Herpes B-virus (Cercopithecine herpesvirus 1)

1. Herpes B-virus (Cercopithecine herpesvirus 1) Primer Provided in accordance with recommendations of the B Virus Working Group (CID 2002; 35:1191-1203) and DHHS (NIOSH) Publication No. 99-100

2. Herpes B Virus - Who needs training? Any personnel who reasonably anticipate contact with macaques, or macaque blood, body fluids, or other potentially infectious materials (i.e. unfixed tissue) need to take the Herpes B Virus training. This includes you, if you work directly with macaques and/or handle macaque tissues (i.e. blood, cerebrospinal fluid, fresh or frozen tissue) in a wet laboratory.

3. Herpes B Virus – Objectives of training At the end of this presentation, you should know: Where to find additional information on Herpes B virus What to do in the event of an exposure How to prevent exposure to Herpes B virus (and other blood borne pathogens) More about Herpes B virus and its risk to you

4. Herpes B Virus Alpha herpesvirus is in the same family as the herpes simplex virus. It is carried asymptomatically in macaques. It can be a rare, but sometimes fatal, infection in people. Human Simplex Virus 1

5. Herpes B Virus – Infection in People Prevention is key to preventing transmission! FACT: Approximately 50 cases reported worldwide FACT: 70% case-fatality rate FACT: Improved prognosis with early diagnosis and use of antiviral medication December 18, 1998 / 47(49);1073-6,1083 Fatal Cercopithecine herpesvirus 1 (B Virus) Infection Following a Mucocutaneous Exposure and Interim Recommendations for Worker Protection* *http://www.cdc.gov/mmwr/preview/mmwrhtml/00056008.htm

6. Herpes B virus – Transmission Documented routes of transmission include: Exposure to the infectious tissues or fluids of macaques Rarely, person-person transmission (one case) Bite, scratch, needlestick, or mucosal splash Man with Jaundice • Ocular, oral, or genital secretions • Central nervous system tissues and cerebrospinal fluid Wife who applied steroid cream to vesicular skin lesions of B virus-infected patient

7. Herpes B virus – Transmission Exposures thought to pose greatest risk: • Deep puncture wounds that are difficult to clean • Inadequately cleansed wounds • Wounds sustained on the face (especially wounds to the eye), neck, or thorax Man with Jaundice

8. Herpes B virus – Symptoms in People • Intermediate onset: • Fever, headache, muscle weakness or paralysis, conjunctivitis (ocular exposures) • Early onset: • Blisters/ulcers, pain, numbness, or itching at exposure site • Late onset: • Nausea/vomiting, altered mentation, paralysis, coma Onset is usually 1-4 weeks following exposure

9. Herpes B virus –Prevention Approaches To reduce risk of exposure, use: • Standard Universal Precautions used for human blood borne pathogens • Engineering Controls • Safe Work Practices • Minimize exposure to hazards • Education/training of personnel • Personal Protective Equipment (PPE)

10. Note: It is a good idea to use standard precautions whenever you work with animals and/or their tissues (regardless of species) Herpes B virus – PreventionStandard Universal Precautions • Consider all blood, body fluids, tissues, cells, etc., infectious • Use personal protective equipment • Conduct proper cleanup and decontamination

11. Herpes B virus – PreventionEngineering Controls Examples include: • Transfer/catch boxes • Needles with safety caps • Ventilated work benches Use devices that are designed to eliminate or minimize hazards, and know how to use them correctly.

12. Herpes B virus – PreventionSafe Work Practices Use work practices that minimize exposure: • Limit direct contact with awake macaques • No eating or drinking is allowed in animal associated areas • Handle and dispose of contaminated waste appropriately • Wash your hands after removing gloves

13. Herpes B virus – PreventionSafe Work Practices Education/training Know the hazards • Know how to control • the hazards • Have sufficient skills to execute safe work practices

14. Herpes B virus – PreventionPersonnel Protective Equipment (PPE) If you work directly with monkeys, wear appropriate PPE, including: • cap • fluid-resistant mask • gown • gloves • shoe covers • eye protection— goggles or face shield • If you have direct contact, you must wear a uniform under the personal protective equipment. Street clothes are not permitted. All uniforms should be laundered on-site.

15. Herpes B virus – Post Exposure Management • Written protocols • Exposure kits and eyewash stations • Herpes B virus medical alert cards • Location of: • Employee Health Services • Emergency Department You should familiarize yourself with the following:

16. Herpes B virus – Written Post Exposure Protocols • If an exposure is suspected, obtain a Herpes B Exposure packet located near ARP offices and in Animal Facilities. This packet includes: • Instructions • Medical Center Occurrence Report • Employee Clinic Illness Report

17. Herpes B virus – Exposure (Bite/Scratch/Splash) Kits • Located in proximity to all primate work areas • Contents include instructions for immediate first aid • Contact the Animal Resources Program (ARP) if you need a kit for your laboratory

18. Herpes B virus – Medical Alert Cards Carry the Medical Alert Card with you at all times. Contact ARP to obtain a card. This card is designed to: • Remind you of the symptoms • Provide contactinformation for a local health care provider

19. Herpes B virus – Post Exposure Management “The most critical period for the prevention of Herpes B virus and other infections is during the first few minutes after an exposure occurs.” Man with Jaundice The B Virus Working Group (CID 2002:35 1191-1203)

20. Herpes B Virus - Exposure What should I do? • Locate the nearest exposure kit and follow the directions in the kit • Inform your supervisor and the ARP veterinary staff* • Report the incident • Pick up exposure packet and complete forms or file an online injury report: www1.wfubmc.edu/ehs/report.html • Report to Employee Health Services—after 4 PM, go to the Emergency Department for evaluation *Important Note: It is essential that you notify the ARP staff at the time of exposure, as samples must be obtained from the monkey to test for active virus that could affect your treatment.

21. Herpes B virus – Post Exposure Management (Skin) • Rapid (within 1-3 minutes) and thorough cleansing of wound with soap or detergent for a minimum of 15 minutes (use a timer!) • Notify your supervisor and ARP veterinary staff • Report to Employee Health Services or the Emergency Department (after 4 PM) for evaluation Use the softside of the brush

22. Herpes B virus – Post Exposure Management (Mucous Membrane) • Rapid and thorough flushing of exposure site • Minimum of 15 minutes • H20 or sterile saline • Notify your supervisor and ARP veterinary staff • Report to Employee Health Services or the Emergency Department (after 4 PM) for evaluation

23. Herpes B virus – ExposureWhat can you expect after you report to MCEHS/ED? • You will be asked about the circumstances of your exposure and the adequacy of attention paid to the exposure site • You will be tested and counseled regarding your risk of contracting Herpes B virus • Depending on the type of exposure, prophylaxis may be offered

24. Herpes B Virus – Postexposure Prophylaxis Four main variables to assess: • Source of exposure • Timeliness and adequacy of first aid • Type of wound or exposure (depth and location) • Exposure to high-risk material (CNS, saliva, cell cultures, etc)

25. Herpes B Virus – Post-exposure Prophylaxis Recommendations* Recommended • Skin or mucosal exposure to high-risk source • Inadequately cleaned skin or mucosal exposure • Laceration of head, neck, or torso • Deep puncture bite • Needlestick associated with high-risk tissue/fluid • Positive post-cleansing culture Considered • Everything in between Not recommended • Skin exposure in which the skin remains intact • Exposure associated with non-macaque species *B Virus Working Group (CID 2002:35 1191-1203)

26. Herpes B Virus – Postexposure Prophylaxis Ultimately, the decision to use prophylaxis will be made by you together with your health care provider. Regardless, follow-up is essential. Be sure to report any unusual symptoms to your supervisor and health care provider.

27. Herpes B Virus – A Review • Know the risk present in your workplace activities • To reduce risk of exposure to Herpes B Virus (and other blood borne pathogens), use appropriate: • Standard Universal Precautions • Engineering Controls • Safe Work Practices • Personal Protective Equipment (PPE)

28. Herpes B Virus – A Review • Be familiar with appropriate post-exposure management procedures • Remember… prompt cleansing of the exposure site is key to preventing transmission! • Report all exposures to your supervisor, the ARP veterinary staff, and proceed to Employee Health Services or the Emergency Department for appropriate follow-up

29. For additional information: • WFU Medical Center Employee Health Services (716-4801) • WFU Environmental Health & Safety (716-9375) • WFU Animal Resources Program (713-7394) • CDC Website: http://www.cdc.gov/ncidod/diseases/bvirus.htm

30. Prepared by: WFUHS Herpes B Virus Task Force EH&S Information & Education Coordinator For questions, please call 716-6084.