SOPs

Non-Human Primate Bite, Scratch, and Exposure SOP

Unit for Laboratory Animal Medicine
Mar 8, 2024 12:00 am

Macacine herpesvirus 1, also known as Herpes B virus is carried by non-human primate (NHP) in the genus Macaca, such as the rhesus (Macaca mulatta), cynomolgus (M, fascicularis), pigtail macaque (M. nemestrina) and other Asiatic macaque species. The virus can be transmitted from these NHPs to humans through exposure to the animal's saliva or other bodily fluids or tissues. Most infections have been contracted through skin injuries such as bites, scratches, needle sticks or lacerations, or through splashes of body substances into mucous membranes like the conjunctiva of the eye. The stability of the virus on cage surfaces is not known but such contaminated surfaces must be considered as possible sources of infection. 

Infected NHPs generally show no signs of illness or may have oral ulcers similar to "cold sores". It is nearly impossible to determine whether a particular NHP is carrying or shedding B virus. Therefore, all MACAQUE NHPs are treated as though infected, and their bodily fluids and soiled cages are handled as if they were contaminated.

Non-macaque NHP species are not carriers of the macacine herpesvirus 1 (Herpes B virus) and any exposure to these animal’s saliva or other bodily fluids or tissues will not result with the Herpes B virus infection. It is still recommended to be seen by a health care professional such as Occupational Health Services (OHS) or the emergency room if after hours.

  • Responsibility

    1. ULAM Personnel
    2. Investigative Personnel
  • Glossary Definitions

    ULAM Pathology Core

    ULAM Pathology Core; a pathology core laboratory within the Unit for Laboratory Animal Medicine that provides diagnostic support for the veterinary care program and recharge-based pathology services in support of non-clinical research projects at the University of Michigan. ULAM Pathology core includes the Clinical Pathology lab (formerly Animal Diagnostic Laboratory or ADL).

  • Procedures

    1. PPE and Training

    1. All University of Michigan personnel wear designated personal protective equipment (PPE) when in contact with non-human primates (NHP), their bodily fluids, or their soiled cages.
      1. Refer to EHS PPE charts.
    2. ULAM provides training on Herpes B infections and the use of Non-Human Primate Bite/Scratch Kits to all personnel working with NHPs. Training is mandatory for compliance with current animal care standards.

    2. Injury – Non-Macaque NHP Species

    1. Injured personnel:
      1. Perform general first aid procedures, e.g., thoroughly washing the injury with soap and water. 
      2. Report all injuries to the immediate supervisor within 24 hours.
      3. Proceeding to U-M Occupational Health Services is recommended.
        1. Herpes B Viral cultures and serum samples are not collected from the patient or the NHP involved in the injury.
    2. Injured personnel or the immediate supervisor:
      1. Complete the Work-Related Illness and Injury form on the U-M Work Connections website.
        1. Claim forms can also be printed then faxed, mailed, or emailed to the Work Connections office.
      2. Submit an ATR to inform the veterinary personnel that a personnel injury has occurred.
      3. Complete the EHS Incident and Near Miss Report Form.

    3. Injury – Macaque NHP Species

    Note: The Work-Related Illness and Injury form on the U-M Work Connections website is here.

    4. Monitoring Personnel Post-Exposure

    1. Patients are referred to U-M Occupational Health Services for follow-up examinations and collection of additional blood samples.

    5. Monitoring Animals Post-Exposure

    1. ULAMs Electronic Medical Record (EMR) system and EHS maintain records of all NHP bites/scratches/needlesticks/eye splashes.
    2. The veterinary technician records the following information in the NHP’s medical record:
      1. Date of injury
      2. Wound location
      3. How the injury occurred
    3. A ULAM veterinarian performs an anesthetized physical examination of the NHP as soon as possible, ideally within 24 hours. 
      1. Examine the NHP’s eyes for conjunctivitis, and the mouth and genitalia, including extruding the penis, closely for the presence of:
        1. Ulcers
        2. Crusts
        3. Scabs
        4. Exudate
      2. Record the findings on the NHP’s medical record.
      3. Examine the current medical history of the NHP.
      4. The examining veterinarian or delegate communicates any clinical signs observed by telephone to U-M Occupational Health Services.
      5. Trained personnel (veterinary or investigative personnel) obtain blood and viral cultures from the NHP after the examination is complete and submits samples to the ULAM Pathology Core.
        1. ULAM veterinary personnel complete the ULAM Clinical Pathology Laboratory External Submission Form entirely except for the top right portion labeled “ULAM Pathology Core Use Only”.
        2. Use M4RT media and swabs constructed with dacron tips and nylon shafts.
          1. ULAM veterinary technicians’ stock and maintain the appropriate supplies in the MSAB and NCRC Pharmacy’s.
        3. Blood samples for serology:
          1. Collect two 5-7 ml samples of blood in red-topped tubes. Do not use anticoagulants.
          2. Label the tubes with:
            1. Date
            2. Clinical number of the NHP
          3. ULAM Pathology Core personnel separates the serum into a 2-ml non-glass serum storage tube before shipping.
            1. Separate and store serum in -80 freezer in ULAM Clinical Pathology Laboratory for shipping on next business day if ULAM Clinical Pathology laboratory personnel are not available.
        4. Viral Cultures:
          1. Collect 4 swabs for culture of Herpes B virus:
            1. One from the mouth
            2. One from the conjunctiva of each eye
            3. One from the genitalia
          2. Place each swab in a separate tube of Viraport transport medium and break the shaft of the swab, leaving the swab in the medium.
            1. Label each tube with:
              1. NHPs clinical number
              2. Date
              3. Site from which the culture was taken.
              4. Store swabs in -80o freezer located in the ULAM Clinical Pathology laboratory for shipping on next business day if ULAM Clinical Pathology laboratory personnel are not available.
    4. Sample Submission 
      1. ULAM Pathology Core personnel:
        1. Report the exposure to EHS via email (EHS-animalsafety@umich.edu) at the time of sample submission.
        2. Complete “ULAM Pathology Core Use Only” portion on the ULAM Clinical Pathology Laboratory External Submission Form submitted with the samples from the veterinary personnel.
        3. Submit the samples and the form to National B Virus Resource Laboratory, or another laboratory agreed upon by the veterinary and ULAM Pathology Core personnel.
          1. VRL Diagnostics
          2. Submit 1 of the two serum samples and all 4 swabs from the NHP serology and culture, respectively.
          3. Follow the B Virus submission protocol in the ULAM Pathology Core for sample preparation and transport.
            1. Request a serum titer for Herpes B.
            2. Label the other serum sample as Sample 1 and place in the -80° freezer located in the ULAM Clinical Pathology laboratory.
              1. Dispose the reserve sample 1 after initial sample is successfully received and tested.
            3. ULAM Pathology Core personnel distribute copies of the results to the area veterinary technician, veterinary resident, and faculty veterinarian when results from the B Virus Resource Laboratory are received.
              1. The veterinary technician records the results in the animal’s medical record.
            4. ULAM Pathology Core personnel emails results to U-M Occupational Health (occupational-health@med.umich.edu).
            5. Follow-up samples
              1.  The ULAM veterinary team obtains a second serum sample from the NHP 2-3 weeks after the injury was sustained if results of the first test are not found to be at the maximum detectable level. 
                1. Label the second sample as Sample 2. Refer to 5.c. for sample processing.
                2. Request titers to determine whether a rise in titer levels has occurred indicating an active infection.
              2. Distribute follow-up sample results in the same manner as initial samples. See Procedures section 5.c.i.3.iii-iv.

    6. Non-Human Primate Bite/Scratch Kits

    1. First aid kits are maintained in or near all NHP housing and cage wash areas.
    2. NHP Bite/Scratch Kit Maintenance and Restocking
      1. The area veterinary technicians maintain and restock the Non-Human Primate Bite/Scratch Kits in ULAM managed areas.
      2. The PI or designated investigative personnel are responsible for maintenance and restocking of the laboratory’s Non-Human Primate Bite/Scratch Kits in PI managed areas.
        1. Ensure investigative personnel are aware of the location of the kits.
      3. Bite/Scratch kit content list (Appendix A)
        1. Purchase supplies from the vendors listed below or from ULAM (contact the ULAM Office at 764-0277). 
      4. Copies of the kit forms are attached. (Appendices B through E)
  • Appendix A: Contents of NHP Exposure Kit

     

       Item

    Vendor

    Stock Number 

       Hibiclens (8 ounce)

       MWI

    036222

       1 liter bottle of saline for irrigation

       MWI

    501032

       3 sterile packs of gauze sponges

       MWI

    035943

       1 pair of disposable nitrile gloves size M

       Medline

    484802

       1 pair of disposable nitrile gloves size XL

       Medline

    484804

       Non-sterile gauze sponges

       MWI

    065047

       Sterile eyewash or saline

       B2 Pharmacy

    N/A

       Plastic bowl

       N/A

    N/A

       Copy of Non-Human Primate Bite, Scratch, and Exposure SOP and all appendices

       Research A to Z

    N/A

       National B Virus Submission Form – Georgia State University

       ULAM Clinical Pathology laboratory, or https://biotech.gsu.edu/virology/   

    N/A
  • Appendix B: First Aid Procedures for Bites, Scratches, and Needle Sticks

    1. Put on exam gloves before scrubbing the wound. If the injury involves a single hand, glove the other hand before proceeding. If the injury does not involve a hand, glove both hands before proceeding. Place non-sterile gauze sponges in the plastic bowl. Moisten the sponges with saline first, then pour Hibiclens onto sponges to saturate them.
    2. With a gloved hand, scrub the wound vigorously with Hibiclens-soaked sponges for 3-5 minutes. Discard gauze and pour saline on the wound to rinse area. Repeat scrubs and rinses two more times for a total of 15 minutes of scrubbing. Cover wound with sterile gauze.
    3. Call U-M Occupational Health Services at 734-764-8021 and notify them of your injury; determine where to proceed for evaluation.
    4. Complete primate portion of National B Virus Submission Form. This form is included in the NHP Bite Scratch Kit. Include the primate's clinical number, date of injury, and type of injury (needle stick, etc.) Bring the completed B Virus Submission Form (https://biotech.gsu.edu/virology/PDFs/2015%20Submission%20Form.pdf) with you when you go to U-M Occupational Health Services/Emergency room.
  • Appendix C: First Aid Procedures for Eye Splashes

    1. Rinse eyes immediately with water at an eyewash station or sink for 15 minutes. If water is not available, use Sterile eyewash or saline irrigating solution. Do not use Hibiclens in the eyes.
    2. Call U-M Occupational Health Services at 734-764-8021 and notify them of your injury; determine where to proceed for evaluation.
    3. Complete primate portion of National B Virus Submission Form. This form is included in the NHP Bite Scratch Kit. Include the primate's clinical number, date of injury, and type of injury (needle stick, etc.) Bring the completed B Virus Submission Form (https://biotech.gsu.edu/virology/PDFs/2015%20Submission%20Form.pdf) with you when you go to U-M Occupational Health Services/Emergency room.
  • Appendix D: Procedures Following First Aid

    1. After following the First Aid Procedures above, proceed directly to the U-M Occupational Health Services or Emergency Room.
    2. Inform your supervisor of the injury. Contact or have your supervisor contact the ULAM area veterinary technician (764-0277) to report the injury.
    3. Submit workman's compensation forms (i.e., Supervisor's Report of Employee Accident or Illness, Form no. U-M MIOSHA 101A).
  • Appendix E: Summary of Emergency Room NHP Bite Protocol

    The steps below are meant to provide the injured personnel with information on what should be occurring if the injury is being assessed and treated at the emergency room. 

    • The steps below are an excerpt from the Emergency Departments policy and procedures for NHP bites.

     Refer to Monkey Bite Protocol found in ED Policy and Procedure Manual for additional information.

    1. Repeat irrigation/cleansing;
      1. Eye irrigation: 15 minutes with normal saline
      2. Wound irrigation: 15 minutes with Chlorpactin
    2. Perform a viral culture of the wound.
    3. Draw a red top tube.
    4. Check tetanus immunization status, administer if necessary.
    5. Contact ID fellow.
    6. Leave message on U-M Occupational Health Services answering machine informing them of the exposure (734-764-8021).
    7. Provide copy of discharge instructions to patient.
    8. Place this form in the follow-up box at the registration desk.
  • Appendix F: NHP Bite/Scratch Visual Guide

    A laminated copy should be in every bite/scratch kit

Species: Primates
Questions?

If you have questions or comments about this document, contact ULAM Veterinary Staff (ULAM-vets@umich.edu)