Herpes Bvirus Cercopithecine herpesvirus 1

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Herpes B-virus (Cercopithecine herpesvirus 1)
Primer
Provided in accordance with recommendations of
the B Virus Working Group (CID 2002
351191-1203) and DHHS (NIOSH) Publication No.
99-100
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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.
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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
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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
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Herpes B Virus Infection in People
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

• Prevention is key to preventing transmission!

http//www.cdc.gov/mmwr/preview/mmwrhtml/00056008
.htm
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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
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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
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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
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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)

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Herpes B virus PreventionStandard Universal
Precautions

• Consider all blood, body fluids, tissues,
  cells, etc., infectious

• Use personal protective equipment

• Conduct proper cleanup and decontamination

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Herpes B virus PreventionEngineering Controls
Use devices that are designed to eliminate or
minimize hazards, and know how to use them
correctly.

• Examples include
• Transfer/catch boxes
• Needles with safety caps
• Ventilated work benches

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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

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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
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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.
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Herpes B virus Post Exposure Management
You should familiarize yourself with the
following

• Written protocols
• Exposure kits and eyewash stations
• Herpes B virus medical alert cards
• Location of
• Employee Health Services
• Emergency Department

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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

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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

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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 contact information for a local
  health care provider

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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 200235 1191-1203)
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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 Servicesafter 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.
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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 soft side of the brush
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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

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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

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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)

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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 200235 1191-1203)
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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.

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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)

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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

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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/b
  virus.htm

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Prepared by

• WFUHS Herpes B Virus Task Force
• EHS Information Education Coordinator

For questions, please call 716-6084.