What is the treatment for herpes B exposure from research monkeys?

Treatment for Herpes B Virus Exposure from Research Monkeys

Immediate post-exposure prophylaxis with valacyclovir or acyclovir should be initiated as soon as possible (preferably within 24 hours) after exposure to herpes B virus from research monkeys to prevent potentially fatal meningoencephalitis. 1

Understanding Herpes B Virus

• Herpes B virus (Macacine herpesvirus 1) is endemic in macaque monkeys and poses a significant occupational hazard for researchers, animal caretakers, and laboratory personnel 2, 3
• While causing mild or asymptomatic infection in macaques, herpes B virus can cause fatal encephalomyelitis in humans with a mortality rate of approximately 70% if left untreated 2
• Transmission occurs through bites, scratches, percutaneous injuries, or mucosal splash exposure from infected macaques 1

Immediate Post-Exposure Protocol

First Aid (Immediate Actions)

• Thoroughly cleanse the exposed area with soap and water for at least 15 minutes 1
• For mucous membrane exposures (eyes, mouth), flush with sterile saline or water for 15 minutes 1
• Do not delay washing even if antiviral medications are not immediately available 2

Medical Evaluation

• Seek immediate medical attention from a healthcare provider knowledgeable about herpes B virus 2
• Report all macaque exposures, even if seemingly minor 3
• Document the circumstances of exposure, including the monkey's health status if known 1

Antiviral Prophylaxis

First-Line Treatment

• Initiate antiviral therapy as soon as possible, preferably within 24 hours of exposure 1
• Recommended regimens:
  • Valacyclovir 1g orally three times daily for 14 days, OR
  • Acyclovir 800mg orally five times daily for 14 days 1

For Severe Exposures or High-Risk Cases

• Consider intravenous acyclovir 5-10 mg/kg every 8 hours, especially for:
  • Deep wounds
  • Wounds to the head, neck or torso
  • Exposures from known infected monkeys
  • Delayed treatment (>24 hours after exposure) 1

Special Considerations

• For acyclovir-resistant cases, intravenous foscarnet or cidofovir may be considered 4
• Immunocompromised individuals may require more aggressive management and longer duration of therapy 5

Monitoring After Exposure

• Close clinical monitoring for at least 2 weeks for development of:
  • Vesicular lesions at exposure site
  • Pain or numbness at or near exposure site
  • Itching, tingling, or burning sensations
  • Fever, muscle aches, fatigue
  • Headache, altered mental status 1
• If symptoms develop, immediate hospitalization and aggressive treatment with intravenous antivirals is required 2

Prevention Strategies

• Use appropriate personal protective equipment when working with macaques or their tissues 2
• Implement proper training for all personnel working with macaques 2
• Establish clear exposure reporting protocols in research facilities 3
• Consider serological surveillance of monkey colonies 6

Common Pitfalls to Avoid

• Delaying first aid or antiviral treatment (efficacy decreases significantly with time) 1
• Failing to report seemingly minor exposures 2
• Confusing herpes B virus with herpes simplex virus (HSV) in diagnostic testing (extensive antigen crossover can cause false-positive results) 3
• Using topical antivirals alone, which are substantially less effective than systemic therapy 5