(Based on recommendations from Cohen et al):
Skin exposures where skin remains intact do not carry a risk of transmission and no further assessment or follow up is required.
For all other injuries, proceed to the injury risk assessment below
Note: If you are using a mobile phone or tablet you may wish to turn the device to landscape to view the tables on this page better.
| Source animal |
| Healthy macaque |
0 |
| Macaque that is ill or immunocompromised |
1 |
| Macaque that is known to be shedding herpes B virus |
1 |
| Macaque that has lesions compatible with herpes B virus disease |
1 |
| Test results from vet indicates macaque is infected with herpes B virus |
1 |
| Injury |
| Skin exposure in which skin remains intact |
Not at risk: leave risk assessment |
| Mucosal exposure |
1 |
| Needlestick involving blood |
1 |
| Laceration (with loss of skin integrity) in any location other than head, neck or torso |
1 |
| Puncture or laceration occurring after exposure to objects (a) contaminated with body fluid (other than that from a lesion), or (b) potentially infected cell culture |
1 |
| Laceration of head, neck or torso |
2 |
| Deep puncture bite in any location |
2 |
| Needlestick associated with tissue/fluid from nervous system, lesions suspicious for B virus, eyelids or mucosa |
2 |
| 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 |
2 |
| First aid |
|
| Adequately cleaned |
0 |
| Inadequately cleaned |
1 |
Suggested actions:
| Total score |
Risk assessment |
Recommended actions |
| 2 or more |
High |
Commence postexposure prophylaxis: aciclovir 800mg five times daily for 14 days, or valaciclovir 1gram three times daily for 14 days |
| 1 |
Moderate |
No prophylaxis, follow up required |
| 0 |
Low |
No prophylaxis. Give patient advice. No follow up required. |
Treatment of possible cases of Herpes B disease
Any patients presenting with fever, flu-like symptoms, vesicles at site of injury or signs of encephalopathy following an injury with a non-human primate should be immediately discussed with the ID registrar on-call (pager 8161 9am-7pm, ID Consultant on-call via switchboard out with these).
Assess Rabies risk as per PHE rabies post-exposure guidelines
Follow *NHS Lothian antimicrobial guidelines for management of animal bites (For prophylaxis use the recommendations for human bites).
All monkey bites are considered “tetanus prone”. Recommended actions are given in the table below and are based on PHE guidance.
| Vaccination status |
Immediate treatment |
| Those aged 11 years and over, who have received an adequate priming course of tetanus vaccine with the last dose within the last 10 years |
None required |
|
Received adequate priming course of tetanus vaccine but last dose more than 10 years ago
(Includes UK born after 1961 with history of accepting vaccinations)
|
Immediate reinforcing dose of vaccine |
|
Not received adequate priming course
of tetanus vaccine
(Includes uncertain immunisation status and/or born before 1961)
|
Immediate reinforcing dose of vaccine
One dose of human tetanus immunoglobulin in a different site
|
Infectious diseases
