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Zoonotic Diseases of Non-Human Primates

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1 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

2 What is a zoonotic disease?
A zoonotic disease is one that can be transmitted from animals to humans or from humans to animals.

3 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?

4 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.

5 What is our goal for this training?
Were you to work in a facility that housed non-human 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.

6 What diseases will we discuss?
Herpes B Tuberculosis Shigellosis Measles Ebola Hemorrhagic Fever Marburg Hemorrhagic Fever Hepatitis

7 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)

8 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)

9 pigtail macaque cynomolgus monkey rhesus monkey stump-tail macaque
photo from AALAS learning library pigtail macaque cynomolgus monkey photo from AALAS learning library photo from AALAS learning library rhesus monkey stump-tail macaque

10 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)

11 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.

12 How are people exposed to herpes B?
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


14 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)

15 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)

16 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)

17 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)

18 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)

19 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)

20 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)

21 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)

22 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)

23 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)

24 PPE Monkey handlers should wear: leather gloves
long sleeved garments for hand and arm protection (2)

25 PPE Goggles or glasses and a mask or a chin- length 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)

26 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.

27 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, This incident is the first documented case of a B virus infection resulting from an ocular exposure to macaque secretions.

28 Review Questions What does it mean when we say that B virus is endemic in macaques and that they are asymptomatic carriers.

29 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.

30 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?

31 Answer Virus shedding is more frequent during the mating season, if an animal is immunosuppressed, or stressed. You can still contract B virus at any time, these are simply times when virus shedding is more frequent.

32 Question Why would safety glasses not be adequate eye protection when working with macaques?

33 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.

34 Tuberculosis 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)

35 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)

36 Tuberculosis However, nonhuman primates are of primary importance in the consideration of these diseases in the laboratory-animal environment. (2)

37 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)

38 TB – How do I get it? 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)

39 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)

40 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)

41 Symptoms of TB 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)

42 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)

43 Symptoms of TB 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)

44 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)

45 Prevention/Precautions
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

46 Prevention/Precautions
Prompt euthanasia of infected animals Necropsy and microbiological and histopathological analysis of animals confirmed positive.

47 Prevention/Precautions
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)

48 Review Questions How do NHP generally develop TB?

49 Answer 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

50 Question How is a TB test administered in NHPs?

51 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.

52 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

53 Shigellosis – What is it?
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)

54 How do I get shigellosis?
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)

55 How do I get shigellosis?
Shigellosis is transmitted by a direct or indirect fecal-oral route. Shigella spp. are very infectious, requiring only organisms to produce infections. (2)

56 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.

57 How do I get shigellosis?
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)

58 How do I get shigellosis?
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)

59 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)

60 Prevalence? Shigellosis is particularly common and causes recurrent problems in settings where hygiene is poor and can sometimes sweep through entire communities. (6)

61 Prevalence 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.

62 Symptoms 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. 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)

63 Precautions/Prevention
Prevention of shigellosis in a laboratory-animal 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)

64 Precautions/Prevention
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   

65 Precautions/Prevention
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.

66 Review Questions How is shigellosis transmitted?

67 Answer Shigellosis is transmitted by a direct or indirect fecal-oral route.

68 Question What population of people are most likely to get shigellosis?

69 Answer Children, especially toddlers aged 2 to 4, are the most likely to get shigellosis.

70 Measles What is it? It’s a viral disease.
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) Measles virion seen through a microscope

71 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)

72 What are the symptoms? 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

73 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)

74 What are the symptoms? Complications of viral replication or secondary bacterial infection can result in pneumonia, otitis media, diarrhea, or, rarely, encephalitis. (2)

75 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.

76 Review Question Are New World monkeys susceptible to measles?

77 Answer Yes – both Old and New World Monkeys are susceptible to measles.

78 Question True or false:
Clinical signs of measles are dramatically different in monkeys than in humans.

79 Answer False - Clinical signs are similar in NHP and humans.

80 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 (7)

81 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)

82 What is it? There are four identified subtypes of Ebola virus. Three of the four have caused disease in humans: Ebola-Zaire, Ebola-Sudan, and Ebola-Ivory Coast. The fourth, Ebola-Reston, has caused disease in nonhuman primates, but not in humans.(7)

83 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)

84 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)

85 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)

86 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)

87 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)

88 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)

89 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)

90 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)

91 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)

92 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)

93 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)

94 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)

95 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)

96 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)

97 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)

98 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.

99 Review Question Which animal is the reservoir for the Ebola Virus?

100 Answer The natural reservoir is not known

101 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.

102 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.

103 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)

104 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)

105 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)

106 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 , when the then largest known outbreak, (154 cases, resulting in 128 deaths) occurred in the Democratic Republic of Congo. (9)

107 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 →

108 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)

109 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)

110 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)

111 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)

112 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)

113 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)

114 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)

115 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)

116 Review Questions – True or False
Marburg Hemorrhagic Fever symptoms are very unique, which is why it is so easy to identify when it appears.

117 Answer False – the symptoms are non-specific, making it difficult to identify.

118 True or False As with most other MHF outbreaks, the recent Angolan outbreak case fatality rate was well below fifty percent.

119 Answer False – The most recent outbreak had a case fatality rate of 88%. Most previous outbreaks were also above 50%.

120 Hepatitis A What is it? Hepatitis A is a liver disease caused by the hepatitis A virus.

121 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)

122 How is it transmitted? Many nonhuman primate species are susceptible:
Chimpanzees and other great apes marmosets owl mokeys cynomolgus monkeys patas monkeys (2)

123 Chimpanzee Owl Monkey Patas Monkey

124 How is it transmitted? Hepatitis A virus is transmitted via the fecal-oral route, and some outbreaks can be related to contaminated feed and water.(2)

125 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)

126 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)

127 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)

128 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)

129 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.

130 Review Questions How is Hepatitis A transmitted?

131 Answer Fecal-oral route

132 Question – True or False
In NHPs, hepatitis A is much more serious with obvious clinical signs.

133 Answer False - The disease in NHPs is much less severe than in humans and is often subclinical.

134 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

135 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 ;35: 2. National Research Council. Occupational Health and Safety in the Care and Use of Research Animals. Page 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 5. AALAS. ALAT Training Manual 6. CDC. Shigellosis. 7. CDC. Ebola Hemorrhagic Fever. 8. World Health Organization. Ebola Haemorrhagic Fever in the Republic of the Congo – Update 2. 9. CDC. Questions and Answers about Marburg Hemorrhagic Fever. 10. World Health Organization. Marburg Haemorrhagic fever in Angola – Update 25. 11. CDC. CDC Assists in Public Health Response to Marburg Hemorrhagic Fever Outbreak in Angola. May, 24,

136 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.

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