Protocol for Exposure to Secretions of Body Fluids from Old World Non-human Primates

Type of Exposure

If any person is bitten or scratched by an Old World non-human primate, lacerated or punctured by an instrument or needle contaminated by non-human primate secretions (saliva, secretions from mouth lesions, mucous membranes, conjunctiva), or splashed in the mouth or eye (mucous membranes) with primate secretions, immediate response is crucial and mandatory. This treatment includes:

• Soak, irrigate, and scrub the laceration with any soap solution for five minutes. Betadine surgical scrub brushes are available in each non-human primate housing room.
• Soak or scrub a puncture wound for 20 minutes in a soap solution.
• Irrigate eyes with water only (if wearing contact lenses remove prior to irrigating). Eyewash stations are present in the corridor within 50 feet of all non-human primate housing rooms.
• Rinse mouth with water and/or 3% hydrogen peroxide. Rinse for 5 minutes.
• Notify the Department of Comparative Medicine (DCM), X5-2651 of the incident.

The individual must go to University Health Service (UHS) on weekdays between 8 a.m.-5 p.m., or to the Emergency Department (ED) on weekends or after hours, immediately after or while soaking the wound.

UHS/ED

If the initial examination is performed in the ED, the employee must go to UHS for a follow-up examination on the next business day. A UHS or ED physician will evaluate the injury, collect a serum sample from the person exposed, and send the specimen to Clinical Chemistry to be frozen. The physician will evaluate the need for prophylactic acyclovir. There are no CDC guidelines regarding administration of acyclovir. The virus is most highly concentrated in the saliva and conjunctival secretions. Therefore, a person suffering a bite (breaking the skin) should be considered for prophylaxis unless contraindicated. In addition, a person should be encouraged to take acyclovir when he/she have had contact with monkey conjunctival secretions or saliva either to a mucous membrane, non-intact skin or an open wound. Other exposures should be evaluated regarding risk of contamination with monkey saliva and extent of exposure.

Treatment

The dosage for prophylaxis with acyclovir is 800 mg 5 times/day for 10-14 days.

Side Effects

Possible side effects from acyclovir include nausea and/or vomiting or headache. If the culture on the monkey is positive for herpes, a longer course of therapy should be considered. If the employee was not prophylaxed, a course of therapy should then be considered.

Standing Orders

RN may dispense first dose per above criteria, phone in rest of Rx. per MD approval.

Signs/Symptoms

Dizziness; headache; and intense itching, pain or numbness and vesicular rash at the exposure site. Other flu-like symptoms may develop. Symptoms occur generally within one month of exposure. The exposed employee should report any symptoms to UHS.

DCM Veterinarians

DCM veterinarians will perform a physical examination on the non-human primate. A serum sample from the non-human primate will be taken and evaluated for an antibody titer to Herpes Simiae. A culture from the monkey's mucous membranes will also be sent.

There are no current CDC guidelines regarding the exposed employee's subsequent contact with others. However, we recommend that the exposed employee avoid physical contact of the exposed area with others during incubation time (approximately 3-4 weeks or until negative results from the monkey are obtained).