| B-virus
Other viral
infections
Gastrointestinal
disease
Bacterial
pneumonia
Tuberculosis
Zoonotic
Diseases of nonhuman primates
Handling
Clinical Samples
Copyright 2007, University of Minnesota Board of Regents.
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Nonhuman Primate
Biosafety
In June 2003, "Occupational Safety and Health in the Care and Use of Non-Human Primates" was published. This report covers topics particularly relevant to facilities in which nonhuman primates are housed or where nonhuman primate blood or tissues are used. The report is available at http://www.nap.edu/catalog/10713.html. The report describes the hazards associated with work involving nonhuman primates and discusses the components of a successful Occupational Health and Safety Program, including hazard identification, risk assessment, applicable safety regulations, risk management, and personnel training. Topics include techniques for assessing the degree of risk for those hazards, options for managing those risks, worker training, and personal protective equipment; institutional management of workers after suspected exposures; and examples of safety and health programs in both large and small nonhuman primate facilities.
Zoonotic Disease
Nonhuman primates can carry
a variety of zoonotic diseases as detailed below. Zoonoses are diseases
that can be transmitted between species. It is important to note
that in many cases the transmission can go in both directions. Therefore,
the use of protective clothing not only protects you, but also the animals.
While prevention of disease is important, knowing how to handle exposures
is also important. These procedures are listed under individual diseases.
A further safety tool is a medical alert card that can be carried in your
wallet indicating to health care workers that you work with nonhuman primates.
These cards are available from RAR
or you can develop one of your own if you desire.
Cercopithecine Herpes Virus I
Most species of macaque monkeys
(rhesus, cynomolgus, pigtail) can carry a virus known as B virus, Herpesvirus
simiae or Cercopithecine Herpes Virus I. It is very similar to human herpes
virus which causes cold sores in humans. In the monkey, the virus causes
simple cold sores. In the monkey, the virus usually does not cause
disease, but in humans it causes a brain infection (encephalitis) that
is fatal in over 85% of cases. Infection in humans is rare, but most
cases have involved contact with nonhuman primates. Immediate diagnosis
and treatment with antiviral drugs has saved lives. The procedure outlined
below is adapted from recommendations from the Centers for Disease Control
and has been shown to reduce the risk of contracting Herpes B in the event
of a bite or other wound, or an exposure to mucous membranes or broken
skin.
Since B virus has a high
prevalence in conventional primate colonies, and animals can carry the
disease without showing symptoms, it is best to assume that all primates
are infected. Body fluids such as saliva and urine present the highest
risk to workers. Caretakers are at special risk, since routine care
and cage washing involves frequent contact with sharp edges on contaminated
cages and production of aerosols from spraying animal waste. In laboratories,
activities such as pipetting, opening containers and centrifuging urine,
blood or mucosal swabs can present risk of contamination. Use of
protective clothing, eye protection and respiratory protection are essential.
Consistent caution and respect for the monkey is always a good idea.
In addition, if you ever spot what looks like a cold sore on a monkey,
be sure to contact RAR before handling the animal or its cage.
[Link
to Website on Prevention of Herpes B infection]
Bite, Splash, Scratch
Procedures to Follow in Case of Contact with Body Fluids from a Nonhuman Primate (Rhesus or cynomolgus only)
- REMAIN CALM. Nothing happens so quickly that you can't take a breath and assess the situation. IF you have one of the following:
- A bite or scratch that causes bleeding
- A cage scratch that causes bleeding
- A puncture by a needle (that was used on a rhesus or cynomolgus monkey)
- Splashing of feces, urine, saliva or blood into your eye or mouth or a cut or open area in your skin.
THEN follow the procedures below:
- Open the sealed packet containing the scrub brush and soap. Wet the brush and scrub the wound for 15 minutes using the bristles, not just the sponge side. This may be painful, but will greatly reduce the risk of a life-threatening infection. For an eye splash, rinse your eyes at the eye wash station for 15 minutes.
- Swab the wound deeply, if you can, using one of the viral culture swabs. Do not swab your eyes. Place the swab in the vial containing the viral transport media, break off the end of the swab shaft and tightly seal the screw cap. Place the specimen in a biohazard transport bag and seal.
- Go directly to Boynton Health Service Urgent Care (625-8400) during business hours. Boynton's hours are: Mondays 8:00 a.m. to 6:00 p.m. and Tuesday through Friday 8 a.m. to 4:30 p.m. Take your swab with you as well as this two-sided sheet marked "NHP Bite, Splash, Scratch Protocol". Go directly to Boynton Health Service and report to the main check-in appointment desk. Do not wait in line but instead go directly to the receptionist at the check-in desk and report that you had an exposure to a non-human primate and you are here to be seen in urgent care now.
When Boynton is closed go to the Fairview-University Hospital emergency room. When possible a co-worker should call the emergency room ahead of time (612 273-2700) and tell a physician or nurse the nature of the exposure.
- Call RAR at 612 624-9100 and/or page the on-duty veterinarian as soon as possible after the exposure. It is important that the monkey be sedated and tested for Herpes B virus. Also, the animal care supervisor can be contacted on weekends until 1 PM at 624-6169 (until 1 p.m.), or by paging 8-527-3853.
- File a First Report of Injury form with your Departmental administrator as soon as you are able.
Information for Boynton Health Regarding Non-Human Primate Bites, Scratches or Splashes onto Mucous Membrane (Macaque Species)
- Confirm that the wound is related to a macaque species (Rhesus and cynomolgus monkeys are currently used. The only non-macaque species currently being used is baboon). For a wound inflicted by a non-macaque, follow normal animal bite procedures. Boynton Health Service staff should refer to Detailed Health Care Provider Protocol for Exposure to Nonhuman Primates (macaque species).
- Confirm that Research Animal Resources (RAR) has been contacted (phone number 612-624-9100). RAR is responsible for obtaining swabs and serum samples from the animal involved and for submitting these samples for testing.
- Assess adequacy of prior cleaning. If there is any doubt that the wound was cleaned thoroughly for a full 15 minutes, clean the wound again for 15 minutes. The wound should be scrubbed with an EZ scrub (prepackaged hexachlorophene scrub brush), using the bristle side vigorously. For eye exposure or mucous membrane exposure, irrigate with sterile saline or running water for at least 15 minutes.
- Patient should be carrying a culture swab from the wound taken after cleansing. If this has not been done, check to be sure the wound has been cleansed and then proceed to swab the wound as deeply as you can, using one of the viral culture swabs. Place the swab in the vial containing the viral transport media, break off the end of the swab shaft and tightly seal the screw cap. Place the specimen in a biohazard transport bag and seal. All swabs should be marked regarding source and site.
- Order laboratory Tests: Patient should be sent to lab with request marked with Dr. Risdahl’s provider number (571) ON a green lab request form under "other" write:
- Acute serology for herpes virus simiae.
- Wound culture (list site) for herpes virus simiae (see #4 above)
- Dr. Risdahl or her designee will follow up on test results.
- Make sure patient has current tetanus vaccine.
- Patient must be seen and assessed by physician in Urgent Care before discharge.
- If wound has any potential to be exposed to herpes virus simiae, even if remote or minor, the patient should be started on Valacyclovir 1 gram po tid for 14 days (500 mg tabs- 2 tabs po tid #84)(see BHS Detailed Health Care Provider Protocol).
- Schedule follow-up visit with Dr. Risdahl or designee one week after exposure.
- Instruct patient to return immediately if pain, numbness, paralysis, vesicular lesion, or other problems at the site of the wound or anywhere else.
Contact Boynton Health Service Occupational Health Director, Jeanne Ayers, (612-626-5422) or nursing supervisor to report that care was initiated for exposure.
Resource persons: Dr. Risdahl, BHS, 624-1134; Dr. Gillett or Suzanne Ford, RAR: 624-9100.
Other Viral Infections
Nonhuman primates can develop
measles,
usually following exposure to infected humans. Workers should be
vaccinated against measles. Workers with measles should not work
with nonhuman primates until they have recovered. Clinical signs
in the animals are similar to those in humans, including a red rash on
the face and hands. Transmission is usually by direct contact.
Influenza
virus can be transmitted between humans and nonhuman primates. Signs
of disease for both humans and animals include fever and upper respiratory
signs such as coughing, sneezing and nasoocular secretions. The disease
is potentially fatal in immunocompromised individuals. Transmission
is by aerosol. Prevention is achieved through the use of protective
clothing and respiratory protection.
Several pox viruses,
including monkeypox and Yaba virus can cause painful nodular lesions in
the skin of humans and nonhuman primates. Transmission is by direct
contact, although infected tissues could present a risk to laboratory workers.
Prevention of disease is through use of protective clothing.
Nonhuman primates may be
carriers of filoviruses such as Ebola.
These viruses cause an acute hemorrhagic fever in humans and nonhuman primates
that is often fatal. Flood and body fluids are potential sources
of the virus. Use of protective clothing and eyewear is preventative.
Animals are screened upon entry into the country for filoviruses.
Gastrointestinal disease
Bacterial agents such as Salmonella,
Shigella,
and intestinal parasites such as Giardia,
Entamoeba histolyticaand
Balantidium coli can be carried by many species of nonhuman primates.
Feces are the primary source of infections. Gloves, a laboratory
coat and a respiratory mask should be worn when handling fecal samples
or sanitizing caging. Symptoms of these diseases include diarrhea
with or without blood, vomiting, and fever in both humans and nonhuman
primates. Medical attention should be sought immediately.
Bacterial pneumonia
Streptococcus
pneumonia can cause an acute bacterial pneumonia in humans and
nonhuman primates. Infected animals and lung or sputum samples can
present a risk to workers. Sudden onset of fever, malaise and coughing
are symptoms of bacterial pneumonia. Medical attention should be
sought immediately.
Tuberculosis
Mycobacterium
tuberculosis causes a rapidly fatal pneumonia in most Old World
primate species, and chronic pneumonia in humans. Typically, infected
humans present a much greater risk to the animals than animals do to humans.
It would be unusual for the disease to be transmitted to humans, unless
the animal is undergoing surgery or pathologic examination. Infected
tissue samples can also present a risk to laboratory workers. Prevention
of disease includes routine use of respiratory protection and protective
clothing when working with tissues or when coming into close proximity
to animals. Animals and human handlers are screened every 6 months
for disease. Animals are also quarantined and screened on entry into
the facility.
Guidelines for Handling of Nonhuman Primate Clinical
Samples
Animal handlers are not the
only personnel who are at risk of zoonotic diseases from nonhuman primates.
Some diseases may be transmitted through body fluids and tissues.
Care should be taken by anyone handling these samples to prevent potential
exposure to zoonotic pathogens. These guidelines are adapted from
the universal precautions for handling human samples. Complete details
of the universal precautions can be found in the CDC publication Biosafety
in Microbiological and Biomedical Laboratories.
Training
All personnel in
contact with clinical samples must be trained
in the nature of the hazards presented by nonhuman primate samples, and
in the methods for preventing exposure. This training is available
through RAR (call 624-9100). Bloodborne pathogen training is also
available through the Department of Environmental Health and Safety (call
626-2330). The procedures presented in this training are identical
to those presented by RAR, however, the risks are pertinent to human samples.
Refer to the above information on risks from nonhuman primate samples.
Personal Protective Equipment and Clothing
-
Protective clothing should be
worn when handling clinical samples.
-
Disposable gloves and long-sleeved
protective clothing should be worn at all times
-
If there is the potential for
splashing (e.g. opening sample containers, pipetting, vortexing) eye and
respiratory protection should be used. This should include a respiratory
mask with a moisture barrier and a splash guard, safety glasses with side
panels, or or a face shield.
-
Protective clothing should be
replaced if it is contaminated.
-
Protective clothing should be
removed on leaving the work area and placed in a biohazard disposal container
or laundry.
-
Wash hands after removing gloves.
Procedures
-
Follow proper sharps handling
procedures.
-
Don’t recap needles, if possible.
If it is necessary to recap, use a device or a one-handed technique.
-
Use a piece of cardboard or
other device to pick up broken glass or loose sharps. This should
be discarded or decontaminated following use.
-
Dispose of sharps in a puncture-proof
container labeled "Biohazard".
-
If there is a spill, decontaminate
the spilled material with 10% bleach or a similar disinfectant.
-
Use a device, not your mouth
to pipette samples.
-
Samples should be kept in unbreakable,
leak-proof containers. Place the primary container in a secondary
container when transporting samples or when the primary container has become
contaminated on the outside.
-
Decontaminate work surfaces
after use using an appropriate disinfectant, such as 1% bleach.
-
Areas where samples are stored
should be labeled with a red or orange biohazard sign.
-
If samples are to be mailed
or transferred to another location, the container should labeled as a biohazard
with a red or orange label. Any special shipping procedures required
by law or by the carrier for biohazard samples should be followed.
-
Further details on laboratory
procedures are found in the CDC publication Biosafety in Microbiological
and Biomedical Laboratories.
Exposure to body fluids or tissues
Post-exposure procedures
should be followed if there is a needle stick, or exposure of body fluids
or fresh tissues to broken skin or a mucous membrane. Refer to the
attached page or, the "Nonhuman Primate Bite Kit" found in nonhuman primate
housing areas.
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The information contained in this site is intended as
a reference for University of Minnesota investigators, and animal husbandry
and veterinary staff. Drug information and dosages are derived from a variety
of sources and do not necessarily guarantee safety or efficacy. Information
obtained through this site should not be relied upon as professional veterinary
advice. Any medications administered or procedures performed on animals
should only be performed by or under order of a qualified, licensed veterinarian. |