Patient discussions
Laboratory workers and animal workers who are in close contact with macaques (or their body fluids) are at high risk of exposure to B virus. These people should be informed of the hazards associated with macaques and the importance of notifying senior personnel (including occupational health personnel) if bites, scratches, or mucocutaneous exposures occur. They should also be educated on administering first aid and the need for rapid evaluation by occupational health personnel.
Administering first aid:
Immediate first aid following any high-risk contact with a macaque (bite, scratch, percutaneous injuries contaminated with macaque body fluids, or mucous membrane or non-intact skin exposure to potentially infectious fluid or other material without injury) is crucial.
Wounds and fluid exposures that have been thoroughly cleansed within 5 minutes of the exposure are likely to have a reduced risk for B virus infection. Washing of the affected site should be performed for a minimum of 15 minutes. Possible skin exposures should be washed with povidone-iodine, soap, or detergent soap.[42] All of these agents are known to be capable of inactivating viruses such as herpesviruses that have a lipid envelope.[58][59][60] Gentle massaging of the wound during cleansing can improve penetration of the antimicrobial solution. Dakin’s solution, a 1:20 bleach to water solution, is more toxic than povidone-iodine and can irritate the skin. Bleach solutions are relatively unstable, and should be prepared at the time of use. If Dakin’s solution is used, the affected area should be washed with detergent subsequently as described above.
Skin wounds should not be incised, biopsied, or swabbed as these actions could act to drive the virus more deeply into tissues.
None of the solutions and detergents discussed for use on skin lesions should ever be used to cleanse eyes or other mucous membranes. For such exposures the affected area should be irrigated without delay with sterile saline solution or water for a minimum of 15 minutes. If the nearest eye wash station cannot be reached in less than a few minutes, a 1-litre bag of sterile saline should be kept at the work site. If workers are based at a remote location with no available wash solution, a 1-litre bag of sterile saline should be carried with them to the site to avoid any delay in cleansing the wound or mucosa.
On-site evaluation by occupational health personnel:
Immediately after cleansing a potential B virus exposure, the affected person should report to their occupational healthcare provider for counselling and education, and to receive written materials describing the signs and symptoms of B virus infection.
It is also important for the occupational healthcare provider to facilitate rapid access to a local medical consultant familiar with both human B virus infection and other infectious agents associated with non-human primates.
Formal education and written protocols for engaging with both the occupational healthcare provider and with local medical experts should be available at the work site. Written information about human B virus infection should also be made available to area physicians in case exposures occur after hours when on-site medical assistance may be unavailable.
Travel:
Information about the risks associated with macaques freely roaming in parks and temples should be made readily available to tourists and others who plan to travel to countries or areas where contact with these monkeys is likely. Such information should also include instructions for first aid in case of a potential exposure, and for the need to visit a medical expert familiar with B virus infections at the earliest opportunity.
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