Transcript Zoonotic Diseases of Non

Zoonotic Diseases
of Non-Human
Primates
Note: The images in this presentation are for
non-profit, educational use only.
Neil Grove
University of North Carolina
– Chapel Hill
Division of Laboratory
Animal Medicine
What is a zoonotic disease?
A zoonotic
disease is one
that can be transmitted
from animals to humans or
from humans to animals.
With each disease we will attempt to
answer the following questions:
What is it?
 How do I get it?
 What are the
symptoms?
 What precautions
can I take to avoid
getting it?

What is the goal of this training?


The goal is to give you a general
familiarization with the zoonotic diseases of
primary concern in non-human primates.
The content of this training does not begin
to cover all of the issues and
considerations surrounding safely working
with animals that are possible carriers of
these diseases.
What is our goal for this training?


Were you to work in a facility that housed nonhuman primates, you would be trained extensively
on all hazards involving these diseases and the
precautions taken to avoid their acquisition.
For those working with non-human primates that
may carry these diseases, proper PPE,
heightened awareness and alertness while
working the animals, and following procedures
can literally be the difference between life and
death.
What diseases will we discuss?

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Herpes B
Tuberculosis
Shigellosis
Measles
Ebola Hemorrhagic Fever
Marburg Hemorrhagic Fever
Hepatitis
Herpes B – What is it?

B virus (Cercopithecine herpesvirus 1) is a
zoonotic agent that can cause fatal
encephalomyelitis (concurrent inflammation
of the brain and spinal cord) in humans.(1)
Herpes B – What is it?

B virus is a naturally occuring infectious
agent that is endemic (disease occurs
continuously and with predictable regularity
in a specific area or population) among
macaque monkeys (including rhesus and
pig-tailed macaques, cynomalgus
monkeys, and other macaques). (1)
photo from AALAS learning library
http://pin.primate.wisc.edu/factsheets/entry/pigtail_macaque
pigtail macaque
cynomolgus monkey
photo from AALAS learning library
photo from AALAS learning library
rhesus monkey
stump-tail macaque
How Can You Tell Which Monkeys
Carry B virus and are shedding it?



You can’t:
B virus infection generally is asymptomatic
or mild in macaques. (1)
B virus infects ≥70% of surveyed captive
adult macaques. (2)
How Can You Tell Which Monkeys
Carry B virus and are shedding it?

Although virus shedding is more frequent
during the mating season (roughly March to
June) or when an animal is ill, under stress,
or immunosuppressed, there are often no
signs of shedding. Macaques should
always be regarded as potentially
infectious.
How are people exposed to herpes B?
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Documented routes of exposure include:
bites
scratches
exposure to tissue culture material
exposure to tissue obtained during monkey
autopsy
needle stick injuries
cage scratches
mucosal splash
human to human transmission
Symptoms

The incubation period between initial
exposure and onset of clinical signs ranges
from 2 days to one month, but the time at
which symptoms arise after exposure can
vary widely. (2)
Symptoms

After exposure by bite,
scratch, or other local
trauma, or
contamination of
vulnerable sites,
humans might develop
a herpetiform vesicle
at the site of
inoculation. (2)
Symptoms

Early clinical signs include myalgia, fever, headache,
and fatigue and are followed by progressive
neurological disease with numbness, hyperesthesia
(sensitive skin), paresthesia (tingling), diplopia (seeing
double), ataxia (unable to coordinate voluntary muscle
movements), confusion, urinary retention, convulsions,
dyshphagia (difficulty swallowing), and an ascending
flaccid paralysis.(lacking in muscle tone and tendon
reflexes) (2)
Symptoms

Among untreated humans, the mortality
rate associated with B virus infection is
estimated to be 80%. The mortality rate
has declined since the advent of antiviral
therapy. (1)
Prevention/Preparation

Employers should conduct training and
periodic assessments to ensure that worker
protection programs are effective. In
particular, all employees who come into
contact with macaques or macaque tissues
should be trained about the risks of B virus
and other infections and the importance of
preventive measures. (4)
Prevention/Preparation

All macaque monkeys not known to be
free of B virus infection should be
regarded as infected because viral
shedding is intermittent and can occur in
the absence of visible lesions. (3)
Prevention/Precautions

So that baseline serum levels are available
for comparison in the event of an exposure,
the occupational health care provider
should consider collecting and then storing
serum samples obtained from primate
workers at the time of employment.(1)
Precautions/Prevention

Materials including supplies used for first
aid and specimen collection, copies of
written instructional materials, and
treatment protocols for exposures should
be available in areas where exposure can
occur. (1)
Precautions/Prevention

Workers need to be aware that any episode
of prolonged fever (for >48h), flulike
symptoms, or symptoms compatible with B
virus infection, even in the absence of a
known exposure, needs to be reported to
their supervisor and to occupational health
care personnel. (1)
Precautions/Prevention

Primate workers should be given a card to
carry in their wallet that indicates the
symptoms of B virus infection and contact
information for a local health care provider
who is knowledgeable about B virus. (1)
PPE
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Monkey handlers should wear:
leather gloves
long sleeved garments for hand and arm
protection (2)
PPE
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Goggles or glasses and a mask or a chinlength wraparound face shield is
recommended to protect the mucous
membranes of workers in areas where
captive macaques are located.
Face shields or glasses with side shields
must be able to prevent splashes to the
head from running down into the eyes. (1)
Case Report

On October 29, 1997, a 22-year-old researcher at
a primate-center field station was assisting with a
routine group capture of rhesus macaques
(Macaca mulatta) in a free-ranging corral.
Personnel conducting the capture wore uniforms,
disposable latex gloves, and surgical masks. Eye
protection was not worn. During the transfer of an
unidentified macaque into a squeeze cage,
undetermined liquid from the animal entered the
researchers eye.
Case Report

The worker wiped her eye at the time of exposure.
Approximately 45 minutes later she flushed her
eye with tap water for 23 minutes. There was no
medical treatment or consultation at the time of
the exposure. The researcher subsequently
developed a Cercopithecine herpesvirus 1 (B
virus) infection; despite intensive antiviral therapy,
she died on December 10, 1997. This incident is
the first documented case of a B virus infection
resulting from an ocular exposure to macaque
secretions.
Review Questions

What does it mean when we say that B
virus is endemic in macaques and that they
are asymptomatic carriers.
Answer

Basically, it means that it can be assumed
that B virus is always present among
macaques, and if they were carrying it
there is no way that you would know it just
by looking at them.
Question

Under what circumstances is B virus
shedding more frequent among infected
macaques? If you were working with
macaques, would this be the only time that
you would worry about contracting it?
Answer
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Virus shedding is more frequent during the
mating season, if an animal is
immunosuppressed, or stressed.
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You can still contract B virus at any time,
these are simply times when virus shedding
is more frequent.
Question

Why would safety glasses not be adequate
eye protection when working with
macaques?
Answer

Safety glasses do not fully protect the eyes
from a splash from the side or from
anything that could run down the head into
the eyes.
Tuberculosis
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What is it?

Tuberculosis of animals and humans is
caused by acid-fast bacilli of the genus
mycobacterium.
Lab animals are potential reservoirs of
several mycobacterial species including M.
tuberculosis, M. avium-intracellulare, M.
bovis, and M. marinum. (2)

Tuberculosis

In addition to cattle, birds, and humans that
serve as the main reservoir for these
mycobacteria, many lab animals – including
nonhuman primates, swine, sheep, goats,
rabbits, cats, dogs, and ferrets – are
susceptible to infection and contribute to
the spread of the disease. (2)
Tuberculosis

However, nonhuman primates are of
primary importance in the consideration of
these diseases in the laboratory-animal
environment. (2)
Tuberculosis

Nonhuman primates
generally develop
tuberculosis from
humans during
capture and
exportation from parts
of the world where the
prevalence of the
disease in humans
and animals is high.
(2)
TB – How do I get it?

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TB is transmitted via aerosols from infected
animals or tissues.
Lab animal personnel involved in the care,
use, or necropsy of infected animals are
especially at risk for TB. (2)
TB – How do I get it?

Humans can contract the disease in the lab
through exposure to infectious aerosols
generated by the handling of dirty bedding,
the use of high-pressure water sanitizers,
or the coughing of animals with respiratory
involvement. (2)
TB – How do I get it?

Other potential sources of exposure include
fecal shedding by animals with enteric
infection and skin exudates resulting from
scofuloderma or suppurative fistulated
lymph nodes. Mycobacterial disease can
also be spread by entry of bacilli into the
body by ingestion or wound contamination.
(2)
Symptoms of TB
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Most commonly reflects involvement of
pulmonary system.
Characterized by cough, sputum production,
and eventually hemoptysis (expectoration of
blood from respiratory tract).
Incubation period for development of
demonstrable primary lesion or a substantial
secondary skin reaction is 4-12 wks. (2)
Symptoms of TB

After that, the risk of progressive pulmonary
or extrapulmonary disease remains highest
during the next 1-2 yrs, but recrudescence
of a latent infection persist for the rest of
the persons life. (2)
Symptoms of TB
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Extrapulmonary forms of
the disease can involve
any tissue or organ
system and include
disseminated infections of
multiple organs.
General symptoms as the
disease progresses
include weight loss,
fatigue, fever, chills, and
cachexia (general physical
wasting). (2)
Precautions/Prevention

Facilities housing primates
perform TB tests on all
primates at least twice
yearly. The test involves
injection of a small amount
of tuberculin (killed TB
bacteria) injected
intradermally into the
eyelid of the monkey. Any
redness or swelling at the
injection site may indicate
that the animal is infected
with tuberculosis. (5)
Prevention/Precautions
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Personnel education
Periodic surveillance for infection in
nonhuman primates and their handlers
(human TB test also done intradermally)
Isolation and quarantine of any suspect
animals
Prevention/Precautions
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Prompt euthanasia of
infected animals
Necropsy and
microbiological and
histopathological
analysis of animals
confirmed positive.
Prevention/Precautions
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Personnel who convert to a positive
tuberculin skin reaction should be
evaluated further. Institutions should
recognize the risk that such personnel pose
for nonhuman primate populations; it might
warrant their reassignment to work with
other animals. (2)
Review Questions

How do NHP generally develop TB?
Answer
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Nonhuman primates generally develop
tuberculosis from humans during capture
and exportation from parts of the world
where the prevalence of the disease in
humans and animals is high
Question

How is a TB test administered in NHPs?
Answer

The test involves injection of a small
amount of tuberculin (killed TB bacteria)
injected intradermally into the eyelid of the
monkey. Any redness or swelling at the
injection site may indicate that the animal is
infected with tuberculosis. The eyelid is
used because the results are easily
observed.
Shigellosis

What is it?

Shigellosis is an
infectious disease
caused by a group of
bacteria called Shigella.

The Shigella germ is
actually a family of
bacteria that can cause
diarrhea in humans.
Shigella flexneri
Shigellosis – What is it?
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There are several different kinds of Shigella bacteria:
Shigella sonnei, also known as "Group D" Shigella,
accounts for over two-thirds of the shigellosis in the
United States.
A second type, Shigella flexneri, or "group B" Shigella,
accounts for almost all of the rest.
Other types of Shigella are rare in this country, though
they continue to be important causes of disease in the
developing world. One type found in the developing
world, Shigella dysenteriae type 1, causes deadly
epidemics there. (6)
How do I get shigellosis?
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Nonhuman primates can harbor all three of the
common types of shigella bacteria (S. flexneri, S.
sonnei, and S. dysenteriae) previously listed.
Nonhuman primates are the only important
reservoir for shigellosis in the animal facilities,
although zoonotic transmission of the organism
from guinea pigs, other rodents, and dogs has
been recorded under unique circumstances. (2)
How do I get shigellosis?

Shigellosis is transmitted by a direct or
indirect fecal-oral route. Shigella spp. are
very infectious, requiring only 10-100
organisms to produce infections. (2)
How do I get shigellosis?

Shigellosis can be transmitted from human
to human.

Shigella are present in the diarrheal stools
of infected persons while they are sick and
for a week or two afterwards.
How do I get shigellosis?
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Most Shigella infections are the
result of the bacterium passing from
stools or soiled fingers of one person
to the mouth of another person.
This happens when basic hygiene
and hand washing habits are
inadequate. It is particularly likely to
occur among toddlers who are not
fully toilet-trained. Family members
and playmates of such children are
at high risk of becoming infected. (6)
How do I get shigellosis?
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Food may become contaminated by infected food
handlers who forget to wash their hands with soap after
using the bathroom.
Vegetables can become contaminated if they are
harvested from a field with sewage in it.
Flies can breed in infected feces and then contaminate
food.
Shigella infections can also be acquired by drinking or
swimming in contaminated water. Water may become
contaminated if sewage runs into it, or if someone with
shigellosis swims in it. (6)
Prevalence?

Every year, about 18,000 cases of
shigellosis are reported in the United
States. Because many milder cases are not
diagnosed or reported, the actual number
of infections may be twenty times greater.
(6)
Prevalence?

Shigellosis is particularly common and
causes recurrent problems in settings
where hygiene is poor and can sometimes
sweep through entire communities. (6)
Prevalence
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Shigellosis is more common in summer than
winter.
Children, especially toddlers aged 2 to 4, are
the most likely to get shigellosis. Many cases
are related to the spread of illness in child-care
settings, and many more are the result of the
spread of the illness in families with small
children.
In the developing world, shigellosis is far more
common and is present in most communities
most of the time.
Symptoms
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Most who are infected with Shigella develop diarrhea, fever,
and stomach cramps starting a day or two after they are
exposed to the bacterium. The diarrhea is often bloody.
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Shigellosis usually resolves in 5 to 7 days. In some persons,
especially young children and the elderly, the diarrhea can be
so severe that the patient needs to be hospitalized. A severe
infection with high fever may also be associated with seizures
in children less than 2 years old. Some persons who are
infected may have no symptoms at all, but may still pass the
Shigella bacteria to others. (6)
Precautions/Prevention
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Prevention of shigellosis in a laboratoryanimal facility should be based on
identification and treatment of the carrier
state or disease in a NHP reservoir.
Personnel should also rely on the use of
protective clothing, personal hygiene, and
sanitation measures to prevent the
transmission of the disease. (6)
Precautions/Prevention
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Some tips for preventing the spread of
shigellosis:
Wash hands with soap carefully and frequently,
especially after going to the bathroom, after
changing diapers, and before preparing foods or
beverages
Dispose of soiled diapers properly
Disinfect diaper changing areas after using
them
Precautions/Prevention
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Keep children with diarrhea out of child care settings
Supervise handwashing of toddlers and small children
after they use the toilet
Persons with diarrheal illness should not prepare food
for others
If you are traveling to the developing world, "boil it, cook
it, peel it, or forget it”
Wash hands after removing PPE when working with
NHPs or their caging.
Review Questions

How is shigellosis transmitted?
Answer
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Shigellosis is transmitted by a direct or
indirect fecal-oral route.
Question
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What population of people are most likely
to get shigellosis?

Why?
Answer
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Children, especially toddlers aged 2 to 4,
are the most likely to get shigellosis.
Measles
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What is it?
It’s a viral disease.
Measles virion seen through a microscope
Humans are the reservoir for measles.
Nonhuman primates become infected through
contact with human populations with endemic
measles.
Old and New World NHPs are susceptible
Spreads rapidly through infected NHP colonies (2)
How do I get it?


Measles is a highly communicable disease.
Measles is transmitted via infectious
aerosols, contact with nasal or throat
secretions, or contact with fomites freshly
contaminated with infectious secretions. (2)
What are the symptoms?
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Clinical signs similar in
NHP and humans
In humans, fever
develops after an
incubation period of
about 10d and is
followed by
conjunctivitis, coryza,
cough, and Koplik’s
spots inside the mouth.
Koplik’s spots
What are the symptoms?

Later, a characteristic
exanthematous rash
develops, beginning
on the face, becoming
generalized over the
body, and ending
sometimes in flaky
desquamation.(2)
What are the symptoms?

Complications of viral replication or
secondary bacterial infection can result in
pneumonia, otitis media, diarrhea, or,
rarely, encephalitis. (2)
Prevention/Precautions

As always, PPE, PPE, PPE

Vaccination of all NHP handlers against
measles should be ensured, and
vaccination of NHP populations should be
considered.
Review Question

Are New World monkeys susceptible to
measles?
Answer

Yes – both Old and New World Monkeys
are susceptible to measles.
Question
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True or false:

Clinical signs of measles are dramatically
different in monkeys than in humans.
Answer
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False - Clinical signs are similar in NHP
and humans.
Ebola Hemorrhagic Fever

What is Ebola
hemorrhagic fever?

Ebola hemorrhagic fever
(Ebola HF) is a severe,
often-fatal disease in
humans and nonhuman
primates (monkeys,
gorillas, and chimpanzees)
that has appeared
sporadically since its initial
recognition in 1976. (7)
What is it?

The disease is caused by infection with
Ebola virus, named after a river in the
Democratic Republic of the Congo
(formerly Zaire) in Africa, where it was first
recognized. The virus is one of two
members of a family of RNA viruses called
the Filoviridae. (7)
What is it?

There are four identified subtypes of Ebola
virus. Three of the four have caused
disease in humans: Ebola-Zaire, EbolaSudan, and Ebola-Ivory Coast. The fourth,
Ebola-Reston, has caused disease in
nonhuman primates, but not in humans.(7)
What is it?

The exact origin, locations, and natural
habitat (known as the "natural reservoir") of
Ebola virus remain unknown. However, on
the basis of available evidence and the
nature of similar viruses, researchers
believe that the virus is zoonotic and is
normally maintained in an animal host that
is native to the African continent. (7)
What is it?

A similar host is probably associated with
Ebola-Reston which was isolated from
infected cynomolgus monkeys that were
imported to the United States and Italy from
the Philippines. The virus is not known to
be native to other continents, such as North
America. (7)
Where is it?

Cases of Ebola HF have
been reported in the
Democratic Republic of
the Congo, Gabon,
Sudan, the Ivory Coast,
Uganda, and the
Republic of the Congo.
No case of the disease in
humans has ever been
reported in the United
States. (7)
Where is it?

Ebola-Reston virus caused severe illness
and death in monkeys imported to research
facilities in the United States and Italy from
the Philippines; during these outbreaks,
several research workers became infected
with the virus, but did not become ill.(7)
Where is it? – Most recent case.


Ebola hemorrhagic fever in the Republic of the
Congo - 16 June 2005
From 25 April to 16 June 2005, a total of 12 cases
(1 laboratory-confirmed and 11 epidemiologically
linked) including 9 deaths has been reported in
Etoumbi and Mbomo in Cuvette Ouest Region.
The last reported death occurred on 26 May. (8)
How is it contracted?

Because the natural reservoir of the virus is
unknown, the manner in which the virus first
appears in a human at the start of an outbreak
has not been determined.

Researchers have hypothesized that the first
patient becomes infected through contact with an
infected animal. (7)
How is it contracted?

After the first case-patient in an outbreak setting is infected, the
virus can be transmitted in several ways:

Direct contact with the blood and/or secretions of an infected
person.

Contact with objects, such as needles, that have been
contaminated with infected secretions.

Thus, the virus is often spread through families and friends because
they come in close contact with such secretions when caring for
infected persons. (7)
How is it contracted?



Often transmitted in the health care setting.
It includes both types of transmission
described above.
In African health-care facilities, patients are
often cared for without the use of a mask,
gown, or gloves. This has led to exposure
of health care workers(7)
How is it contracted?


When needles or syringes are used, they
may not be of the disposable type, or may
not have been sterilized, but only rinsed
before reinsertion into multi-use vials of
medicine.
If needles or syringes become
contaminated with virus and are then
reused, numerous people can become
infected. (7)
How is it contracted?


Ebola-Reston appeared in a primate research
facility in Virginia, where it may have been
transmitted from monkey to monkey through the
air.
While all Ebola virus species have displayed the
ability to be spread through airborne particles
(aerosols) under research conditions, this type
of spread has not been documented among
humans in a real-world setting, such as a
hospital or household. (7)
What are the symptoms



The incubation period ranges from 2 to 21 days.
The onset of illness is abrupt.
Characterized by fever, headache, joint and
muscle aches, sore throat, and weakness,
followed by diarrhea, vomiting, and stomach pain.
A rash, red eyes, hiccups and internal and
external bleeding may be seen in some patients.
(7)
Circumstances and location of some
outbreaks between 1996 and 2002.

Researchers do not
understand why some
people are able to recover
from Ebola HF and others
are not. However, it is
known that patients who
die usually have not
developed a significant
immune response to the
virus at the time of
death.(7)
Prevention/Precautions

Because the identity and location of the
natural reservoir of Ebola virus are
unknown, there are few established primary
prevention measures.

Health-care providers must be able to
recognize a case of Ebola HF should one
appear. (7)
Prevention/Precautions

Wearing of protective clothing, such as
masks, gloves, gowns, and goggles is
essential.

Use infection-control measures, including
complete equipment sterilization and the
isolation of Ebola HF patients from contact
with unprotected persons. (7)
Prevention/Precautions

The aim of all of these techniques is to
avoid any person’s contact with the blood
or secretions of any patient.

If a patient with Ebola HF dies, it is equally
important that direct contact with the body
of the deceased patient be prevented. (7)
Prevention/Precautions


Lab animal workers must always wear
appropriate PPE.
The fact that Ebola Reston was found in
the US should heighten lab animal workers’
awareness that caution should always be
exercised when working with animals – you
never know what they may be carrying.
Review Question

Which animal is the reservoir for the Ebola
Virus?
Answer

The natural reservoir is not known
True or False

Because all types of Ebola are limited to
continental Africa, lab animal workers have
no reason to worry about coming in contact
with it in the United States.
Answer


False – the Reston subtype, though not yet
known to be harmful to humans, has been
found in the U.S.
Additionally, African rodents may also be a
reservoir and enter the US through the pet
trade. This practice was stopped recently
after the monkey pox outbreak caused by
Gambian giant rats and dormice.
Marburg Virus Hemorrhagic Fever
Negative stain image
of an isolate of
Marburg virus


What is it?
Marburg hemorrhagic fever is a rare, severe
type of hemorrhagic fever which affects both
humans and non-human primates, and is often
fatal. Caused by a genetically unique zoonotic
RNA virus of the filovirus family, its recognition
led to the creation of this virus family. The four
species of Ebola virus are the only other known
members of the filovirus family. (9)
What is it?
 Marburg
virus was first recognized in
1967, when outbreaks of hemorrhagic
fever occurred simultaneously in
laboratories in Marburg and Frankfurt,
Germany and in Belgrade, Yugoslavia
(now Serbia). (9)
What is it?

A total of 32 people became ill; they
included laboratory workers as well as
several medical personnel and family
members who had cared for them. The first
people infected had been exposed to
African green monkeys or their tissues. In
Marburg, the monkeys had been imported
for research and to prepare polio vaccine.
(9)
Where is it now?


Recent occurrences have
been limited to countries in
sub-Saharan Africa.
The current outbreak in Angola
is the first report of Marburg
virus disease since 19982000, when the then largest
known outbreak, (154 cases,
resulting in 128 deaths)
occurred in the Democratic
Republic of Congo. (9)
Outbreaks of Marburg HF.
As of 23 August 2005, the
Ministry of Health in Angola
reported a total of 374 cases,
including 329 deaths (CFR 88%)
reported countrywide. Last
confirmed case of Marburg died
on 21 July 2005 in Songo
municipality, Uige Province.
There have been no laboratory
confirmed cases since then.
(10)
Update on this outbreak →
How is it contracted?



Just how the animal host first transmits Marburg
virus to humans is unknown.
Humans who become ill with Marburg
hemorrhagic fever may spread the virus to other
people.
Persons who have handled infected monkeys and
have come in direct contact with their fluids or cell
cultures, have become infected. (9)
How is it contracted?


Spread of the virus between humans has
occurred in a setting of close contact, often
in a hospital.
Droplets of body fluids, or direct contact
with persons, equipment, or other objects
contaminated with infectious blood or
tissues are all highly suspect as sources of
disease.(9)
What are the symptoms?


After an incubation period
of 5-10 days, the onset of
the disease is sudden and
is marked by fever, chills,
headache, and myalgia.
Around the fifth day after
the onset of symptoms, a
maculopapular rash, most
prominent on the trunk
(chest, back, stomach),
may occur. (9)
What are the symptoms?


Nausea, vomiting, chest pain, a sore throat,
abdominal pain, and diarrhea then may
appear.
Symptoms become increasingly severe and
may include jaundice, inflammation of the
pancreas, severe weight loss, delirium,
shock, liver failure, and multi-organ
dysfunction.(9)
What are the symptoms?

Because many of the signs and symptoms
of Marburg hemorrhagic fever are similar to
those of other infectious diseases, such as
malaria or typhoid fever, diagnosis of the
disease can be difficult, especially if only a
single case is involved.(9)
Precautions/Prevention

Due to our limited knowledge of the
disease, preventive measures against
transmission from the original animal host
have not yet been established. (9)
Precautions/Prevention




Measures for prevention of secondary
transmission are similar to those used for other
hemorrhagic (Ebola) fevers:
Wearing of protective gowns, gloves, and
masks
Placing the infected individual in strict isolation
Sterilization or proper disposal of needles,
equipment, and patient excretions.(9)
Precautions/Prevention


Viruses causing hemorrhagic fever exist in many
places around the world, and modern travel
patterns raise the possibility of importing an
infectious disease to the United States or to other
countries where the disease has not been
previously reported.
However, if Marburg virus infection were to reach
the United States, health officials here have the
ability to effectively isolate infected individuals and
stop the spread of disease.(11)
Review Questions – True or False

Marburg Hemorrhagic Fever symptoms are
very unique, which is why it is so easy to
identify when it appears.
Answer

False – the symptoms are non-specific,
making it difficult to identify.
True or False

As with most other MHF outbreaks, the
recent Angolan outbreak case fatality rate
was well below fifty percent.
Answer

False – The most recent outbreak had a
case fatality rate of 88%. Most previous
outbreaks were also above 50%.
Hepatitis A


What is it?
Hepatitis A is a liver disease caused by the
hepatitis A virus.
How is it transmitted?



Humans are the primary reservoir for
Hepatitis A virus.
Non-human primate infections result from
contact with infected humans.
More than 200 cases of Hepatitis A virus
infection in humans have been associated
with nonhuman primates. (2)
How is it transmitted?






Many nonhuman primate species are
susceptible:
Chimpanzees and other great apes
marmosets
owl mokeys
cynomolgus monkeys
patas monkeys (2)
Owl Monkey
Chimpanzee
Patas Monkey
How is it transmitted?

Hepatitis A virus is transmitted via the fecaloral route, and some outbreaks can be
related to contaminated feed and water.(2)
Symptoms - NHP






The disease in NHP is much less severe
than in humans and is often subclinical.
Some species of NHP develop:
malaise
vomiting
jaundice
increased serum concentrations of hepatic
enzymes. (2)
Symptoms - Humans






Varies from mild illness lasting 1-2 weeks to a
severely debilitating illness lasting several
months. After an incubation period of about a
month, patients experience an abrupt onset of:
fever
malaise
anorexia
nausea
abdominal discomfort followed in a few days by
jaundice (2)
Precautions/Prevention

As with any other zoonotic disease, the use
protective clothing, good personal hygiene,
and appropriate practices of sanitation of
equipment and facilities are essential. (2)
Hepatitis B,C,D,E


As with Hepatitis A, humans are the natural
host for Hepatitis B,C,D,E.
Various NHP, particularly chimpanzees, can
be infected experimentally, but only one
case of natural infection has been
reported.(2)
Hepatitis B,C,D,E



Although natural infections of NHP with Hepatitis
B,C,D,E viruses are extremely rare, personnel
should adhere to appropriate precautions when
handling NHPs.
Hepatitis B vaccines are available and highly
recommended for personnel involved with
hepatitis B virus.(2)
Many counties in North Carolina offer Hepatitis B
vaccinations to middle schoolers.
Review Questions

How is Hepatitis A transmitted?
Answer

Fecal-oral route
Question – True or False

In NHPs, hepatitis A is much more serious
with obvious clinical signs.
Answer

False - The disease in NHPs is much less
severe than in humans and is often
subclinical.
In Closing



Education and understanding are essential
Wearing appropriate PPE and exercising caution
when working with animals, whether it be rodents
or NHPs, whether it be in Africa or in the US, is of
utmost importance – a new outbreak is always a
possibility.
Good personal hygiene is essential for disease
prevention
References












1. Cohen, Davenport, Stewart, Deithcman, Hilliard, Chapman, and the B Virus Working Group. Reccomendations for
Prevention of and Therapy for Exposure to B Virus. Clinical Infectious Diseases. 2002;35:1191-203
2. National Research Council. Occupational Health and Safety in the Care and Use of Research Animals. Page 67.
1997.
3. CDC. Guidleines for Prevention of Herpesvirus Simiae (B virus) Infection in Monkey Handlers. Morbidity and Mortality
Weekly Report. October 23, 1987.
4. NIOSH. Cercopithecine herpesvirus 1 (B Virus) Infection Resulting from Ocular Exposure. 1999.
5. AALAS. ALAT Training Manual. 2001.
6. CDC. Shigellosis. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_g.htm
7. CDC. Ebola Hemorrhagic Fever. http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola.htm
8. World Health Organization. Ebola Haemorrhagic Fever in the Republic of the Congo – Update 2.
http://www.who.int/csr/don/2005_06_16/en/index.html
9. CDC. Questions and Answers about Marburg Hemorrhagic Fever.
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg/qa.htm
10. World Health Organization. Marburg Haemorrhagic fever in Angola – Update 25.
http://www.who.int/csr/don/2005_08_24/en/index.html
11. CDC. CDC Assists in Public Health Response to Marburg Hemorrhagic Fever Outbreak in Angola. May, 24, 2005.
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg/cdcrole.htm
Disclaimer


This presentation was completed while I was
employed by Priority One Services (POS) at the
National Institute of Environmental Health
Sciences. Thus, both organizations deserve
credit for supporting the work.
However, the views expressed in this presentation
are mine, and do not necessarily reflect those of
POS, NIEHS, or UNC DlAM.