Non-Herpes B Exposure

After Hours Post-Exposure Prophylaxis for Biological Exposures

PnP #130-13

Effective Date: February 2024

A. Purpose 

To describe the process where workers with biological exposures can receive necessary emergency treatment outside of the UC Davis Occupational Health Clinic's business hours. 

B. Policy 

The University complies with all pertinent Federal, State, and local statutes, standards, and regulations regarding the provision of personnel health programs for individuals who have contact with or are exposed to live vertebrate animals or biological products used in research or teaching. Occupational Health endeavors to assist in augmenting the knowledge base of local emergency rooms and urgent care centers that may be unfamiliar with the complexities of managing these biological exposures, including the emergency administration of Post-Exposure Prophylaxis (PEP) medications. 

Examples of such exposures include but are not limited to:

• Bloodborne Pathogens (HIV, SIV) from a needlestick or splash

• Lentiviral vectors with oncogenes or toxins, usually from needlestick

• Exposure to Brucella from aerosol, splash, or needlestick 

• Herpes B virus* from a needle stick or splash from work with unfixed primate tissues 

  • (*Additional instructions for Herpes B exposures below)

The following procedure is for employees/student employees who receive a paycheck from the University. If the exposed person is a student they are to contact Student Health and Counseling services for treatment. 

C. Procedure 

Exposed employees receive treatment at UC Davis Occupational Health Clinic during business hours (8:00 am-5:00 pm Monday, Tuesday, Thursday and Friday, 9:00 am-5:00 pm Wednesday, closed from 12-1 pm daily for lunch). Preferably, employees call ahead so staff can triage the appointment. 

In the event of an after-hours biological exposure, the following process shall be followed: 

• Cease work and begin immediate first aid. 

  • Skin wounds - immediately wash skin with a solution containing detergent soap (i.e. chlorhexidine or povidone-iodine) for 15 minutes. Gently clean, be careful not to further abrade the skin. Rinse well with water. 

  • Mucosa Membranes - go to the eyewash station and flush with sterile saline or water for 15 minutes. Do not use soap. 

  • Mouth - flush and spit repeatedly with water only. Do not swallow. 

• After adequate first aid is performed at the worksite, proceed to: 

  • 1. Davis Urgent Care 4515 Fermi Place, Suite 105, Davis, CA 95616. Hours of operation 9:00 am – 9:00 pm 365 days per year including holidays (last patient seen at 8:00 pm).

    • This is the preferable place for treatment as they can provide several days of medication that will cover the employee until the next business day that Occupational Health is open.

  • 2. Sutter Davis Hospital Emergency Room 200 Sutter Place, Davis, CA, 95616. 

    • The ER is only able to give one dose of medication at the time of visit and the prescription is given to fill at a pharmacy that is covered under Workers Comp with Optum network. See below for a list of covered pharmacies.

  • The nearest Urgent Care or Emergency Room if outside of the Davis area.

• On-call Occupational Health staff are available after-hours for consultation with ER & Urgent Care medical staff at (530) 302-5529. The Occupational Health medical staff will provide education about the exposure and treatment risks, benefits, and alternatives.

• If the exposure is to Herpes B virus, which requires timely treatment, see Herpes B Exposure below for specific treatment recommendations. 

  • The goal is that the affected employee/student employee will receive PEP within two (2) hours of the exposure. 

• The employees at these institutions will have educational information on exposed pathogens as well. 

• If the patient is seen outside of Occupational Health, the facility will fax records, UCD Employee Injury Information, and Record of Medication Given for Potentially Infectious Post-Exposure Prophylaxis (see printable packet) to Occupational Health (530) 752-5277 for continuity of care before the next business day. 

• The supervisor will be notified and a Worker’s Compensation claim will be initiated. 

• The exposed worker will contact the UC Davis Occupational Health Clinic (530) 752-6051 the next business day to schedule an appointment. Additional treatment may include wound care, blood work, and medication adjustment. 

Herpes B Exposure

Non-Human Primate (Macaque Rhesus) Exposure: Initial and follow-up treatment for exposure to Herpes Simian B Virus 

Attachment to PnP #130-13

Effective Date: February 2024 

A. Background 

University of California at Davis has laboratories on campus working with two non-human primate (NHP) species: Old World macaque (Rhesus) species, and New World marmoset species. Note, New World marmosets are not carriers for Herpes B virus, and bites/injuries from these animals are not included in this protocol. For New World marmoset injuries, follow standard first aid care and animal exposure policies as indicated. 

Herpes Simian B virus (Macacine herpesvirus 1 (formerly Cercopithecine herpesvirus 1, CHV-1), Herpesvirus simiae, B virus) is a zoonotic agent that can cause fatal encephalomyelopathy in humans. The virus is naturally occurring and endemic among macaque (Rhesus) monkeys and other Old World primates in the wild and in research populations. Persons at risk for Herpes B virus exposure include veterinarians, animal health technicians, laboratory workers, and researchers. Most exposures are managed at the Occupational Health Clinic. It is the University policy that work with the macaque species only occurs during daytime business hours. However, unforeseen circumstances may require that initial evaluation and treatment be performed when Occupational Health Services is not open, thus the need for training of our healthcare partners. Oral, ocular, and genital secretions and CSF and CNS tissues of macaque monkeys are potentially infectious. Documented routes of B virus infection include bites and scratches, exposure to tissue culture material, exposure to tissue obtained during autopsy, needle sticks, cage scratches, and mucosal splash. Deep puncture wounds, inadequately cleaned wounds, and wounds on the face, neck, thorax, or eyes may pose a greater risk. The only documented case of human-to-human transmission has been when the virus was transferred from an infected wound to another person’s open wound via topical hydrocortisone cream. 

All macaque primate exposures should be evaluated immediately and initial management for Herpes B exposure should start as soon as possible. For all extensive and/or profusely bleeding injuries, patients should be stabilized and 911 called for assistance. It is important that all medical providers including emergency paramedics, Davis Urgent Care, and Sutter Davis Hospital Emergency Room staff understand that the wound may be contaminated with Herpes B virus, that anyone examining or cleansing the wound must use universal precautions, and that first-aid should be instituted immediately.

The adequacy and timeliness of wound decontamination procedures are the most important factors determining the risk of infection after exposure to Herpes B virus. Thorough cleansing, that lasts for a full 15 minutes, within five minutes of injury or exposure greatly lessens the risk of progressing to Herpes B virus infection. 

All personnel working with or having access to macaques, their body fluids, unfixed tissues, or equipment potentially contaminated with Herpes B virus, must receive training on their laboratory’s Standard Operating Procedure, as well as have completed Herpes B virus training. 

B. Initial Management and Treatment of Exposure to Herpes B Virus: 

Universal precautions are indicated for the assessment and care of all wounds. 

Assess for and treat any life-threatening wounds and control bleeding as necessary, activate EMS as appropriate. 

1. First aid: First aid should be performed at the worksite for macaque bites, scratches, splashes, exposures to unfixed tissues, body fluids, and injuries from needle sticks or other equipment potentially contaminated with Herpes B virus: 

• Cleansing must begin immediately, best within five (5) minutes of the exposure, and may need to be repeated on arrival at UC or the ER. This is the most important step in the management and treatment of exposure. 

  • Skin wounds - immediately wash skin with a solution containing detergent soap (i.e. chlorhexidine or povidone iodine) for 15 minutes. Gently clean, be careful not to further abrade the skin. Rinse well with water. 

  • Mucosal Membranes - go to the eyewash station and flush with sterile saline or water for 15 minutes. Do not use soap.

  • Mouth - flush and spit repeatedly with water only. Do not swallow. 

C. Treatment at Occupational Health or Outside Facilities

After adequate first aid is performed at the worksite, proceed to UC Davis Occupational Health Clinic during business hours (8:00 am-5:00 pm Monday, Tuesday, Thursday and Friday, 9:00 am-5:00 pm Wednesday, closed from 12-1 pm daily for lunch). Preferably, call ahead at (530) 752-6051 so staff can triage the appointment. 

If exposure occurs when Occupational Health Services is closed proceed to: 

• 1. Davis Urgent Care 4515 Fermi Place, Suite 105, Davis, CA 95616. Hours of operation 9:00 am – 9:00 pm 365 days per year including holidays (last patient seen at 8:00 pm)

  • This is the preferable place for treatment as they can provide several days of medication that will cover the employee until the next business day that Occupational Health is open.

• 2. Sutter Davis Hospital Emergency Room 200 Sutter Place, Davis, CA 95616. Open 24 hours 

  • The ER is only able to give one dose of medication at the time of visit and the prescription is given to fill at a pharmacy that is covered under Workers Comp with Optum network. See below for a list of covered pharmacies.

• 3. The nearest Urgent Care or Emergency Room if outside of the Davis area 

a. Exposed employees will hand-carry the printable exposure information packet to the Urgent Care or Emergency Room. Occupational Health Services supplies the informational packets to the campus departments. 

• Each packet includes but is not limited to: 

  • instructions for treatment of exposure 

  • patient medication information sheets 

  • a blank Record of Medication Given 

  • a blank UCD Employee Injury Information fax sheet to be filled out by the Provider at the DUC or ER and faxed to Occupational Health Services at (530) 752-5277 

  • An infectious disease card 

b. The clinician will assess the adequacy of first aid/decontamination and whether further cleansing is necessary. 

c. Do not culture or swab the exposure site. Doing so may force virus on the surface of the wound further into the wound, and may further contaminate the wound with infected material located nearby. d. It is important that emergency paramedics, Davis Urgent Care, and Sutter Davis Hospital Emergency Room staff understand that the wound may be contaminated with Herpes B virus, that anyone examining or cleansing the wound must use Universal Precautions, and that first-aid should be instituted immediately. 

e. Reiterate that injury is due to exposure to Herpes B virus from a non-human primate exposure, NOT Hepatitis B (or other herpes virus) 

Only after expert consultation and in unusual circumstances would it be advised to culture the wound, and only ever after initial wound cleansing has been performed. Specimens for PCR or culture are usually only obtained if clinical symptoms are present, or if antibody-positive serology suggests infection. Contact the National B Virus Research Center (link below) if needed with questions. 

The blood serum collection for B-Virus will be handled by Occupational Health Services when the employee follows up after the Urgent Care/ER visit 

f. Wound care (antibiotics, dressings, etc.) as indicated by the severity of the wound. 

g. Tetanus prophylaxis as appropriate. 

h. Review clinical symptoms of Herpes B virus infection with the patient. 

i. Employee must follow up with Occupational Health in 1-3 days for further treatment/monitoring 

j. If Occupational Health Services will be closed, contact the on-call medical provider at (530) 302-5529, to develop a follow-up plan.

k. Review options for Herpes B virus prophylactic antiviral medication (below). 

D. Post Exposure Prophylaxis

• Prophylaxis recommended 

  • Skin exposure (with loss of skin integrity) or mucosal exposure (with or without injury) to a high-risk source (e.g., a macaque that is ill, immunocompromised, or known to be shedding virus or that has lesions compatible with B virus disease) 

  • Inadequately cleaned skin exposure (with loss of skin integrity) or mucosal exposure (with or without injury) 

  • Laceration of the head, neck, or torso 

  • Deep puncture bite 

  • Needle stick associated tissue or fluid from the nervous system, lesions suspicious of B virus, eyelids, or mucosa 

  • Puncture or laceration after exposure to objects (a) contaminated either with fluid from monkey oral or genital lesions or with nervous system tissues, or (b) known to contain B virus 

• Prophylaxis considered 

  • Mucosal splash that has been adequately cleaned 

  • Laceration that has been adequately cleaned 

  • Needle stick involving blood from an ill or immunocompromised macaque 

  • Puncture or laceration occurring after exposure to (a) objects contaminated with body fluid (other than that from lesion), or (b) potentially infected cell culture 

• Prophylaxis not recommended 

  • Skin exposure in which the skin remains intact 

  • Exposure associated with new world (non-macaque) species of nonhuman primates 

• Antiviral agents recommended for post-exposure prophylaxis 

  • Valacyclovir, oral, 1 g given three times daily for 14 days in adults and non-pregnant women. 

  • Acyclovir, oral, 800 milligrams given five times daily for 14 days. (For pregnant women, acyclovir is the preferred agent.) 

Agents should be initiated within 2 hours of exposure. 

For cases in which a wound culture comes back positive for Herpes B virus: initiate prophylaxis, regardless of time from exposure, even if it has been more than 5 days. 

E. Reporting 

1. All Non-human primate exposures should be reported to the employee’s supervisor and Occupational Health Services. 

• The on-call medical staff can be reached at 530-302-5529. 

2. Occupational Health will report all Non-Human Primate Exposures to EH&S. 

• Be prepared to report the time and date of injury, nature of the injury, victim’s name and job title, department name, supervisor name, location of the incident, name of the contact person at the site, and where (if any) the victim was taken. Occupational Health Services staff can be contacted during business hours at 530-752-6051, and after-hours at 530-302-5529. You may email occupationalhealth@ucdavis.edu to report as well. 

F. Follow-Up Care 

1. For employees who receive initial treatment at a facility other than UC Davis Occupational Health, the patient should contact UC Davis Occupational Health Clinic on the next business day to schedule a follow-up to assess tolerance of prophylactic medication and assess for symptoms of Herpes B Virus. 

2. Follow-up testing/serology: 

• Initial sample - at the time of the Exposure (or at the first appointment with Occupational Health if seen at an outside facility) 

• 2nd Sample - 14-21 days after Exposure (or at the onset of clinical symptoms) 

• 3rd Sample - 30 days after completing post-exposure prophylaxis Page 11 of 29

• Final check at 6 months post-exposure as recommended by Occupational Health 

G. References 

Guidelines are based upon Recommendations of the B Virus Working Group and are summarized in the article: 

Recommendations for Prevention of and Therapy for Exposure to B Virus. Jeffrey I. Cohen, David S. Davenport, John A. Stewart, Scott Deitchman, Julia K. Hilliard, Louise B Chapman, and the B virus working group. Clinical Infectious Diseases 2002:35 (15 November) 1191-1203. 

For expert consultation, contact the National B Virus Research Center in Atlanta, Georgia at 404-413-6550.