Surgery in the shadow of Nipah: Preparedness, precautions, and protocols.

Nipah virus (NiV) is a highly lethal zoonotic infection with a case fatality rate of 70-75% and is recognized by the World Health Organization as a priority pathogen with epidemic potential. Recent cases in India highlight the ongoing risk of re-emergence, particularly in resource-constrained health systems. While surveillance and outbreak containment are often emphasized, the implications of NiV for surgical and perioperative care remain less often discussed. Operating rooms are high-risk environments for nosocomial transmission owing to aerosol-generating procedures and exposure to body fluids. Drawing on lessons from past infectious disease outbreaks and recent global experiences with COVID-19, we wish to outline perioperative risks, evidence-informed precautions, and system-level preparedness strategies tailored for surgical teams.