Standard Operating Procedures for Case Management of Employees Potentially Exposed to Herpes Virus Simiae (B Virus) Bites or scratches from nonhuman primates of the genus Macaque (examples: Rhesus, Pigtail, Cynomolgus) or ANY piece of equipment that may have been exposed to their secretions or blood, such as a needle stick or scratch from a cage, require special attention and adherence to a strict protocol because of the risk of B virus infection. High risk wounds are considered to be head/neck exposure, deep puncture wounds, and inadequately cleansed wounds. Infection with B virus in humans can be fatal. Employee Responsibilities Supervisor Responsibilities Veterinary Responsibilities Employee Health/BJC North ER Responsibilities I. Employee Responsibilities A. Skin Wound 1. IMMEDIATELY go to sink, wet the wound with water and apply providone iodine or chlorhexadine disinfectant to the wound. 2. Scrub the injured area with disinfectant and water for 20 minutes. 3. Rinse the wound thoroughly and pat dry. 4. Inform your supervisor of the exposure. 5. If your supervisor is unavailable, call the DCM office at 362-3700 AND Employee Health Service (EHS) 362-3528 for instructions. 6. If it is after hours OR on the weekend, page DCM at 841-5302 AND EHS at 871-2966 for instructions. 7. Identify the animal or equipment that caused your injury. B. Exposure of Eye or Mouth 1. Flush the injured area with sterile saline solution or running water (ie. Eyewash) for 15 minutes. 2. Inform your supervisor of the exposure. 3. If your supervisor is unavailable, call the DCM office at 362-3700 AND Employee Health Service (EHS) 362-3528 for instructions. 4. If it is after hours OR on the weekend, page DCM at 841-5302 AND EHS at 871-2966 for instructions. 5. Identify the animal or equipment that caused your injury. II. Supervisor Responsibilities A. Verify that the animal involved in the human exposure is a Macaque or trace the source if possible. B. Verify that the employee has washed the injured area. C. If the employee hasn't already done so, contact BOTH DCM and EHS at the above numbers. D. Fill out a WUSM Injury/Exposure Report. III. Veterinary Responsibilities A. Clinical/Primate Veterinarian 1. Identify the specific macaque involved in the human exposure and note previous Herpes B viral serological and culture results for that animal. 2. Get the Herpes B viral bite/wound kit and four sterile vials containing Bartel's viral transport medium from the refrigerator in the East McDonnell Necropsy room (Room 319). 3. Examine the chemically restrained macaque, looking specifically for oral and genital lesions (e.g., vesicles, ulcerations, etc.) or conjunctivitis, which may be indicative of active Herpes B viral shedding. 4. Collect the following samples:   1. 5ml blood in a serum tube   2.Sterile swabs placed in individual tubes of Bartel's viral transport medium from each of the following sites: one buccal swab, two conjunctival (each eye) swabd and one genital swab. 5. Label all vials with monkey identification number, collection date and site of virology sample. Fill out NIH B Virus Request Form.   ON WEEKENDS AND AFTER HOURS: Virology and serum specimens should be placed in the -80oC freezer in the DCM diagnostic laboratory, CSRB North Tower, 2nd Floor. These should be shipped on the following work day; alert the responsible individuals (lab personnel, primate vet). DURING NORMAL WORKING HOURS: Take the sample to the DCM diagnostic lab for processing. 6. DCM will supply and restock a bite/wound kit as described in Guidelines for Prevention and Treatment of B Virus Infections in Exposed Persons, CDC Publications, 1995. B. DCM Diagnostic Lab Responsibilities 1. The Diagnostic Laboratory (DCM Lab) receives monkey samples for virus isolation and Herpes B serology from the clinical veterinarian. 2. The DCM lab ships monkey samples and human samples (collected by EHS) to the Herpes B Virus Testing Laboratory by overnight delivery. 3. Both human and monkey results received by the DCM lab are sent to EHS for the human record and the clinical veterinarian for the monkey record. Originals are filed in the DCM Lab. IV. Employee Health/BJC North ER Responsibilities A. Oral Valacyclovir (1gram T.I.D.) is the preferred post-exposure drug in adults and non-pregnant women. Oral acyclovir (800 mg 5 times daily) is the alternative choice and recommendation for pregnant women. The usual course of this drug therapy is two weeks. B. Follow-up appointments should be made for one, two, three weeks, and three months. If baseline laboratory data was not obtained within the past six months, blood should be drawn after exposure. Laboratory data should also be obtained at three weeks and three months post-exposure. C. The presence of any signs or symptoms should be reported immediately to EHS. Last updated: March 10, 2005.