In the laboratory setting, non-human primates pose a real potential for exposure of personnel to zoonotic diseases. Although transmission of zoonotic diseases from non-human primates to humans is rare, laboratory personnel and animal care staff are at risk due to animal exposure. Serious injury from bites and scratches can occur. These types of injuries/ exposures can be avoided if personnel are properly trained prior to beginning any type of work with non-human primates. Staff working with non-human primate tissue should also receive first-aid training in the event of a needle stick or injury from a surgical/procedural instrument.

Non-human primates are highly susceptible to human diseases, such as influenza, measles and tuberculosis. Personnel working with primates must be TB tested prior to working with non-human primates and re-tested annually. Any individual who is experiencing cold/flu symptoms or has active herpes simplex lesions (e.g. cold sore ) should avoid going into non-human primate areas until their symptoms have resolved.

Note:

• Due to the serious zoonotic potential of Herpes B-virus, all macaque users (Macaca fasicularis/cynomolgus monkeys, Macaca mulatta/rhesus monkeys) must attend a first aid workshop prior to working with these animals.
• All personnel working with non-human primates MUST have proof of annual TB testing. Personnel that do not have a documented negative TB test within the last 12 months are required to wear both a surgical mask and a face shield.

Recommended Preventative Measures

• Require a TB test annually for all staff working with non-human primates
• Only trained personnel should handle monkeys. Handling and restraint training can be scheduled through Center for Comparative Medicine.
• Wash hands after handling animals or related equipment
• Never wear protective clothing outside the animal areas
• When seeking medical advice for any illness, inform your physician that you work with nonhuman primates
• All personnel observing husbandry procedures or surgical experiments must wear full protective clothing.  Limit observers to necessary personnel.

Protective clothing appropriate before entering animal holding rooms.	Protective clothing appropriate for laboratory procedures (including euthanasia and perfusion procedures) and acute and survival surgeries. (For all laboratory personnel, including observers.)
Disposable head bonnet Disposable or UConn-laundered moisture resistant gown or lab coat Disposable moisture resistant shoe covers Disposable gloves (equipment handlers may also be required to wear leather or fabric protective over gloves) Face mask with goggles containing peripheral protection or face shield with chin guard	Surgical scrub suit Disposable head bonnet Disposable or UConn-laundered moisture resistant gown or lab coat Disposable moisture resistant shoe covers Disposable gloves. Double gloving is required for personnel performing any procedural or surgical manipulations Surgical mask and goggles containing peripheral vision protection or face shield with chin guard

Monkeys in Transport

Monkeys should be transported outside of the animal housing either in dedicated transport cages and covered with a moisture resistant cloth. Protective clothing should remain on while working with or around the animal at all time except during transport.

Waste Management

• Disposables: All disposables, feces and left over food is treated as medical waste.
• Non-disposable soiled cloth materials including lab coats and surgical towels are sent out to a professional laundry service and are treated by commercial laundering service as BSL 2 contaminated articles.
• Cages are pre-cleaned in the animal room before sent to the washroom

Response to Injury

Any potential exposure to macaque blood/saliva/urine/feces/tissue is considered an injury and must be treated as follows. this includes cuts or scratches from a cage inside a macaque room, needle sticks, bites, splashes, etc. if in doubt ,treat it as an exposure.

Bite/Scratch Emergency Kits

Bite/ scratch emergency kids are located outside all rooms housing macaques. staff must be familiar with the location of the kits. all are square white medical cabinets with bright orange signs that say “Monkey bite/scratch emergency kit.” Dimensions are approximately 20″ x 20.”

Procedure

1. Scrub or irrigate wound immediately with a mixture of soap and irrigation solution. you must do this within 2 to 3 minutes of exposure. since the B-virus may enter the body within minutes of exposure, this is the only way to keep it from entering the wound and becoming infected. Scrub or irrigate the wound for 15 to 20 minutes. For exposures of the eyes, nose, mucous membranes: irrigate with the sterile eye solution in first aid kit immediately and then find an eye wash station to continue rinsing your eyes for 15 to 20 minutes. Never use a bleach solution in your eyes For bites, lacerations or needle sticks: soak and scrub the wound with the soap mixture. Deep wounds can be gently massaged to increase contact with the mixture. Keep scrubbing for 15 to 20 minutes. Wash all of the soap mixture out of the wound after you are done scrubbing.
2. Visit Employee Health during working hours (Dowling South Building, 3rd Floor) or the Emergency Department during Weekends, Holidays and after hours (Dempsey Hospital first floor, 860-679-2588) for a wound culture, a blood sample and other immediate care as necessary. Bring the bag labeled Employee Health/Emergency Department from the first aid kit with you. This should include sterile swabs, culture and serum tubes, a protocol for further evaluation, a signs and symptoms of infection sheet and a form for sample submission to Georgia State University Viral Immunology Center.
3. Notify Veterinary Services during working hours call 860-679-2731, during weekends, holidays and after hours call 860-679-2626 and ask the operator to page the attending veterinarian. Veterinary services will follow up on the health status of the monkeys.

Specific Occupational Hazards

There are several viruses associated with non-human primates that can cause significant disease in people. These include the Hemorrhagic Fever Viruses, Filoviruses and Monkey Pox Viruses. These are usually associated with recently imported, wild-caught animals in quarantine, but are very rare in domestically bred animals. These viruses can cause fatal diseases in people.

Note: There are numerous viruses associated with primates which have unknown or uncertain pathogenic potential. Examples include:

• SIV and STLV, This is the simian counterpart to HIV and HTLV
• Foamy agent and various other simian viruses, e.g., SV5, SV40, etc.
• Herpesviruses saimiri (squirrels), tamarinus (tamarinds), etc. These may be progenitors of human viruses and their role in human illness is unknown at this time.

Cercopithicine Herpesvirus 1 (CHV1, Herpesvirus Simiae, Monkey B Virus)

This disease is quite rare in people but is either fatal or causes permanent neurological disease. most macaques are asymptomatic carriers or display only mild oral lesions that are difficult to detect. therefore, all macaques should be presumed to be shedding B virus.

• Reservoir/source of infection to people: Macaques are the major source of infection; although other old world primates may be infected
• Transmission: Transmission occurs via bites, scratches, splashes (any body fluid or secretion, feces) needle sticks and any direct contact with macaque tissue
• Disease in people: The disease in people is associated with a rapidly ascending encephalomyelitis leading to death in 50 percent of the cases. Permanent neurological deficits are present in survivors.

Tuberculosis

This disease may be transmitted to people through contact with birds, livestock, and non-human primates. Routine TB testing is performed on all UConn non-human primates.

• Reservoir/source of infection to people: Mycobacterium spp. may be transmitted to non-human primates (old world primates are particularly susceptible) from humans which can be a source of infection to other people and monkeys
• Transmission: Tuberculosis is usually transmitted by the aerosolization of infective bacilli which can be found in the sputum as well as other body fluids. Contact with body fluids during necropsy may be a major mode of transmission to humans
• Disease in people: Pulmonary tuberculosis is the most common type but other organs may also be involved.

Shigellosis

This is a relatively common zoonotic disease that must be differentiated from salmonellosis, campylobacteriosis and other enteric diseases.

• Reservoir/source of infection to people: Humans are the main reservoir of disease but like tuberculosis, infected monkeys can be a source of infection. Any non-human primate may harbor Shigella bacteria, and clinical signs may not be apparent
• Transmission: fecal/oral
• Disease in people: Diarrhea, may be with blood or mucus.

Salmonella

• Reservoir/source to people: Non-human primates, dogs, cats, birds, reptiles (especially iguanas and turtles), and wild rodents
• Transmission: fecal/oral
• Disease in people: Gastrointestinal disease, can be febrile with septicemia.

Cryptosporidium

Protozoal organism that is common in mammals, particularly younger animals.

• Reservoir/source of infection: Many mammals
• Transmission: Fecal/oral
• Disease in People: Self-limiting diarrhea except in immune compromised people where it can be quite severe. No treatment.

Giardia

• This protozoan is found in many mammals.
• Reservoir/source: non-human primates, other mammals, standing water
• Transmission: Fecal/oral
• Disease in People: Diarrhea +/- other systemic signs such as severe cramping and nausea/vomiting.

Allergies

General animal related allergies are common. Although there are no known allergens associated with monkeys, the non-human primate environment may have common allergens present such as dust from bedding.

Causative Agent

DNA Herpesvirus. There are more than 35 herpesviruses of NHPs, most of which are not zoonotic. This disease has been described as one of the most feared infections of non-human primate handlers. First reported case of encephalitis caused by B virus in monkey handler was in 1932. Called B virus after the initials W.B. of the first patient. 23 additional cases described through 1973. Four cases including first known person to person transmission occurred in Pensacola, FL in 1987. Most of these cases resulted in encephalitis and 20 resulted in fatalities. In 1988, two confirmed cases occurred. Both were identified early and clinical signs were averted by administration of Acyclovir.

Reservoir and Incidence

The virus is enzootic in rhesus, cyno and other Asiatic monkeys of macaque genus. Baboons, Chimpanzees, and African Greens have also shown positive titers. Young monkeys can be infected by adult carriers as soon as they lose maternal antibody. One study found that 80 percent of adult monkeys in a closed colony had been infected. The virus has been isolated from trigeminal and lumbosacral ganglia in clinically normal sero-positive rhesus and cyno’s.

Transmission

Transmission of the virus is basically by direct contact. Transmission to man is thought to occur via bites, scratches, aerosols, or improper handling of contaminated monkey tissues. Virus has been isolated from saliva, blood, urine, feces, and kidney tissue cultures of infected monkeys. Most cases have occurred in people exposed to monkeys or monkey tissues. One case occurred by common use of an over-the-counter antibiotic ointment passing the virus from an infected individual to another person. An additional case occurred by self inoculation of a needle, after the needle had been use for blood collection. The virus has been isolated from animals that had no visible lesions. AN INFECTED MONKEY SHOULD BE CONSIDERED INFECTED FOR LIFE.

Disease in Non-human Primates

The animal may be completely asymptomatic. The virus may cause mild cold sore type lesions of mucous membranes, dorsum of the tongue, lips or face; similar to those caused by Herpes simplex in man. These usually heal spontaneously in 7 to 14 days. There may be mild conjunctivitis and nasal discharge are present. In some animals the disease may be severe and cause considerable discomfort as well as neurological signs and symptoms. The virus remains latent and may reactivate spontaneously or in ties of stress resulting in virus shedding. An animal should be considered to be infected for life. AN INFECTED ANIMAL CAN APPEAR NORMAL!

Disease in Humans

The disease has been characterized by a variety of symptoms which generally occur within a month of exposure. Symptoms have included vesicular skin lesions at or near the site of inoculation, localized neurological symptoms, ascending paralysis, and ultimately encephalitis. Death usually occurs three to 21 days after the appearance of clinical signs. A unique feature of the Pensacola cases was the occurrence of mild disease in two of four patients. Both of these received Acyclovir early in the course of the disease. They became culture negative and lesions resolved during therapy.

Since there is a high percentage of infection in monkeys yet relatively few human cases, risk of acquiring infection appears to be low. Possible reasons for this apparently low rate of transmission may include:

• Infrequent virus shedding by macaques.
• Cross reactive immunity stimulated by Herpes simplex infection or Herpes zoster (chicken pox).
• Undetected asymptomatic infection in man. The frequency of this has not yet been adequately assessed but antibody titers have been found in some monkey handlers showing no signs of disease.

In a retrospective study of 95 banked sera from monkey handlers at NIH, three percent were found to be sero-positive, with no history of a bite. NIH is currently conducting a prospective study of monkey handlers to determine incidence of antibody specific for Herpes B.

Diagnosis

Diagnosis is by histology, virus culture, and serology.

Treatment

Anti viral therapy with Acyclovir (9-[2-hydroxyethoxymethyl] guanine), both in vivo and in vitro efficacy against B-virus has been demonstrated. Hyperimmune human B-virus globulin or vaccine is not currently available. These are from the guidelines established by the B-Virus Working Group, June 1987:

• Macaques should be used for research only when clearly indicated.
• B virus – free animals should be used whenever possible and maintained under conditions to assure maintenance of this status.
• Direct handling of macaques should be minimized and appropriate restraint methods employed (i.e., squeeze cages, chemical restraint, pole and collar etc.).
• Protective clothing should be worn when working with macaques or macaque tissues (long sleeves, gloves, mask, goggles).
• Cages and equipment should be maintained free of sharp edges that could cause injuries.
• Access to areas where macaques are housed should be limited.
• Routine screening of animals for B virus is NOT recommended.
• Animals with lesions should be quarantined until lesions have healed.
• Education and training of personnel should be assured.
• An occupational medical service should be available.
  • Employee serum samples collected and banked annually.
  • All bite or scratch wounds should be immediately and thoroughly scrubbed with soap and water (or Modified Dakin’s solution: buffered sodium hypochlorite 0.5 percent) Refer for medical treatment if necessary.
  • All bite or scratch wounds should be reported, documented, and followed up for one month.

If you get bitten or scratched by a non-human primate or are working in non-human primate areas:

You need to follow the procedure that the Center for Comparative Medicine has developed in conjunction with EHS.

Your Potential Risks

Based on the species you are working with, you should be aware of the following potential health risks:

• Asthma and Allergy in Animal Handlers
• Bites and Scratches
• Cercopithecine Herpesvirus 1 (Herpes B Virus)
• Cryptosporidiosis
• Ebola/Marburg/Filoviruses
• Enteric Bacteria
• Giardiasis
• Lymphochoriomeningitis Virus
• Physical Injury
• Preventing Asthma in Animal Handlers
• Rabies
• Tuberculosis

What You Should Do

1. Be knowledgeable about the potential for developing allergies and/or asthma due to animal handling- especially if you are already allergic.

2. Consider using a NIOSH-approved N95 respirator- even if you do not have any symptoms. These respirators have been shown to reduce the chance of developing laboratory animal allergies. In order to use a respirator, you must have a fit test through the Environmental Health & Safety.

3. Know proper handling techniques of non-human primates. Only trained individuals should handle non-human primates. Handling and restraint training can be scheduled through the Center for Comparative Medicine.

4. Always wash your hands after coming in contact with non-human primates or their saliva, urine, blood, feces, and/or bedding materials.

5. If you are using non-human primates, please be sure to read Non-Human Primate Specific Occupational Health and Safety Risks.

6. If you need to know the procedures to be followed for collecting non-human primate or human samples because of a non-human primate exposure (e.g., bite, scratch, etc.), please read Special procedures for non-human primate specimen handling (PDF).

What Is Toxoplasmosis?

Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii which can infect many animals, including man. Toxoplasma occurs worldwide. Most infections are silent and have no ill effect on the patient; however, occasionally infections can be devastating – in immuno-compromised patients, for instance.

Routes of Infection

Humans become infected when they eat undercooked mean in which Toxoplasma cysts are present. They may also become infected if they ingest oocysts from cat feces. The parasite passes one stage of its life cycle in the gut of cats and another stage of its life cycle in the tissues of other animals. Humans can be infected by both phases.

Risks

Most human beings are infected by eating undercooked meat, but exposure to infected cat feces is also a significant hazard, especially for pregnant women. The risk is very low if the research cats have been housed in a rodent-proof facility for a month or more and have been fed only commercial cat food. If there is a chance that feral mice can find their way into the facility, then the risk is much greater. If the cats have been obtained from a random source within the last month, then there is a much greater possibility that their feces may be infectious.

Prevention

In the research facility, the research facility should be designed so that no rodents have access to the inside of the buildings. Cats should be considered to be at risk if:

• Evidence of feral rodents are seen around the facility.
• Cats are fed raw meat.
• Cats have been obtained within the last 30 days from an outside source.
• Routine health screens of the cats reveal coccidial oocysts.

Special Note to Women of Childbearing Age

Women who are of childbearing age, or who are contemplating pregnancy, and who work with cats in a research setting should consult with the occupational health physician at Employee Health Services (860-679-2893) and discuss the advisability of having their titer to T. gondii measured as part of their routine prenatal care.

Physical injuries can occur through accidents in any workplace and the animal facility or research laboratory is no exception. Physical injuries are commonly the result of improper techniques in lifting.

Physical injuries inflicted directly by animals are most likely to be serious when using larger animals- non-human primates, for instance. Everyone should make sure they are properly trained in the handling of any animal they are required to handle during the course of their work at the Health Center. Please refer to information on animal bites if you receive any bite from any animal at the Health Center. For information on bites from nonhuman primates, please read Non-Human Primate Specific Occupational Health and Safety Risks.

What Is Cryptosporidiosis?

Cryptosporidium parvum is a protozoan parasite can infect mammals, birds, reptiles, and even fish. It belongs to a larger group of parasites that are collectively called “coccidia.” Cryptosporidium is a common cause of human diarrhea, although it is less common than diarrhea caused by human viruses. Large outbreaks of Cryptosporidiosis have occurred in cities when the city water supply has become contaminated. Cryptosporidiosis is especially common in the young, both in animals and in man. Most infected people recover without treatment but C. parvum can cause especially severe disease in people that have weakened immune systems or who are positive for HIV.

Routes of Infection

People and animals are infected with C. parvum when they allow fecal material from an infected person or animal to enter their mouth. The organism reproduces rapidly in the intestine, and the feces of infected animals and humans are highly infectious. The disease is diagnosed by finding oocysts in the feces of patient. The oocysts are highly resistant to disinfectants. Infected feces from wild or domestic animals may cause ponds, lakes, and reservoirs to become contaminated.

Two to ten days after ingesting the organism, a watery diarrhea may develop, often accompanied by cramping, nausea, and malaise. Healthy individuals generally recover in three to 14 days without any treatment. In people whose immune systems are compromised, the diarrhea can be much worse, and the organism can sometimes invade organs other than the intestine.

Risks

Most human cases have occurred as a result of accidental contamination of urban water supplies. Those who care for infected animals or humans are also at increased risk of being infected. Infection is most likely to be present in young animals with diarrhea. Any young animal with diarrhea, be they a mammal, a reptile, or a bird, should be considered potentially infectious. The animal most likely to be infected is a calf less than one year old who has diarrhea.

Prevention

The single most effective preventive measure that you could take to protect yourself would be thorough, regular hand washing with soap and warm water after handling animals with diarrhea. Good ways to infect yourself would be to eat or drink in the animal facility, or to fail to wash your hands before eating, drinking or smoking after working with animals.

If you work with young animals with diarrhea, and you develop a severe watery diarrhea, you should report the illness to your supervisor and consult with a physician at Employee Health Service (860-679-2893). An accurate diagnosis can be made by a microscopic examination of feces.

What Is Cat Scratch Disease?

Cat Scratch Disease (CSD) is caused by the bite or scratch of a cat infected with Bartonella henselae. It is found in all parts of the world, but the infection occurs more often in the fall and winter. In the United States, about 22,000 cases of CSD are diagnosed annually. There is no evidence that fleas spread the disease from cats to humans. Bartonella henselae does not make a cat appear sick and the cat may carry the agent for months.

Routes of Infection

Humans become infected when a cat infected with B. henselae bites or scratches them. A blister or small bump often develops several days after the scratch or bite and generally is not painful. Lymph nodes close to the blister or bum begins to swell which then become warm and red. This then progresses to include fever, fatigue, loss of appetite, headache, rash, sore throat, and overall ill feeling.

Risks

CSD is not contagious, but people can become infected if an animal’s saliva comes in contact with broken skin or an eye. Having one episode of CSD usually makes people immune for the rest of their lives.

Prevention

Washing your hands thoroughly with soap and water after handling cats will reduce the risk of acquiring CSD.

Your Potential Risks

Based on the species you are working with, you should be aware of the following potential health risks:

• Asthma and Allergy in Animal Handlers
• Bites and Scratches
• Campylobacter
• Cat Scratch Disease
• Cryptosporidiosis
• Enteric Pathogenic Bacteria
• Giardiasis
• Physical Injury
• Preventing Asthma in Animal Handlers
• Toxoplasmosis

 

What You Should Do

1. Be knowledgeable about the potential for developing allergies and/or asthma due to animal handling- especially if you are already allergic.

2. Consider using a NIOSH-approved N95 respirator- even if you do not have any symptoms. These respirators have been shown to reduce the chance of developing laboratory animal allergies. In order to use a respirator, you must have a fit test through the Environmental Health & Safety.

3. Know proper handling techniques of cats. Only trained personnel should handle cats. Handling and restraint training can be scheduled through the Center for Comparative Medicine.

4. Gloves and long-sleeved apparel should be worn at all times when working with cats. Minimize wearing protective clothing, such as lab coats, outside of animal areas and laboratories.

5. Keep transport carriers out of labs/offices/public areas.

6. Use disposable supplies whenever possible. Sanitize laboratory and surgical areas after animal work.

7. Always wash your hands after coming in contact with cats or their saliva, urine, blood, feces, and/or bedding materials. This is the primary method of preventing laboratory acquired infections associated with the use of cats- even if you use gloves.

What Is Psittacosis?

Psittacosis is an infectious disease in humans that has a mild, non-specific flu-like symptoms. It refers to any infection or disease caused by the organisms Chlamydia psittaci, one of several microorganisms in the genus Chlamydia. Parrot disease, ornithosis, and chlamydiosis are other names for psittacosis. Birds typically have a latent infection and can shed the organism either intermittently or continuously for weeks or months.

Routes of Infection

Humans become infected by breathing in the organism when the urine, respiratory secretion, or dried feces of infected birds become aerosolized (i.e., dispersed in the air as very fine droplets or dust particles). Other sources of exposure include mouth-to-beak contact, a bite from an infected bird, and handling the plumage and tissues of infected birds. Person-to-person transmission of the disease is rare. People who have the disease will generally present within 4 to 15 days after exposure with fever, chills, cough, weakness or fatigue, muscle and chest pain, loss of appetite, nausea, diarrhea, vomiting, headache, sweating, and an abnormal intolerance to light. Psittacosis is primarily a lung disease, but it can involve several organs and, rarely, can be fatal.

Risks

Psittacosis is an occupational health hazard for people whose work brings them into contact with birds.

Prevention

Preventive measures include feeding birds properly, avoiding overcrowding, adequate ventilation systems, and clean caging.

What Is Newcastle Disease?

Newcastle Disease is a contagious and fatal viral disease affecting most species of birds. Clinical signs are extremely variable depending on the strain of virus, species and age of bird, concurrent disease, and preexisting immunity. It is caused by a Rubulavirus. Death rate can be close to 100 percent in unvaccinated poultry flocks.

Routes of Infection

Infection results from direct contact between healthy birds and the bodily discharges of infected birds. The disease is transmitted through infected bird’ droppings and secretions from the nose, mouth, and eyes. It spreads rapidly among birds kept in confinement.

Risks

In humans, Newcastle disease is rare and presents a mild to moderate and sometimes painful conjunctivitis as a result of an individual rubbing their eyes after having handled infective material. Very rarely does it present with respiratory symptoms as a result of having inhaled dust from infected material.

Treatment

There is no treatment for Newcastle disease. There is vaccination in use for prevention of this disease.