THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
Page
I.D.09
1 of 15
Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
I.
PURPOSE
To provide guidelines for the consistent management of employees potentially exposed to Cercopithecine
herpesvirus 1 (formerly Herpesvirus simiae "B virus") through biohazardous injuries and exposures.
This policy has been modified from a policy prepared by the University of Wisconsin-Madison which is
used with their permission.
II.
POLICY
A minimum of Biosafety Level 2 practices, containment equipment and facilities are recommended for
all activities involving the use or manipulation of tissues, body fluids and primary tissue cultures from
Macaca spp. (macaques) and other Old World monkeys. All personnel working with macaques and other
Old World species or entering rooms housing these animals, should wear appropriate protective
equipment (gloves, eyewear, masks, disposable coveralls).
The Principal Investigator (PI) or animal care supervisor must provide all members of his/her research
team or animal care workers the information on the dangers of B virus infection, including recognition of
the modes of transmission, methods of protection from exposure, post-exposure follow-up, and symptoms
of B virus infection.
The Thomas Jefferson University Health Services shall be responsible for the appropriate assessment,
treatment and follow-up of potentially exposed employees. Employees should report to the TJU Hospital
emergency department during off hours or when University Health Services is not open. The Office of
Animal Resources veterinarians are responsible for the assessment and follow-up of the involved
monkey.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
Page
I.D.09
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
III.
BACKGROUND
Cercopithecine Herpesvirus (also known as Herpesvirus simiae B virus) was first isolated by Sabin and
Wright in 1932 from the brain and spinal cord of a researcher who died of meningoencephalitis following
a bite from a macaque monkey. The virus has since been recognized to be endemic among Old World
Macaca genus monkeys (macaques) and to cause minimal morbidity in its natural host. Humans who
have contact with macaques or their products may be exposed to B virus through bites, scratches,
contaminated needle sticks and other routes. No other Old World and no New World monkeys are
known to naturally harbor B virus. The prevalence rate of B virus infection is low among immature
animals but approaches 80-90% in adult populations. Chronically infected monkeys actively shed virus
only intermittently (estimate prevalence rates 2-3%). Monkeys are more likely to shed B virus when they
are ill, under stress, immunocompromised, or during breeding season. Potentially infectious fluids are
ocular, oral and genital secretions from the monkey as well as primary cell cultures derived from
macaque kidney cells, aerosol exposure, and exposure to cleaned monkey skull. The risk of infection is
higher in certain types of exposures. Deep puncture wounds, inadequately cleansed wounds, and
wounds to the face, neck or thorax are considered to be high risk. Exposure to peripheral blood has not
been demonstrated to cause infections in humans.
As of December, 1995, fewer than 40 human B virus infections have been described in the English
literature, of which fewer than 30 are reported in detail. Twelve of those cases occurred in the 1950’s,
concomitant with testing polio vaccines in macaques. Despite as many as several thousand annual
monkey inflicted bites, scratches and other exposures, B virus infection has rarely been documented in
humans and must be considered an uncommon result of biohazardous injury. Since the 1987 Florida
cluster of human infections and the Centers for Disease Control and Prevention (CDC) and the National
Institutes of Health (NIH) publication of recommendations for preventing B virus infections, thousands
of specimens from bitten or scratched primate workers have been tested for B virus. Several hundred
primate handlers have been empirically treated for B virus infection pending test results. Even with this
intensive surveillance, only 6 confirmed human infections have been detected since January, 1993. The
only reported human to human transmission of B virus infection occurred through direct, repeated
inoculation of drainage from herpetiform lesions on to skin with contact dermatitis, possibly facilitated
by the use of steroid cream. Although theoretically possible, no other instances of human to human
transmission have been reported. There is no documented case of asymptomatic infection.
In an attempt to formulate a rational approach to the management of B virus exposure in humans, the
CDC sponsored a B Virus Working Group consisting of invited infectious disease specialists, primate
and laboratory animal veterinarians and herpesvirus experts. These published guidelines are based upon
limited information available from human cases, a small number of unpublished cases managed by Group
members, knowledge of the herpes simplex virus (the closest human counterpart of B virus) and
consensus opinion of the Group in the absence of hard data (1, 2).
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
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I.D.09
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 6/06/01, 06/26/08,
05/24/11, 07/22/2014 _
IV.
ROUTE OF EXPOSURE
Transmission to humans occurs by exposure to contaminated Macaque saliva, secretions, or tissues.
The most likely routes to transmission are bites and scratches or splashes. Exposure to peripheral
blood from macaques has not been reported to cause infection in humans. However, all macaques
and their tissues should be regarded as infected. There has been a report of person-to-person
transmission.
V.
a.)
Bite or scratch by a macaque that breaks the skin.
b.)
Laceration from contaminated instruments used during surgery or necropsy involving
the central nervous system, eyes, mouth, or urogenital areas.
c.)
Laceration from dental instruments used on macaque, or glass containing macaque cell
culture lines.
d.)
Needle stick from a contaminated needle used on macaque eyelid (TB syringe) or
oropharynx; for aspirating skin or mucosal lesions; at any site on a macaque.
e.)
Splash of macaque oral secretions or aerosolized tissue into eyes or onto mucous
membranes.
f.)
Fomites contaminated by ocular, oral or urogenital secretions or skin lesion/fluid from a
macaque.
g.)
Low or no known risk of exposure would include any exposure to non-human primates
other than macaques; exposure to non-human primate cell culture system, exposure to
nonhuman primate blood.
FORMS
TJU forms are available from departmental secretaries as well as LAS Supervisor staff or the
Workers Compensation - 1st floor Main building.
•
•
Employee Accident Report: Electronic form on Jeffshare must be filled out. However,
paper copy of Form No. 0155-10 should also be filled out and taken with you if you are
going to the Emergency Department for treatment.
See the University Veterinarian in regard to appropriate forms for diagnostic
evaluation of the animals.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
Page
I.D.09
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014 ______
VI.
PROCEDURE
A.
The Injured Employee’s Role
Prevention
1.)
Prevention of B virus infection must always be the first goal
and can be achieved through the following measures:
a.)
All macaque monkeys and their tissue should be regarded
as infected. Viral shedding is intermittent and can occur in
the absence of visible lesions.
b.)
Handling of macaques should be minimized and should be
done by trained personnel.
c.)
Transfer and squeeze-back cages and pole and collar transfer should be
used to move monkeys whenever possible.
d.)
Ketamine sedation may be used to facilitate removal of
monkeys from cages, particularly large or difficult animals.
e.)
Use appropriate personal protective gear (mask, goggles/face
shields, long sleeved and long legged clothing, gloves)
when handling animals or cleaning cages.
f.)
Do not recap needles or sharps!
g.)
Dispose of sharps (scalpel blades, contaminated sharp glass
or needles) immediately after use in a designated,
conveniently located puncture resistant sharps container.
h.)
Surfaces in contact with monkeys or their fluids
should be disinfected after use.
i.)
Cages/equipment with potential for contamination from
monkey fluids should be inspected for sharp edges that may
cause injury to workers.
j.)
Always practice appropriate hand washing technique.
k.)
Routinely report biohazardous injuries.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014 ______
First Aid
1.)
If a biohazardous injury occurs, risk of infection can be reduced by immediate
first aid. A bite kit can be found inside the 3rd floor primate procedure room,
outside the 3rd and 4th floor primate housing rooms, and outside wash bay (6th
floor JAH).
The bite kit should have the following items: providone iodine scrub; brushes;
sterile water; four viral culturettes (for using with the primates); timer; packet
with orange cover sheet that contains this SOP I.D.09 which contains the intake
sheet, consent for treatment sheet, and post-exposure education sheet; paper
copy of the accident report (Rev. 08/09); monkey blood specimen and/or viral
culturette sheet; B virus Exposure Mini-Protocol; and monkey serum shipment
form.
a.)
Set timer for 15 minutes.
Thoroughly cleanse/scrub/irrigate the wound with soap or
topical antimicrobial agent (povidone iodine or
chlorohexidine) for 15 minutes. If eyes, mouth, nose
or other mucous membranes have been exposed, irrigate the
site for 15 minutes with sterile saline or rapidly flowing tap
water.
b.)
Culturing a wound prior to cleansing is not recommended due to the risk
of further contamination with infected material. The cuturettes have
been placed in the bite kit for the veterinary staff to use when obtaining
samples from the monkey.
c.)
After cleansing the injury, cover the injury (sterile dressing
if available) and proceed to University Health Services. If
after hours, proceed to the Emergency Department. An
accident report must be completed Form No. 0155-10 (Rev.
2/05). If you go to the Emergency Department as soon as practical,
report the injury to your supervisor.
d.)
If possible, report the identification number of the involved
animal.
e.)
If you go to the Emergency Department take a copy of the handouts with
the orange cover sheet with you to the physician.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
Reporting
1.)
AFTER the appropriate first aid measures have been completed, the employee
should report the exposure to his/her supervisor. The on-line accident report
should be completed by the employee and signed by the supervisor; if the
employee is going to the Emergency Department the paper accident report is also
filled out (form No. 0155-10). The supervisor will contact University Health
Services (x 5-6835) to alert them that an exposure has occurred and will send the
employee without delay. If the exposure occurs after 4:00 p.m. Monday through
Friday or on weekends, the employee will report to the Emergency Department.
A copy of this policy and the accident report will be sent with the employee who
is seen in the Emergency Department.
The supervisor will contact the University Veterinarian to report the exposure
and to identify which animal was involved, if possible. PI must also be notified.
In addition, the Biological Safety Officer (Sue Gotta at 503-7422) must be
notified that an exposure has taken place. University Health Services will
forward the accident report to the Department of Environmental Health and
Safety.
Injury Follow-Up
1.)
The incubation for infection is 2 days to 5 weeks. Exposed employees will be
seen in University Health Services for the original injury, 3 days post injury and
again 4 weeks post injury. The early signs and symptoms suggesting B virus
infection will be reviewed. Exposed employees will be advised to report as soon
as possible for physician evaluation in UHS if any of the following signs or
symptoms occurs. Among untreated humans, estimates of the mortality rate
from B virus infection is approximately 80%.
a.)
Vesicular lesions near injury site
b.)
Localized numbness, itching, pain, tingling
c.)
Regional lymph node enlargement
d.)
Fever
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
Page
I.D.09
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
2.)
e.)
Muscle weakness
f.)
Conjunctivitis
g.)
Stiff neck, headache, nausea, blurred vision
The UHS nurse will see the exposed employee without delay and, despite prior
first aid measures, may repeat the appropriate cleansing. The accident report
will be reviewed to verify the time, date and place of the accident, the monkey
identification and the circumstances leading to the accident. The employee will
be seen next by the UHS nurse practitioner (CRNP) or physician.
The CNRP/MD will review the following:
1.
The employee’s wound or exposure site.
2.
The employee’s current medical history including medications and
allergies.
3.
The date of the employee’s previous tetanus booster.
4.
The primate’s history of B virus serology and current clinical status as
well as the nature of the research involving the primate.
The CRNP/MD will determine the testing to be done. This may include a
culture of the exposed site and/or serologic testing. Serum will be separated
from the blood sample in the Jefferson Clinical Laboratories and then forwarded
to National B virus Resource Center
B.
The Role of Supervisor/PI:
Prevention
Train employees on the risk of B virus infection, the methods of
preventing B virus infection, the need to clean wounds immediately,
and the importance of reporting injuries and/or symptoms to
supervisors.
First Aid
If present at the time of the injury, assist the injured employee to
cleanse the wound for 15 + minutes. If wound is bleeding, take
care not to directly contact employee’s blood without using standard
precautions.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
Page
I.D.09
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
Reporting
If possible, identify the animal causing the injury and notify the staff
veterinarian to review the animal’s record, examine the animal and
collect specimens on the animal for appropriate laboratory tests.
Complete the Supervisor section of the Employee Accident Report and call
Environmental health and Safety at x 5 - 7233 for immediate reporting of the
accident.
If possible isolate the suspect animal and notify a veterinarian, a veterinary
technician, a manager or the P.I.
Refer the employee immediately to UHS or to the Emergency
Department after hours. Call University Health Services or the
Emergency Department prior to sending the employee. The employee will take
the paper copy of the accident form to the Emergency Department when
reporting the injury.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
Page
I.D.09
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
C.
The Role of the Attending Veterinarian
If the non- the human primate can be identified samples should be collected.
Procedure For Obtaining Samples From Non-human Primates.
1.)
The animal identification number is determined if possible.
2.)
The identified animal is anesthetized as soon as possible after the exposure for a
physical examination and sample collection. A thorough examination by the
attending veterinarian is performed with emphasis on mucosal membranes.
3.)
Abnormalities are noted on the B virus submission form in the bite and scratch
kit.
4.)
Blood must be collected in serum separator tubes. A 5-7 ml sample of blood is
collected as close as possible at the time of injury. Allow 15 minutes for clot to
form. The attending veterinarian or qualified technician will centrifuge the
sample. 1.0-2.0 ml of serum is needed. Transfer serum to a serum storage tube.
Properly label the serum sample with the animal ID and serum collection date.
Until the serum samples are shipped, store them at 2-6°C (samples are good for
up to one week) or store them at 60 -80ºC (samples are good indefinitely). The
serum is checked for herpes-B virus within 48 hours.
5.)
If indicated, four sterile swabs for viral culture are collected: (1) buccal, (2) right
conjunctiva, (3) left conjunctiva, and (4) genitalia. If a lesion suggestive of B
virus infection is noted it should also be collected. Properly label sample tubes
with the animal ID, swab collection date, and swab site. Until the viral swabs
are shipped store, store them at 2-6°C (samples are good for up to one week) or
store them at 60 -80ºC (samples are good indefinitely). Swabs are to be placed
in commercially prepared viral transport media from Micro Test (division of
Remel Products); 1-800-255-6730; www.remelinc.com
6.)
Serum samples are collected again 14-21 days later. A second sample must be
collected because paired samples are used to run diagnostic tests.
7.)
Fill out National B Virus Resource Center Submission Form and include it with
Shipment. Forms are located in bite kit and at www.gsu.edu/bvirus.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
I.D.09
Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
D.
10 of 15
_
Sample Shipping: Nonhuman primate & human samples are sent to the same address.
See B Virus Exposure Mini-Protocol. A copy should be kept in the bite kit.
1.)
Contact the laboratory prior to shipping by:
 Telephone: 404-413-6550 (Dr. Julia K. Hilliard, Ph.D., Laboratory Director)
 Fax: 404-413-6556
 Email: bvirus@gsu.edu
2.)
Fill out the National B Virus Resource Center Shipping Form. A copy should be
kept in the bite kit. This copy must be included with specimen shipment.
Ship samples ASAP by overnight courier to
 National B Virus Resource Center
Virology Immunology Center
Georgia State University
161 Jesse Hill Jr. Drive
Atlanta, GA 30303
3.)
Label packages and air bills shipped on Friday for “Saturday Delivery”. Do not
select the “Next Day Delivery” option (this is considered the next business day).
Contact the National B Virus Resource Center with the air bill number for
tracking missing packages on the weekends.
4.)
The box should be filled with an adequate amount of dry ice to ensure the
sample arrives frozen. Use extra dry ice for Friday, weekend or holiday
shipments
5.)
Additional information can be obtained at www.gsu.edu/bvirus
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
I.D.09
Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
E.
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Immediate Management Strategy/Role of University Health Services/Thomas
Jefferson University Hospital Emergency Department
1.)
During normal working hours, all persons with exposure to B Virus should
report to University Health Services (Suite 205, 833 Chestnut Street) after
appropriate cleaning of the wound for 15 minutes. On weekends and after 4 p.m.,
persons with exposures should report to the TJUH Emergency Room.
2.)
The UHS/ED clinical will document the details of the exposure and verify that
the appropriate first aid measures were done. If not completed, the UHS/ED
staff will clean the wound or wash the mucous membranes for 15 minutes.
3.) Cultures of the wound will be done where appropriate in UHS or the Emergency
Department and sent to the National B Virus Resource Center. Blood must be
collected in serum separator tubes. A 5-7 ml sample of blood is collected as close as
possible at the time of injury. Serology for the exposed employee will be drawn in
UHS. If the employee is seen in the ED on the day of the exposure, the employee
will be referred to UHS as soon as possible for serology.
4.)
The UHS/ED staff will evaluate and possibly prescribe the following for any
potential exposure to B Virus:
a.
b.
c.
Antibiotic Prophylaxis:
i
Augmentin 875 mg by mouth every 12hrs considered with bites to
the high risk areas, i.e. fingers and hands.
Tetanus update:
i.
Tdap where possible.
Antiviral Prophylaxis for prevention of the B virus:
i.
Drug of Choice - Valcyclovir l g by mouth every 8hrs fo 14 days.
Alternative Choices
ii.
Famcyclovir 500 mg by mouth every 8hrs for 14 days; OR
iii. Acyclovir 800 mg by mouth 5 times daily for 14 days.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
I.D.09
Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
5.)
12 of 15
Each exposure will be evaluated for four major variables:
a. Animal source
i. Macaques are the only primates which transmit B virus.
ii. Immunocompromised, ill, breeding, and stressed animals are more
likely to transmit the virus.
b. Timeliness/adequacy of first aid
i.
Wounds cleaned within the first few minutes of exposure are less
likely to transmit the virus.
ii. Inadequately cleaned wounds are more likely to transmit the virus.
c.
Type of wound
iii. Wounds to head, neck or torso are considered high risk.
iv. Deep wounds are more difficult to clean and are considered high
risk.
d. Type of materials involved in exposure
v. Exposure to CNS fluid, fluids from eyelids or mucous membranes
are considered high risk.
vi. Blood exposure is considered low risk due to rare viremia in infected
animals.
6.) Counseling - Person to person transmission of B virus disease occurred in one
reported case of B virus disease that involved two people sharing a topical medication.
Exposed employees will be advised to avoid exposing others to body fluids or skin
lesions during the incubation period of 2-35 days, the side effects of the prophylaxis, and
the follow up schedule.
Discussion of potential risks and benefits associated with empiric therapy vs. close
observation must be held with the patient. The UHS CRNP/MD will discuss the pros
and cons of the postexposure prophylaxis and will review the most frequent reported side
effects of nausea, headache, diarrhea and rash. Possible neurologic side effects and renal
impairment has been associated with treatment with acyclovir. A consent for treatment
will be signed by the exposed employee.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
I.D.09
Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
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Based on well documented human B virus exposures, clinical evidence of infection is
most likely to develop between 5 and 30 days after exposure. In the event of
suspected B virus disease, the patient will be thoroughly evaluated with attention
specifically to any dermatologic symptoms and/or neurologic abnormalities. The
evaluation may include cultures of skin lesions, conjunctiva, and oropharynx.
Serologic testing will be ordered as well as routine chemical and hematologic
studies. Treatment with intravenous anti-viral medication will necessitate an inpatient hospitalization. Consultation with an infectious diseases specialist will be
made. Decisions regarding further testing and determination of which anti-viral
medication will be done in accordance with the recommendations of the infectious
disease specialist.
vii.
Discussion of potential risks and benefits associated with empiric therapy vs. close
observation must be held with the patient. The veterinarians may also be reached for
consultation. Dr. Judy Daviau is available by pager at 877-656-9759. If she cannot
be reached, Dr. Cynthia Lang can be paged at 877-656-6428. It will be the
responsibility or the veterinarians to assess the clinical status of the animal and to
arrange for testing.
viii.
Follow up - Exposed employees will be seen in UHS or the ED according to the
following time frame:
a. Day of the exposure.
b. 2-3 days post exposure.
c. 4 weeks post exposure.
d. 3 months post exposure if antiviral prophylaxis taken.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
Section
Page
I.D.09
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
VII.
REFERENCES
1.)
Adapted from University of Wisconsin - Madison, Policy for Management of
Cercopithecine herpesvirus 1 - with permission.
2.)
Cohen JI, Davenport DS, Stewert JA, et al. Recommendations for Prevention of
and Therapy for Exposure to B Virus (Cercopithecine Herpesvirus 1) CID 2002;
35: 1191-1203.
3.)
Holmes GP, Chapman LE, Stewart JA, et al. Guidelines for the prevention of Bvirus infections in exposed persons. Clin Inf Dis 1995; 20:431-439.
4.)
Krugner-Higby L, Schultz KT. Herpesvirus simiae (Herpes B) and SIV as
zoonoses. Lab Animal 1995; 24:24-31.
THOMAS JEFFERSON UNIVERSITY
ANIMAL RESOURCES
STANDARD OPERATING PROCEDURES
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Title
Date Issued/Revised
Policy for the Management of Cercopithecine Herpesvirus
1 (formerly Herpesvirus Simiae or "B Virus") Exposures
04/06/98, 06/06/01, 06/26/08,
05/24/11, 07/22/2014
Signatures:
Reviewed by:
Name
Title
Date
Name
Title
Date
Name
Title
Date
Reviewed by:
Approved by:
SUMMARY OF BIOHAZARDOUS INJURY PROTOCOL FOR THE POTENTIAL EXPOSURE
TO CERCOPITHECINE HERPESVIRUS 1 (FORMERLY HERPESVIRUS SIMIAE OR “B
VIRUS”)
If a biohazards injury occurs, risk of infection can be reduced by immediate first aid. Monkey bite
kits are available in monkey housing areas and laboratories.
a.)
Thoroughly cleanse/scrub/irrigate the wound with soap or topical antimicrobial agent (povidone
iodine or chlorohexidine) for 15 minutes. Gentle washing of the wound is recommended. If
eyes, mouth, nose or other mucous membranes have been exposed, irrigate the site for 15
minutes with sterile saline or rapidly flowing water.
b.)
After cleansing the injury, cover the injury (with a sterile dressing) and proceed to the University
Health Services for further evaluation. Proceed to the Hospital emergency room during off
hours. Employees reporting to the emergency room should bring a copy of this policy and
standard operating procedure for the attending physician’s reference use.
c.)
As soon as practical, report the injury to your supervisor. If possible, report the identification
number of the involved animal.
d.)
Your supervisor should contact the veterinarian responsible for the care of the involved animal
and report the injury.
e.)
The veterinarian will examine and take animal cultures as per Guide for Post-exposure Sampling
of Macaques (attached).
f.)
Supervisor will complete Section A. of the Thomas Jefferson University Accident Report (Form
0155-01) and comply with items 1 - 4 of the accident report.
Important Phone Numbers:
•
University Health Services - x (5) 6835
•
Emergency Department - x (5) 6840
•
Environmental Health and Safety - x (5) 7233
•
Biological Safety Officer - x (3) 7422
•
Laboratory Animal Services - x (3) 6167
CONSENT FOR TREATMENT
FOLLOWING A POTENTIAL EXPOSURE TO CERCOPITHECINE HERPES VIRUS 1,
“MONKEY B VIRUS”
I understand that I have had a potential occupational exposure to Cercopithecine herpes virus
1, also know simply as “B virus”. I have notified my supervisor and completed the proper
paperwok according to department policy. I have had a chance to ask questions and have been
advised of the risk of infection and the signs and symptoms of “B virus” disease. I understand
that I am expected to return to University Health Services (UHS) for follow up and
acknowledge receipt of the information sheet that gives me the specific dates for return. In
addition, I understand that an antiviral medication noted below has been prescribed to me for
fourteen days to prevent transmission of the “B virus”. The UHS/ER clinician has explained
the pro’s and con’s of this post-exposure prophylaxis. I am aware of the possible side effects of
this medication. I will report to UHS if I develop symptoms related to the medication or to a
possible “B virus” infection. If I decide to discontinue the medication before fourteen days, I
understand that I must contact UHS and advise them of my decision. My signature below
indicates my willingness to take the prescribed medication.
Medication Prescribed:
___ valacyclovir 1 g orally every 8 hours for 14 days
___ acyclovir 800 mg orally five times a day for 14 days
___ famcyclovir 500 mg orally every 8 hours for 14 days
Possible side effects include:
Nausea, headache, diarrhea and a rash
Other: _________________________________
_______________________________________
Employee Signature
_______________________________________
Date
______________________________________
UHS/ER Clinician
______________________________________
Date
MACAQUE MONKEY EXPOSURE INTAKE FORM
Date_________________
Exposure Date______________
Employee Name: ______________________________ DOB: ____________
TJU Veterinarians:
Dr. Daviau (877) 656-9759 beeper; Dr. Cynthia Lang (877) 656-6428 beeper
Monkey Information:
Name: _________________
Health Status: _________________
Hx of B virus: _________________
Type of research: _________________
First Aid Measures in Department: ___________________________________
First Aid Performed in UHS/ER: _____________________________________
Physical Examination:
Wound description: ________________________________________
Wound Culture done: _______ Serum Specimen drawn: ______
Assessment of Risk: _____________________________________
B virus Post Exposure Prophylaxis:
___ prophylaxis recommended
___ prophylaxis considered
___ prophylaxis not recommended
Medication:
___ valacyclovir l g po q8h for 14 days
___ acyclovir 800 mg po 5 times per day for 14 days
___ famcyclovir 500 mg po q8h for 14 days
___ tetanus booster
___ Augumentin 825 mg BID for 5-7 days (for bites to hands)
___ other: ___________________________
Counseling:
___ side effects of medication reviewed
___ infection control during incubation period
___ signs and symptoms of B virus disease
___ follow up schedule reviewed
___ patient information sheet given/consent signed
UHS/ER MD/CRNP SIGNATURE: _______________________________________
MACAQUE MONKEY POST-EXPOSURE PATIENT EDUCATION SHEET
Today you have been seen after an occupational exposure to a monkey. You may have been
exposed to a virus called Cercopithecine herpesvirus 1 or simply “B virus”. Although it is
uncommon, there are cases of humans who have contracted this virus after a monkey scratch,
bite, or splash to the eyes or mouth.
The following is a list of dates for follow up in our office. Your supervisor will allow you to be
seen as this is a Workers’ Compensation injury that must be followed closely.
1. Please return to UHS in Suite 205, 833 Chestnut St. on __________________ which is 3
days following your exposure.
2. Please return to UHS in Suite 205, 833 Chestnut St on __________________ which is 4
weeks following your exposure.
3. Please return to UHS in Suite 205, 833 Chestnut St on __________________ which is 3
months after your exposure. This appointment is only necessary if you were given
medication to take after your exposure.
You were given the following medication to take for 14 days:
The most common side effects of this medication include headache, nausea, diarrhea and a
rash. If you develop any of these symptoms, please call our office.
If you develop any of the following symptoms prior to your scheduled return dates, please call
us immediately at 955-6835:
Blisters at the injured site
Localized nunbness, itching pain and tingling at the injured site
Lymph node enlargement
Fever
Muscle weakness in your arms or legs
“Pink eye” symptoms
Stiff neck with headache, nausea, blurred vision
UNIVERSITY HEALTH SERVICES
833 Chestnut Street, Suite 205
(215) 955-6835
hours: Monday – Friday 7:30 am – 4:00 pm
UNIVERSITY HEALTH SERVICES
BLOOD SPECIMEN AND/OR VIRAL CULTURETTE
FOR MONKEY B VIRUS EXPOSURE
ATTENTION CENTRAL RECEIVING
These specimens have been taken from an employee. Please separate the serum STAT and call
University Health Services (5-6835) for pick up. If you receive these specimens from the
Emergency Dept. after 5 PM or on the weekend, please save the serum and call University
Health Services (5-6835) on the following business day. Our staff will collect these specimens.
PLEASE DO NO OPEN THE CULTURETTE TUBE. THERE IS NO TESTING TO BE
DONE ON THESE SPECIMENS BY THE CLINICAL LABORATORIES.
DATE: ____________________________________________
PATIENT NAME: ___________________________________
DOB: ______________________________________________
DEPT: ______________________________________________
If you have any questions, please call our extension at 5-6835. You may leave a message on our
voice mail. Thank you.
Ellen M. O’Connor,
MD Medical Director, University Health Services
CHAIN OF CUSTODY FORM
UHS PERSONNEL:
Date Specimen Handled _______ Signature of RN ____________________
CLINICAL LAB PERSONNEL:
Received by _____________________ Date: __________________________