What Happened?
A researcher assisted in removing a medical device from an anesthetized rhesus macaque monkey. The researcher was wearing surgical attire, including sterile gloves, a gown, a bouffant cap, shoe covers, and a surgical mask, but forgot to lower their face shield to protect their eyes. When removing the device from the animal, the researcher felt fluids splash into one of their eyes. The researcher rinsed their eyes at an eyewash station for 10 minutes and then sought medical care for a potential exposure to Herpes B virus (Cercopithecine herpesvirus 1, or CHV-1).
What Was The Cause?
Proximity to infectious fluids during device removal from mucous membranes heightens the risk of splashes. The immediate cause was the lack of eye protection while handling a potentially CHV-1-infected macaque. Contributing factors included failure to check PPE by other members of the surgical team and an insufficient emergency response. A 15+ minutes rinse time at the eyewash station is the procedure recommended by the CDC.
What Corrective Actions Were Taken?
The animal surgical team was reminded of the PPE requirements for procedures involving rhesus macaques. Dependent on the specific task, the required PPE includes:
- Mouth and nose protection with a surgical face mask
- Eye protection: ANSI-approved safety glasses or goggles for high splash potential; a face shield combined with safety glasses
- Lab coat or surgical gown, plus gloves
- As needed: disposable sleeves, a hairnet, and shoe covers
Pre-procedure PPE checks by the team were implemented as standard practice. Additionally, the biosafety officer reviewed and updated the Herpes B virus exposure emergency response protocol with the team.
How Can Incidents Like This Be Prevented?
- Full compliance with layered PPE eliminates splash risks during macaque procedures.
- Mandatory pre-task PPE checklists by teams to verify shields, masks, gowns, gloves, and extras like hairnets or shoe covers are correctly donned.
- Minimize direct handling of macaques; use restraints or sedation to reduce opportunities for fluid exposure.
- Annual training refreshers on CHV-1 risks, immediate irrigation (15+ minutes), and post-exposure protocols, including antivirals.
- Routine macaque health screening for oral lesions, with cultures if present, to identify shedders early.
A Note on Herpes B Virus
Virtually all documented Herpes B virus infections—approximately 50 cases—have been laboratory-acquired, with 21 fatalities. Most resulted from monkey bites or broken skin exposures (scratches, cuts, needlesticks), though at least one death occurred via ocular mucous membrane exposure. Untreated, the virus carries an 80% mortality rate, with neurological sequelae persisting in survivors. It commonly infects macaques, often asymptomatically, so all macaques, their tissues, and fluids must be treated as infectious.
Resources
QUICK ACTION TIPS
When injured by an animal:
- Remove PPE (goggles, gloves) from the affected area
- For wounds: Immediately wash and gently scrub the wound or the body area that came into contact with the animal thoroughly with soap, detergent, chlorhexidine, or povidone-iodine for 15 minutes. Then, run water over the wound or area for 15 to 20 minutes more, and cover the wound with a clean dressing (CDC)
- For eye or face exposures: flush eyes at an eyewash station for at least 15 minutes (20 min preffered)
- Immediately seek medical attention for post-exposure prophylaxis
- Notify your supervisor, your institution’s animal safety specialist, and/or campus safety officials
Herpes B Virus
- Non-human primate virus known to infect humans
- Risk Group 4
- Symptoms include fever, nausea, vomiting, persistent headache, and more
- Incubation period 3-7 days
