Ritual Nasal Rinsing & Ablution

Many tiny germs live in warm water. Naegleria fowleri is a water-loving ameba (very small germ) that is often found around the world in ponds, lakes, and rivers. It also can hide in pipes connected to tap water.

Because Naegleria is so small, even water that looks, smells, and tastes clean can have the amebae swimming in it. Nasal rinsing with unsafe water can lead to infection.

Infections from Naegleria are deadly and rare.

Many people perform ritual nasal rinsing. This practice is included in Yogic, Ayurvedic, and Islamic traditions. Within the Islamic faith, ritual nasal rinsing is included in a cleansing process called "wudu" or "ablution." It is usually performed several times a day in preparation for prayer.

When water contaminated with Naegleria is sniffed up the nose, the ameba can travel to the brain. This causes the disease primary amebic meningoencephalitis (PAM), which destroys brain tissue and usually results in death.

• Infections are deadly: Of 157 people known to be infected in the United States from 1962 through 2022, only four people have survived.
  • Most Naegleria infections are due to swimming in warm lakes or rivers.
• Infections are rare:
  • Only one Naegleria infection associated with ritual nasal rinsing has been reported in the United States.
    • More infections linked to ritual nasal rinsing have been reported globally.
  • Two additional infections have been linked to using neti pots or similar devices to rinse sinuses with salt solutions made from contaminated tap water.

Use Safe Water to Protect Yourself

This image shows Naegleria about 1,000 times bigger than it really is.

You can lower your risk of becoming infected with Naegleria during ritual nasal rinsing by using treated water. It is safest to use boiled, distilled, sterile, or filtered water. If that is not possible, you can disinfect the water using chlorine.

Water Treatment Options for Nasal Rinsing

• Use water that has been previously boiled for 1 minute and left to cool. At elevations above 6,500 feet, boil for 3 minutes.
• Use water with a label specifying that it is distilled or sterile water.
• If boiled, distilled, or sterile water is not available, use a water filter designed to remove harmful germs.
  • Choose a filter that is labeled “NSF 53” or “NSF 58.” Filter labels that read “absolute pore size of 1 micron or smaller” are also effective.
  • Carefully read and follow the manufacturer’s instructions for the water filter you are using.
• If you are unable to use boiled, sterile, distilled, or filtered water, you can use chlorine bleach to treat the water. Learn how to use bleach to disinfect your water.