation.
After hours, contact the Emergency Animal Disease Hotline on 1800 675 888 and discuss the situation with the Biosecurity Queensland veterinary officer.
The decision to conduct urgent HeV testing is made following discussion between the submitter and relevant Biosecurity Queensland staff. This may include the Biosecurity Queensland veterinary officer and/or the on-duty pathologist.
Requests for urgent testing will be assessed on a case-by-case basis. Reasons that may necessitate urgent testing for HeV include:
- significant human exposure to body fluids of highly suspect HeV infected horse(s)
- exposure of large numbers of animals to body fluids of highly suspect HeV infected horse(s).
BSL specimen receipt is open for sample submission Monday to Friday only (8am–5pm). Don't send samples to be delivered to BSL outside these times without first consulting with the on-duty pathologist. Horse owners are responsible for all costs associated with weekend delivery of samples for urgent HeV testing (Note: courier charges for time-definite deliveries can be significant).
HeV tests
Polymerase chain reaction (PCR) test
This is the primary test conducted at BSL for exclusion of HeV infection, particularly in acutely sick animals. PCR tests can be conducted on blood, swabs and tissue samples. They detect the direct presence of genetic material of Hendra virus in a sample and can detect live or dead viruses but cannot differentiate between them.
A positive result indicates the presence of viral genome in the sample, but does not confirm that the virus is viable and infectious. When accompanied by relevant clinical signs, a positive PCR test result is interpreted to mean an animal has an existing HeV infection.
A negative PCR test result needs to be interpreted in relation to the health of the animal and the broader epidemiological context.
Enzyme linked immunosorbent assay (ELISA) test
This is not routinely used at BSL to exclude HeV infection in acutely sick horses, particularly if they have a history of vaccination. ELISA tests are conducted on serum samples to detect the presence of antibodies and are regarded as a screening test.
A negative ELISA result is a reliable indicator that a horse has not been previously exposed to HeV.
Being a screening test, non-negative ELISA test results, including nonspecific reactor results, require confirmatory testing by virus neutralisation testing (VNT).
A positive result could be due to past infections or vaccination with the production of neutralising anti-G antibodies. Differentiating these requires differentiating infected from vaccinated animals (DIVA) testing.
Virus neutralisation test (VNT)
VNTs detect the presence of HeV antibody in a blood sample and are used to confirm non-negative results from ELISA screening tests.
A positive VNT indicates the animal is seropositive to HeV either from infection or vaccination.
The antibody response to infection or vaccination takes time to develop and this should be considered when interpreting negative results. VNT testing can only be conducted at the Australian Animal Health Laboratory (AAHL) in Geelong.
Differentiating infected from vaccinated animals (DIVA) testing
Development and assessment of DIVA tests is an area of active investigation.
Interpreting a panel of tests that detect the G glycoprotein or other HeV proteins will help us to differentiate between:
- serologically positive animals due to vaccination
- serologically positive animals due to infection.
DIVA testing can only be completed at AAHL in Geelong.
Also consider...
Planning and preparing for a Hendra virus investigation
Warning: Safety of people is the primary consideration when investigating potential Hendra virus (HeV) cases in animals. If you are concerned about your health, you should:
- seek medical advice and contact your local GP
- contact your nearest Queensland Health Public Health Unit
- contact the Queensland Health 24-hour hotline on 13 HEALTH (13 43 25 84).
Apply the precautionary principle. An infected horse can excrete HeV in nasal or nasopharyngeal secretions for several days before the onset of clinical signs. A horse with severe clinical signs poses the greatest transmission risk to other horses and humans through a range of body fluids and excretions.
Veterinary practices should develop and implement infection control and biosecurity procedures to manage the risks associated with investigating and sampling potential HeV cases.
Procedure outline for HeV case investigations
Normal practice management should include thorough preparation before a veterinarian conducts a field investigation of potential HeV. Plans, procedures, appropriate equipment and training are all required to assist the safe, timely handling of investigations.
You can use a laminated procedure or plan for HeV case investigation as a checklist to ensure you address all key elements. This should include a decontamination procedure before leaving the property.
Always take appropriate precautions based on any suspicion of HeV, even with vaccinated horses; don't wait for confirmation.
Steps to consider before investigating a horse with potential HeV infection
You can take the following steps before investigating a horse with potential HeV infection. You should also source extra information to suit your particular situation:
- Obtain as much history as possible from the client's initial phone call or enquiry and make an initial case assessment. To do this, you need to:
- ask if the horse is vaccinated against HeV, or check the HeV Vaccination Registry.
- be familiar with the various HeV clinical presentations.
- If you suspect HeV before you enter a property, know the precautions and procedures to follow. These include:
- work health and safety precautions to ensure the health and safety, as far as is reasonably practicable, of yourself, workers and others who are assisting you
- infection control and biosecurity precautions
- the choice of personal protective equipment (PPE) and disinfectants used
- entry and exit procedures
- appropriate biosecurity advice for clients.
If you don't suspect HeV before the examination of a horse, know the immediate steps to take to minimise the risk and exposure to you and others. Learn more about unplanned contact with an ill horse that may be infected with HeV.
- Develop a sampling protocol.
- Prepare a HeV sample collection procedure that includes:
- samples required and the safest methods of collecting them
- necessary equipment.
- Prepare a HeV sample dispatch procedure which explains:
- how to safely pack samples, or which couriers will provide this service
- where to send samples (send HeV samples to the Biosecurity Sciences Laboratory, not a private laboratory)
- which couriers will transport samples and which couriers provide an out-of-hours service.
- Prepare a HeV sample collection procedure that includes:
- Develop a dedicated field kit to manage possible HeV cases. Include items such as:
- PPE
- cleaning agents and disinfectants
- sampling equipment
- waste disposal bags
- a sharps container.
- Prepare biosecurity advice to give to clients. This information will explain what owners and managers involved with managing the case and the site should do.
- Prepare advice about disposal of carcasses. This may include:
- the disposal method of choice for the area (deep burial on site if possible)
- advice for owners/contractors for safe disposal and to prevent disease spread.
- Prepare a list of contacts you'll be required to liaise with, and record the contact details.
Training
Training is an important part of the HeV investigation plan, ensuring that all relevant people are competent to manage a HeV investigation. We recommend that you keep records of all training conducted.
If PPE is not routinely used, training will be required. A number of PPE suppliers provide training in correct fitting and use of PPE. The Australian Veterinary Association has produced an online video, Suit up! Personal protective equipment for veterinarians about PPE, including how to safely put on and take off full PPE.
The packaging of samples for laboratory testing may also require training (available from private providers) to ensure diagnostic samples comply with transport requirements. Alternatively, you can decide to use a courier company (recording this in the procedure) that will provide a packing and transport service.
Property entry and exit process for routine visits or Hendra virus investigations
Veterinarians should establish entry and exit procedures (for routine property visits or for possible Hendra virus (HeV) investigations) to provide a clear process for applying infection control procedures, including personal protective equipment (PPE), so that personal safety and disease control are managed.
Key steps:
- Define the edge of the hot zone (i.e. the area where HeV contamination may be present).
- Select a site at this edge that has good access from the cold zone.
- At this site, establish an entry/exit decontamination site. This site allows you to prepare safely in the cold zone, including donning PPE, preparing sampling equipment and preparing disinfectant solutions.
- Only enter the hot zone when you're fully prepared.
- The arrangement of this site then allows you to exit through a decontamination process that protects personal safety and prevents disease spread.
- If repeat visits are likely, or if other colleagues may visit, mark the site clearly so the same site is used each time. This prevents other people setting up on potentially contaminated ground.
- Recommend this process to other people who may need to access the hot zone.
Detailed equipment list and procedure
Read the more detailed Hendra virus equipment list and property entry and exit procedure (PDF, 352KB).
Biosecurity advice to clients when Hendra virus is suspected
Hendra virus (HeV) is classified as category 1 restricted matter under the Biosecurity Act 2014.
Horse owners and people who deal with horses, have a general biosecurity obligation to take all reasonable and practical measures to prevent or minimise the effects of a biosecurity risk. HeV poses a serious biosecurity risk. This means you are legally required to reduce the risk of HeV infection and limit the spread of HeV when dealing with horses and other possible carriers.
If Hendra virus (HeV) is suspected in a client's horse it's important to give them sound biosecurity advice to ensure the health, safety and welfare of people and other animals.
As an attending veterinarian, you need to advise the client of the zoonotic potential of HeV and the steps they can take to manage the risk of exposure to themselves and others.
Steps horse owners can take to minimise the risk of HeV exposure
Horse owners should:
- isolate the sick or dead horse from all people, all other horses and all other domestic animals on the premises, and from public access areas where possible
- advise neighbours that a horse on their property is being investigated for HeV infection
- observe the sick horse from a distance and notify the veterinarian if there's any change in the behaviour or health of any other horse on the property.
- avoid close contact with the sick horse.
If your client must have close contact with a sick horse where HeV hasn't been ruled out, you should give them advice about appropriate infection prevention and control measures, for example:
- avoid invasive treatments
- arrange activities so that unaffected horses are handled first and have contact with the sick horse last
- cover cuts and abrasions with a water-resistant dressing
- put on appropriate personal protective equipment (PPE) before approaching the horse
- after handling the horse, remove and dispose of PPE carefully, making sure there's no contact with the facial area, particularly eyes, mouth and nose
- wash hands with soap and water and dry them well, or use hand wipes and a waterless alcohol-based hand rub immediately after removing PPE
- carefully remove any clothing contaminated with a sick horse's body fluids.
If clients have handled a sick horse, they should follow these steps before having contact with other horses:
- wash off any contamination with plenty of soap and water
- shower and wash hair
- change clothes and footwear.
Also advise the client to stop or limit:
- horse movements on and off the property
- movements of horse products (such as manure) and equipment (such as tack, dental equipment) off the property
- visits from horse practitioners (such as farriers or equine dentists) and to advise visiting horse practitioners who must have close contact with the horse about the potential HeV risk.
When disposing of a dead horse the disposal contractor should be informed that the horse is suspected of being infected with HeV. Appropriate precautions should be taken.
Health concerns and medical assistance
Let clients know that they should seek medical advice if they're at all concerned about possible exposure to HeV. They can contact:
- their local GP
- their nearest Queensland Health Public Health Unit
- the Queensland Health 24-hour hotline on 13 HEALTH (13 43 25 84).
Biosecurity Queensland will contact Queensland Health if HeV is confirmed or highly suspected. Queensland Health will decide if any people require monitoring or medical assistance. To make this assessment, Queensland Health will work with the veterinarian and the horse owner to identify the people they may need to contact.
Infection prevention and control and biosecurity precautions
Warning: Hendra virus (HeV) infection of humans is rare, but it is a serious disease that can be fatal. Infection has occurred from high levels of exposure to the respiratory secretions and/or blood from horses infected with HeV (both live horses and dead horses at necropsy examination). Great care is needed to ensure the personal safety of the veterinarian and others who may be involved.
Learn more about precautions to take when Hendra virus is suspected.
Apply the precautionary principle to ensure personal safety and prevent zoonotic risk.
An infected horse can excrete Hendra virus (HeV) in nasal or nasopharyngeal secretions for several days before the onset of clinical signs. A horse with severe clinical signs poses the greatest transmission risk to other horses and humans through a range of body fluids and excretions.
HeV is often diagnosed retrospectively in horses after human exposure has occurred. This reinforces the need to consider HeV early in the investigation phase, and to establish appropriate infection control procedures for day-to-day situations.
Vaccination
A registered vaccine is available for horses. Vaccination of horses is the most effective way to help manage HeV disease. Vaccination of horses provides a public health and work health and safety benefit by reducing the risk of HeV transmission to humans and other susceptible animals.
Whenever HeV infection is suspected, even in vaccinated horses, appropriate biosecurity precautions including personal protective equipment (PPE) should be used as no vaccine can provide 100% guaranteed protection.
Standard precautions against infection
Standard precautions are a set of basic infection control practices used to prevent transmitting diseases through contact with blood, tissues, body fluids, non-intact skin and mucous membranes. You should use these measures when providing care to any animal. This includes all horses, even if they've been vaccinated for HeV, or don't appear infectious or symptomatic.
Standard precautions include, but are not limited to:
- hand hygiene
- aseptic non-touch technique
- sharps safety
- clinical waste management
- laundry management
- standard decontamination procedures
- appropriate reprocessing of equipment
- routine environmental cleaning.
In particular, you should:
- take precautions to prevent any direct contact with, splash back of, or accidental inoculation with blood, body fluids or excretions
- cover any open wounds with a waterproof dressing
- ensure sharps safety, never recap used needles and always use a sharps container to avoid sharps injuries
- perform hand hygiene
- after any exposure to blood and body fluids
- after contact with a horse, its environment and equipment, and before moving on to other activities
- during and after removal of PPE
- adopt appropriate cleaning processes for the environment and equipment, and reprocess reusable equipment used in clinical procedures in accordance with AS 4187
- ensure the safe handling, transport, storage and disposal of clinical waste (including sharps). Sharps must be disposed of in a container specifically designed for the disposal of sharps
- ensure the safe handling, transport, storage and cleaning of contaminated clothing and other laundry
- ensure the safe handling, transport, storage and disposal of pathology specimens
- ensure the safe handling and disposal of animal excreta
- maintain stable hygiene and conduct environmental cleaning using appropriate cleaning agents and disinfectants
- wear PPE.
Airborne precautions
You should adopt standard precautions as well as airborne precautions for procedures that are invasive or that generate aerosols. This includes procedures of the respiratory tract, and other high-risk procedures, such as endoscopy of the upper and lower respiratory tract, dentistry using power floats, necropsy, broncho-alveolar lavage and nasal lavage.
Airborne precautions are additional, transmission-based precautions to prevent inhalation of contaminated aerosols and dusts. They include:
- work practices that minimise the generation of aerosols and dust (e.g. avoiding the use of high-pressure water systems for cleaning)
- ventilation controls
- enhanced PPE. The minimum level of PPE for airborne precautions includes a properly fitted disposable P2 respirator.
Veterinary use of personal protective equipment and disinfectants
Warning: Hendra virus (HeV) infection of humans is rare, but it is a serious disease that can be fatal. Infection has occurred from high levels of exposure to the respiratory secretions and/or blood from horses infected with HeV (both live horses and dead horses at necropsy examination). Great care is needed to ensure the personal safety of the veterinarian and others who may be involved.
Learn more about precautions to take when Hendra virus is suspected.
Personal protective equipment (PPE) is intended to form a barrier between the person and the infectious agent. It may include:
- rubber boots
- splash-proof overalls (long sleeves with a hood) or cotton or disposable overalls with impervious or splash-proof apron
- disposable impermeable gloves (nitrile gloves recommended), double-gloved
- face shield or safety eyewear (to protect against facial splashing)
- a particulate respirator.
PPE responsibilities of veterinarians
Work health and safety legislation requires a person conducting a business or undertaking to ensure that PPE provided to workers is:
- suitable for the work and any hazard associated with the work
- the right size and fit and reasonably comfortable.
The PPE must be maintained, repaired or replaced so that it continues to minimise risk. This includes ensuring that it's clean and hygienic, and in good working order. You should also ensure, as far as is reasonably practical, that the PPE is used or worn by the worker or any other person at the workplace.
To provide the best protection possible, combine PPE with other measures, such as vaccinating horses, HeV planning and preparedness, infection control practices and managing exposure to HeV risks.
Source PPE ahead of time and arrange training in its correct use, storage and maintenance.
If there's a higher level of risk, or a horse is known to be infected with HeV, increase the standard of PPE accordingly.
Using PPE
Always have adequate PPE available at all places where horses are examined. PPE supplies for repeat visits and for those assisting should be available.
Always remove PPE carefully to avoid contamination and perform hand hygiene during and after removing PPE. Decontaminate reusable PPE after use and don't reuse disposable PPE.
The Australian Veterinary Association has produced an online video, Suit-up, about PPE, including correct donning and doffing.
Buying PPE
Discuss your specific safety needs with a supplier of safety equipment to get expert advice and be provided with a selection of products appropriate for individual situations. Alternatively, you can obtain PPE from safety supply stores and most hardware stores.
Heat stress and PPE
We recommend splash-proof PPE rather than impervious PPE. Splash-proof items are usually lighter and better suited to hotter conditions. Impervious (waterproof) PPE, particularly impervious overalls or suits, need to be used with great care as there's a real risk of rapidly overheating, particularly if used in direct sunlight.
Using PPE can create significant heat stress issues. The risk of heat stress should be managed where possible, for example by:
- drinking enough fluids before and during work
- scheduling work times to avoid the hottest part of the day
- using cool clothing and cooling scarves and vests
- using portable shade
- taking frequent rest breaks in cool areas
- rotating teams or use a buddy system,
- knowing the signs of heat stress and stopping work if these signs start to develop.
Respiratory protective equipment
Discuss your specific respiratory protective equipment (RPE) needs with a supplier of safety equipment to get expert advice and products appropriate for individual situations.
A P2 disposable facepiece respirator, or a P2 filter in a half facepiece respirator, is the minimum level of respiratory protection for investigating potential HeV situations where contact with respiratory secretions or aerosols is likely or possible. For a higher level of protection you can use a P2 or P3 filter in a full facepiece respirator, or a powered air-purifying respirator (PAPR).
Note: A standard surgical face mask is not a respirator and won't provide respiratory protection because it doesn't have adequate filtering and/or fitting properties. Don't wear a surgical mask or a dust mask for suspected or confirmed HeV cases as these won't filter bio-aerosols or provide an adequate facial seal.
Training in the use of PPE
Work health and safety legislation requires you to provide workers with information, training and instruction in PPE.
We recommend that you consult a commercial provider about PPE training. Training should include:
- correct donning and doffing procedures (putting on and taking off PPE)
- respirator fit checking
- correct storage, maintenance, cleaning, disinfection and disposal of PPE.
We also recommend that you keep records of PPE training and results of fit testing.
Disinfectants
Specific testing of disinfectant compounds against HeV has not been conducted.
The AUSVETPLAN decontamination manual notes that HeV is a member of Category A viruses. This category of viruses contains a lipid envelope.
The following disinfectants are known to be effective against category A viruses:
- soaps and detergents
- Virkon®
- hypochlorites
- iodophors/iodine
- biguanidines (e.g. chlorhexidine)
- quaternary ammonium compounds.
Others are named in AUSVETPLAN but these require special precautions for their safe use.
Any disinfectants that are hazardous chemicals must be used in accordance with the hazardous chemicals provisions of the Work Health and Safety Regulation 2011.
Work health and safety and Hendra virus
The Work Health and Safety Act 2011 places duties on people at workplaces for health and safety.
A person conducting a business or undertaking (PCBU) has a primary duty of care to ensure, as far as reasonably practical, the health and safety of themselves and workers (e.g. employees, students, trainees, contractors, sub-contractors and volunteers).
The same duty also applies to any other people who may be at risk from work carried out by the business or undertaking (e.g. clients).
If you are a veterinarian or a practice principal, you should ensure the following work health and safety (WHS) precautions:
- Manage the risks to health and safety from Hendra virus (HeV). Safe Work Australia's How to manage work health and safety risks code of practice gives guidance on risk management.
- Develop and implement a plan for responding to suspected HeV cases. This should include minimising the risk to veterinarians, veterinary nurses and others (e.g. clients).
- Develop and implement supporting HeV policies, procedures, equipment and training.
- Adopt recommended infection prevention and control and biosecurity precautions to protect veterinarians, veterinary nurses and others (including clients) against exposure to HeV risks.
- Provide biosecurity advice to clients.
- Discuss HeV vaccination with horse owners. Vaccination of horses provides a public health and work health and safety benefit by reducing the risk of HeV transmission to humans and other susceptible animals.
Work-caused infection with HeV is a notifiable incident. If this happens, you need to notify Workplace Health and Safety Queensland (WHSQ).
For more information, visit the WHSQ website or contact WHSQ on 1300 362 128.
Hendra virus investigation warning - nested content
Warning: Safety of people is the primary consideration when investigating potential Hendra virus (HeV) cases in animals. If you are concerned about your health, you should:
- seek medical advice and contact your local GP
- contact your nearest Queensland Health Public Health Unit
- contact the Queensland Health 24-hour hotline on 13 HEALTH (13 43 25 84).
Apply the precautionary principle. An infected horse can excrete HeV in nasal or nasopharyngeal secretions for several days before the onset of clinical signs. A horse with severe clinical signs poses the greatest transmission risk to other horses and humans through a range of body fluids and excretions.
Hendra virus warning - nested content
Warning: Hendra virus (HeV) infection of humans is rare, but it is a serious disease that can be fatal. Infection has occurred from high levels of exposure to the respiratory secretions and/or blood from horses infected with HeV (both live horses and dead horses at necropsy examination). Great care is needed to ensure the personal safety of the veterinarian and others who may be involved.
Learn more about precautions to take when Hendra virus is suspected.
© The State of Queensland 1995–2024
- Last reviewed: 08 Sep 2021
- Last updated: 08 Sep 2021