Hazard ID 5 – Cercopithecine herpesvirus 1 (B Virus) Infection Resulting from Ocular Exposure
DHHS (NIOSH) Publication Number 99-100
- Mucocutaneous
Hazard ID 5 – Cercopithecine herpesvirus 1 (B Virus) Infection Resulting from Ocular Exposure
DHHS (NIOSH) Publication Number 99-100
- Mucocutaneous exposure to biological fluid from macaque monkeys can result in infection with Cercopithecine herpesvirus 1, commonly known as B virus.
- Eye splashes appear to be common in the primate industry.
- Dendritic corneal lesions characteristic of other ocular herpes virus infections may not be present
- All personnel who work with macaques should wear eyewear conforming to established standards for eye and splash protection.
- If exposure prevention fails, the adequacy and timeliness of wound or exposure decontamination procedures are critical factors in determining the risk for infection.
Description of Hazard
On October 29, 1997, a 22-year-old researcher at a primate-center field station was assisting with a routine group capture of rhesus macaques (Macaca mulatta) in a free-ranging corral. Personnel conducting the capture wore uniforms, disposable latex gloves, and surgical masks. Eye protection was not worn. During the transfer of an unidentified macaque into a squeeze cage, undetermined liquid from the animal entered the researchers eye. The worker wiped her eye at the time of exposure. Approximately 45 minutes later she flushed her eye with tap water for 2-3 minutes. There was no medical treatment or consultation at the time of the exposure. The researcher subsequently developed a Cercopithecine herpesvirus 1 (B virus) infection; despite intensive antiviral therapy, she died on December 10, 1997. This incident is the first documented case of a B virus infection resulting from an ocular exposure to macaque secretions.
On November 8, 1997, the researcher sought medical attention for the first time because the exposed eye was red and swollen. At this time, the emergency department physician specifically looked for dendritic lesions of the cornea that are characteristic of ocular herpes infections. Although dendritic corneal lesions were reported in a previous fatal B virus infection, they were not seen in the present case. On the basis of the reported circumstances of the contact, it was initially concluded that B virus infection was unlikely. This case is reported in the following:
CDC (Centers for Disease Control and Prevention). Fatal Cercopithecine herpesvirus 1 (B Virus) Infection Following a Mucocutaneous Exposure and Interim Recommendations for Worker Protection. Morbidity and Mortality Weekly Report (MMWR) 47(49):10731076,1083; December 18, 1998.
About B Virus
B virus infects >70% of surveyed captive adult macaques, but not other nonhuman primates (NHPs). Like humans infected with Herpesvirus simplex virus, monkeys infected with B virus have a lifelong infection, with intermittent reactivation and shedding of the virus in saliva, conjunctival fluid, or urogenital secretions. Although virus shedding is more frequent during the mating season (roughly March to June) and when an animal is ill, under stress, or immunosuppressed, there are often no signs of shedding. Macaques should always be regarded as potentially infectious.
There have been approximately 40 known cases of fatal human B virus infection described in the English language literature. Previously reported human infections usually have been attributed to macaque bites or scratches, injuries from needles used near a macaques mucous membranes or central nervous system, or contact with infectious products from the macaques. Incubation periods may be as short as 2 days, but more commonly they are 2 to 5 weeks. Most documented infections have occurred among biomedical research employees who worked with macaques. Laboratory workers handling only infected central nervous system or primary monkey kidney cell lines have also been exposed and, in at least one instance, infected. One case of person-to-person transmission has been reported.
Recommendations for Preventing B Virus Infections
Published recommendations for the prevention and treatment of B virus infections in exposed persons include the following:
CDC (Centers for Disease Control and Prevention). Guidelines for the Prevention of Herpesvirus simiae (B Virus) Infection in Monkey Handlers. Morbidity and Mortality Weekly Report (MMWR) 36(41):680683, 687689; October 23, 1987.
Holmes GP, et al.. Guidelines for the Prevention and Treatment of B-Virus Infections in Exposed Persons. Clinical Infectious Diseases 20:421439.
Protective eyewear criteria have been established by the American National Standards Institute (ANSI):
ANSI. Practice for Occupational and Educational Eye and Face Protection, Z87.11989. American Society of Safety Engineers, Des Plaines, IL.
Actions You Should Take
- Preventing worker exposure to biohazardous material is the best protection against infection. All organizations that work with macaques or other NHPs should obtain the documents cited in this report (as well as other guidelines and educational materials) and review the occupational health hazards associated