Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers.

Sapha Barkati,Elizabeth Beauchamp,Cédric P Yansouni,Hashim Ba Taher,Michael D Libman,Brian J Ward

doi:10.3201/eid2509.190045

Abstract

Macaque-related injuries among primate workers can lead to a potentially fatal B virus encephalomyelitis. We describe a decision tool for evaluating the need for antiviral postexposure prophylaxis and provide a retrospective review of the injuries assessed in our center after its implementation in 2010. Among the injuries studied (n = 251), 40.6% were categorized as high-risk (prophylaxis recommended), 44.2% moderate-risk (consider prophylaxis), and 15.1% low-risk (prophylaxis not recommended). Ten percent of low-risk and 98% of high-risk injuries received prophylaxis (p<0.001). Compared with using universal postexposure prophylaxis, using a decision tool can lead to a standardization of practice and a reduction in prescriptions for antiviral medication.

Highlights

Macaque-related injuries among primate workers can lead to a potentially fatal B virus encephalomyelitis
Temples in Asia inhabited by macaques and frequently visited by tourists are sites where macaque-related injuries occur frequently; no cases of B virus infection have been reported in these settings (10)
The risk for secondary transmission appears to be small, human-to-human transmission of herpes B virus has been documented in 1 case when infection developed in the wife of a man who subsequently died of herpes B virus infection (12)

Summary

Introduction

Macaque-related injuries among primate workers can lead to a potentially fatal B virus encephalomyelitis. Factors associated with B virus shedding include immunosuppression, breeding season stress, and a new housing environment (9) These data should be interpreted with caution given the small number of studies on viral shedding in captive macaques and the focus on rhesus monkeys in most of those studies (2). The risk for secondary transmission appears to be small, human-to-human transmission of herpes B virus has been documented in 1 case when infection developed in the wife of a man who subsequently died of herpes B virus infection (12). In this case, the virus was thought to be transmitted when the wife applied a topical corticosteroid cream to her husband’s vesicular lesions, to her own contact dermatitis lesions (12)

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Results

Conclusion