HETA 98–0339–2806

United States Department of Agriculture

Animal and Plant Health Inspection Service

Riverdale, Maryland

Teresa A. Seitz, MPH, CIH

Helga Daftarian, DO, MPH

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports
ii

PREFACE

The Hazard Evaluations and Technical Assistance Branch (HETAB) of the National Institute for

Occupational Safety and Health (NIOSH) conducts field investigations of possible health hazards in the

workplace. These investigations are conducted under the authority of Section 20(a)(6) of the Occupational

Safety and Health (OSHA) Act of 1970, 29 U.S.C. 669(a)(6) which authorizes the Secretary of Health and

Human Services, following a written request from any employer or authorized representative of employees,

to determine whether any substance normally found in the place of employment has potentially toxic effects

in such concentrations as used or found.

HETAB also provides, upon request, technical and consultative assistance to Federal, State, and local

agencies; labor; industry; and other groups or individuals to control occupational health hazards and to

prevent related trauma and disease. Mention of company names or products does not constitute endorsement

by NIOSH.

ACKNOWLEDGMENTS AND AVAILABILITY OF REPORT

This report was prepared by Teresa Seitz and Helga Daftarian of HETAB, Division of Surveillance, Hazard

Evaluations and Field Studies. Desktop publishing was performed by Ellen Blythe. Review and preparation

for printing were performed by Penny Arthur.

Copies of this report have been sent to employee and management representatives at USDA/APHIS and the

OSHA Regional Office. This report is not copyrighted and may be freely reproduced. Single copies of this

report will be available for a period of three years from the date of this report. To expedite your request,

include a self–addressed mailing label along with your written request to:

NIOSH Publications Office

4676 Columbia Parkway

Cincinnati, Ohio 45226

800–356–4674

After this time, copies may be purchased from the National Technical Information Service (NTIS) at

5825 Port Royal Road, Springfield, Virginia 22161. Information regarding the NTIS stock number may be

obtained from the NIOSH Publications Office at the Cincinnati address.

For the purpose of informing affected employees, copies of this report shall be

posted by the employer in a prominent place accessible to the employees for a

period of 30 calendar days.
iii

Highlights of the NIOSH Health Hazard Evaluation

Zoonotic Disease Hazards During Animal Welfare Inspections

In response to a request from the United States Department of Agriculture, Animal and Plant Health

Inspection Service (USDA/APHIS), NIOSH evaluated potential zoonotic disease hazards to Veterinary

Medical Officers (VMOs) and Animal Care Inspectors (ACIs) during animal welfare inspections.

What NIOSH Did

# We observed animal welfare inspections at 16

facilities.

# We talked to employees and CDSHOs about

health and safety concerns.

# We reviewed health and safety documents and

medical monitoring records.

What NIOSH Found

# Safety and sanitary conditions were highly

variable at these facilities.

# Unrestrained animals and other hidden hazards

were often present.

# Protective equipment use by inspectors was

limited.

# Medical monitoring policies were not well

established.

# Medical monitoring data were incomplete.

What USDA/APHIS Managers Can

Do

# Complete the draft safety and health document

and put it into effect.

# Conduct periodic hazard assessments.

# Develop formal protective equipment and

respiratory protection programs. 

# Provide a protective equipment and exposure kit

to inspectors.

# Improve the medical monitoring program.

# Offer periodic training programs for inspectors.

What the VMOs and ACIs Can Do

# Minimize direct contact with animals.

# Avoid areas where infectious materials may

become airborne (cleaning, cage washing, etc.).

# Use protective equipment and respirators when

needed, and wash hands often.

# Learn procedures for cleaning wounds/splashes

and reporting exposures.

# Tell supervisors about health and safety

concerns.

# Attend training programs offered by

USDA/APHIS.

CENTERS FOR DISEASE CONTROL

CDC

AND PREVENTION

What To Do For More Information:

We encourage you to read the full report. If

you would like a copy, either ask your health

and safety representative to make you a copy

or call 1-513/841-4252 and ask for

 HETA Report # 98-0339-2806

Highlights of the HHE Report
iv

Health Hazard Evaluation Report 98–0339–2806

United States Department of Agriculture

Animal and Plant Health Inspection Service

Riverdale, Maryland

September 2000

Teresa A. Seitz, MPH, CIH

Helga Daftarian, DO, MPH

SUMMARY

In response to a September 1998 request from the United States Department of Agriculture, Animal and Plant

Health Inspection Service (USDA/APHIS), a health hazard evaluation was conducted to assess potential

zoonotic disease hazards encountered during animal welfare inspections. During the period January 25 to

March 24, 1999, site visits were made to 16 facilities in the Eastern and Western regions to observe animal

welfare inspections at businesses licensed by or registered with USDA. The businesses visited included

research facilities, animal dealers, exhibitors, and breeders. National Institute for Occupational Safety and

Health (NIOSH) investigators observed work practices, personal protective equipment use, and the extent

and duration of contact with the animals during the inspections. Interviews were conducted with inspectors

and other APHIS personnel, and various health and safety documents were reviewed.

The inspections revealed a wide variation in environmental conditions and potential zoonotic disease hazards

at these facilities. There was potential for exposure to infectious materials via mucous membrane contact,

airborne exposure, direct contact (bites, scratches) and indirect contact. Contact with nonhuman primates

was of greatest concern to the inspectors because of the similarities in pathogen susceptibility and the

potential for acquiring medically important infections such as tuberculosis (TB) and B Virus. Efforts were

generally made by the inspectors to maintain a safe distance from the animals when possible; in some cases

inspections were conducted outdoors or from behind a clear barrier. However, at several facilities the

inspectors encountered hidden hazards (such as unrestrained animals), poor environmental conditions (such

as inadequate lighting or insufficient caging materials), or the presence of undisclosed animals.

While baseline serum samples are collected from some USDA employees at the time of employment for

evidence of prior brucellosis or psittacosis infection, the extent of participation by animal welfare inspectors

was not known. Routine tuberculin skin testing for TB (either annually or semiannually) is required for all

animal welfare inspectors, but sufficient information could not be obtained to determine TB infection or

conversion rates, or to evaluate whether the tests had been conducted and interpreted according to current

Centers for Disease Control and Prevention (CDC) guidelines. Illness and injury logs revealed nonspecific

information on infectious diseases reported among APHIS personnel. 

APHIS employees may be exposed to zoonotic agents during animal welfare inspections. Improved

prevention efforts to eliminate or minimize such exposures are needed. Because engineering

controls are not often available at the inspected facilities, inspectors must rely primarily on

administrative and work practice controls and, secondarily, on the use of personal protective

equipment to minimize exposures. Available medical surveillance data were too limited to fully

evaluate the risk of infection and effectiveness of current prevention efforts. Recommendations are

made in the report to strengthen the zoonotic disease prevention program for animal welfare

inspectors.

Keywords: SIC 9651 (Regulation, Licensing, and Inspection of Miscellaneous Commercial Sectors),

tuberculosis, TB, B Virus, nonhuman primate, animal, zoonoses, infection, inspection, animal welfare. 
TABLE OF CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Acknowledgments and Availability of Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Highlights of the HHE Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Introduction ........................................................................ 1

Background ........................................................................ 1

Methods ........................................................................... 1

Evaluation Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Site Inspection Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Document Reviews and Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Work Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Personal Protective Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Medical Surveillance .............................................................. 7

Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Health Hazard Evaluation Report No. 98–0339 Page 1

INTRODUCTION

In September 1998, the National Institute for

Occupational Safety and Health (NIOSH)

received a request for technical assistance from a

representative of the Safety, Health, and

Environmental staff of the United States

Department of Agriculture, Animal and Plant

Health Inspection Service (USDA/APHIS).

NIOSH was asked to provide assistance in

identifying and assessing potential health hazards

encountered during animal welfare inspections.

USDA/APHIS also requested guidance on

protective equipment use, immunization and

medical surveillance, and standard operating

procedures for reducing the risk of zoonotic

disease transmission during animal welfare

inspections. An interim report with

recommendations was distributed to employee

and management representatives in December

1999, and a summary of the findings and

recommendations of the NIOSH evaluation was

presented to Animal Care personnel in April 2000.

BACKGROUND

APHIS administers the Animal Welfare Act

(AWA), which protects warm–blooded animals

from inhumane treatment and neglect. Farm

animals used for food, fiber, or other agricultural

purposes are specifically excluded. Facilities

covered under the AWA must be licensed by or

registered with USDA and are subject to periodic,

unannounced inspections to determine if adequate

care and treatment are provided in the areas of

housing, handling, sanitation, nutrition, water,

veterinary care, and protection from extreme

weather. AWA–covered businesses include

animal dealers, exhibitors, transporters, and

research facilities. 

At the time of the NIOSH evaluation 64 Animal

Care (AC) personnel conducted the AWA

inspections. Approximately two–thirds of the

inspectors were Veterinary Medical Officers

(VMOs), with the remainder being Animal Care

Inspectors (ACIs). These individuals are located

throughout the country and work out of their

homes using government vehicles to travel to and

from the inspection sites. Inspections may last

from several hours to one or more days,

depending on the size and complexity of the

business. At the conclusion of the site inspection,

a report is prepared detailing any violations of the

AWA, with instructions for correcting the

problems within a given time frame. Legal action

may be taken if deficiencies remain uncorrected at

future inspections. In addition to the VMOs and

ACIs, APHIS animal care supervisors and

investigations personnel may participate in the

on–site inspections. 

METHODS

On January 25–29, 1999, NIOSH personnel

visited eight facilities in Texas, and on

March 22-24, 1999, eight facilities in

Massachusetts, New York, and Connecticut.

Some of the site visits were announced and

some were unannounced. NIOSH personnel were

accompanied by the collateral duty safety and

health officers (CDSHOs) for that region. The

businesses visited included dog kennels, traveling

and roadside petting farms and zoos, exotic and

wild animal breeding facilities, an exotic pet shop,

other animal training and exhibiting facilities, an

exotic feline sanctuary, a livestock/exotic pet

auction facility, and research facilities. The

research facilities included a university–based

facility and a pharmaceutical/biomedical contract

facility. Many of the sites were selected because

they housed nonhuman primates (e.g.,

chimpanzees, baboons, and New World and Old

World monkeys [including macaques]) which

were of particular concern to the employees.

Observations were made of work practices and

personal protective equipment (PPE) use by AC

personnel. NIOSH investigators were particularly

interested in observing the extent and duration of

contact with the animals and their enclosures, and
Page 2 Health Hazard Evaluation Report No. 98–0339

the various environmental conditions that the

inspectors encounter.

Information on medical surveillance was provided

by the requestor and other USDA personnel.

NIOSH investigators interviewed USDA Eastern

and Western Region CDSHOs and animal welfare

inspectors who were present during the site visits.

USDA representatives provided various

documents for NIOSH review. These included the

following: Occupational Safety and Health and

Animal Exposure Surveillance Program

(OSH/AESP) draft document, Safety and Health

Survey form (draft), Herpes B Prevention

Guidelines (interim policy), and the APHIS Types

of Injury Log listing workers’ compensation

case descriptions for 4th Quarter Fiscal Years

1996, 1997, and 1998. Copies of the Federal

Occupational Safety and Health Administration

(OSHA) Log and Summary of Occupational

Injuries and Illnesses (OSHA 100 Log) were not

available for review.

EVALUATION CRITERIA

Information on several zoonotic infections that

were discussed during the course of this

evaluation can be found in the Appendix. A

comprehensive listing of other important zoonoses

and their health outcomes by route of exposure

can be found in two recent review articles.1,2

RESULTS

Site Inspection

Observations

It was evident from the site inspections that the

environments encountered by the inspectors

varied widely. Some of the businesses were

family–owned and housed animals in and around

owners’ homes, while others were larger

operations in which animals were housed in

remote farm locations, in pet shops, or within

academic or research settings. It was also

apparent that safety and sanitary conditions were

quite varied, as was the owners’ and operators’

knowledge of potential animal–related hazards.

There were also variations in individual work

practices of the inspectors and in their use of PPE.

While all inspectors utilized certain practices to

minimize direct contact with the animals and

enclosures, some appeared to be more consistent

in doing so. All of the interviewed inspectors

described situations where they had declined to

conduct certain portions of the inspection due to

health and safety considerations. Some inspectors

were more consistent in requiring that the animals

be restrained before they entered the individual’s

home or work area to conduct the inspection.

Unrestrained animals included various farm

animals, household pets, monkeys, and bear and

tiger cubs. To avoid contact with animal cages,

one inspector asked the facility staff to turn the

cages so that the animals could be viewed from a

distance. Whenever possible, inspectors would

try to observe the animals and enclosures from a

safe distance, and in many situations, this was

done outdoors or from behind windows or other

see–through panels. APHIS employees indicated

that they would not inspect animals under

quarantine, such as in a research setting where

primates were known or suspected to have

tuberculosis (TB). 

Some of the variation in PPE use was dependent

on the hazards encountered in the particular

environment (research vs. non–research setting,

presence of nonhuman primates), while some

appeared to be due to differences in perception of

risk, availability of the PPE, and feeling awkward

wearing PPE while facility employees and/or

visitors were not similarly protected. PPE was

more commonly used in research facilities, and in

some cases was required and supplied by the

facility being inspected (mask with fluid shield,

disposable coveralls, hat and shoe coverings, and

eye protection). Some employees had received

respirator use training and were fit–tested with

disposable N95 respirators, but these respirators
Health Hazard Evaluation Report No. 98–0339 Page 3

were not used by APHIS employees during any of

our site visits and we were informed that they

were not often worn. At a chimpanzee breeding

facility, face shields were worn by the inspectors

to protect against fluid splatter and splashes from

the chimps, but this was a relatively new

procedure. Disposable foot coverings were worn

at one of the dog kennel inspections. No special

protective clothing such as coveralls was worn

at any of the site inspections. Some employees

had purchased waterless hand cleaners and

disinfectant sprays for their soiled boots or shoes.

Document Reviews and

Interviews

The OSH/AESP document was drafted as a

supplement to the APHIS Safety and Health

Manual for Animal Care Employees. This

document outlines the goals for the animal

exposure surveillance program, which include the

following: establishing immunization and routine

monitoring guidelines for certain zoonotic

diseases; explaining the purpose and use of PPE;

establishing protocols for preventing occupational

injuries and occupational exposure to pathogens

or hazardous chemicals; and providing

occupational safety and health education to AC

personnel. Participants in the program would

include all VMOs and ACIs who perform

animal welfare inspections. Other USDA

employees covered under these guidelines include

Headquarters staff personnel who routinely visit

animal facilities, as well as Regional Office staff

and supervisors who may accompany inspectors in

the field. Elements of the immunization program

for AC personnel include pre– and post–exposure

vaccination and/or screening guidelines for the

following diseases: tetanus, TB, rabies, Q–fever,

and B virus infection.

At the time of the evaluation, AC employees were

required to undergo routine purified protein

derivative (PPD)–tuberculin skin testing annually

or semiannually. Pre–exposure vaccination was

recommended, but not required, for tetanus and

rabies. Guidelines for Q-fever and B Virus were

limited to recommendations for exposure

avoidance and immediate treatment measures to

be taken in the event of exposure.

According to information provided by the

requestor, baseline serum samples are normally

obtained from USDA personnel who begin their

employment with APHIS. These serum samples

are sent to a contracted clinic network, that

analyzes them for serologic evidence of prior

brucellosis or psittacosis infection. According to

the requestor, approximately 600 baseline

screening tests for brucellosis are done each

year APHIS–wide. However, the extent of

participation by AC personnel is unknown, and

there was no information provided on the extent

of follow–up testing for these individuals. Results

of serum screening are normally sent to the

employee’s private physician, who is supposed to

provide the results to the individual employee. If

a screening result is abnormal, the physician is

supposed to send a notification letter with the

results of the screening test to USDA. This

information is placed in the employee’s individual

file which is maintained by each APHIS region.

A review of the APHIS Types of Injury Logs for

4th Quarter Fiscal Years (FY) 1996, 1997, and

1998 revealed nonspecific information regarding

infectious diseases reported among APHIS

personnel. Infectious disease–related illness

categories noted in the logs included brucellosis,

hepatitis, tuberculosis, Lyme disease,

“virological/infective/parasitic diseases, not

otherwise classified,” and “traumatic

virological/infective/parasitic diseases.”

Sufficient information was not provided to

distinguish the number of new cases of each

disease for each new fiscal year from existing

cases being carried over from previous years.

Similarly, the log provided no detail as to the job

category for each individual case, whether the

employee worked in Animal Care, Veterinary

Services, or Plant Protection and Quarantine

(PPQ), or the specific occupational exposure

context in which the infection occurred. 
Page 4 Health Hazard Evaluation Report No. 98–0339

Information was obtained from the requestor

regarding the number of APHIS employees who

had demonstrated a positive tuberculin skin test

while working for the USDA. Based on the

information from an informal survey conducted by

the requestor, six PPD–positive individuals were

identified over the last four years. Three of the

employees did not work for AC and the requestor

was unable to furnish additional information

about the remaining three cases. During the

course of the NIOSH evaluation a CDSHO

conducted a phone survey to obtain current

information on the tuberculin skin test status of

animal welfare inspectors. However, this

information has several limitations in assessing

the risk of TB infection among inspectors,

including lack of available baseline skin test data

for comparison, and lack of sufficient information

to determine if skin tests were conducted and

interpreted according to current Centers for

Disease Control and Prevention (CDC) guidelines.

Recall bias and confidentiality issues are

additional concerns.

Information provided by the USDA Medical

Officer in August 1999 indicated that there is

currently no comprehensive medical surveillance

system for USDA/APHIS as a whole, and that

the extent and quality of medical surveillance

varies among USDA regions. The USDA Medical

Officer indicated that brucellosis had been

previously diagnosed in USDA veterinarians, as

had one case of leptospirosis in an ACI. No

further information regarding these cases was

available. 

The “Herpes B Prevention Guidelines” document

provided by AC to the VMOs and ACIs was also

reviewed. This document contains the interim

policy designed to protect AC employees from

exposure to B virus while performing inspections.

The policy recommends maintaining a minimum

distance of five feet from animals and enclosures

to minimize animal bites, scratches, body fluid

splashes, or accidental injury from contact with

sharp enclosure edges. For inspections of

macaque species involving a distance of five feet

or less, a full face shield and goggles/safety

glasses must be worn. Although guidelines for

immediate post–injury wound care and

splash–injury care are included in the guidelines,

inspectors did not have access to pre–arranged

emergency medical consultation at all times, and

may not have had sufficient materials for adequate

wound care in the field. 

DISCUSSION

It is estimated that over 200 infectious diseases

can be transmitted from animals to humans.2

Given that approximately 350 species of animals

are covered under the AWA, specific

recommendations cannot be written to cover all

potential zoonoses or all possible exposure

situations that may be encountered during AWA

inspections. Primary prevention efforts aimed at

eliminating or controlling occupational exposures

to zoonotic agents through use of engineering

controls, administrative controls, and PPE are

most important. Unfortunately, the typical

engineering controls used to minimize exposure to

biohazards (such as special caging, barriers, local

exhaust ventilation, and good general ventilation)

are often not present in the inspected facilities and

this aspect of the work environment is not under

the control of USDA/APHIS. 

Given this absence of engineering controls,

administrative controls or changes in work

practices should be used to minimize employee

exposures to zoonotic agents whenever possible.

All of the inspectors we spoke with utilized such

practices to some extent to either eliminate the

exposure entirely (by refraining from conducting

certain portions of the inspection because of a

perceived hazardous situation) or minimize

exposure by maintaining a safe distance from the

animals and not directly contacting the animals or

their enclosures. Although PPE is considered the

least desirable means of protecting employees, we

encountered some situations where PPE was

needed. This occurred at the research facilities, at
Health Hazard Evaluation Report No. 98–0339 Page 5

an indoor chimpanzee breeding facility, and in an

indoor enclosure for macaques.

Secondary prevention efforts include medical

surveillance programs that complement the

primary prevention efforts listed above. In

addition to providing valuable information for

detecting infection and disease at an early or

subclinical stage, these programs can help monitor

the effectiveness of primary prevention efforts.

At one site, the AC inspector learned during the

NIOSH visit about a group of nonhuman primates

that had been placed under quarantine for

suspected tuberculosis shortly after the site

inspection the previous year. Despite the fact that

this inspector may have had exposure to infectious

animals, the inspector did not learn of this

possible exposure for several months. This

situation highlights the need for periodic

surveillance for TB infection and appropriate

follow–up evaluation of those who test positive to

determine the effectiveness of existing prevention

efforts.

NIOSH investigators were not able to obtain

detailed, substantive medical surveillance data on

AC employees during this evaluation; therefore,

the medical conclusions and recommendations

that are made in this report are general in nature.

For example, despite the fact that AC employees

were required to undergo annual or semi–annual

tuberculin skin testing, written records

documenting the test results were not available.

The HHE requestor and CDSHOs provided some

verbal information on skin test results, but it was

not sufficient to determine either the incidence of

TB infection among animal welfare inspectors or

the risk factors of occupational TB transmission in

this setting. One reason for the difficulty in

obtaining this information is that some of the key

individuals responsible for maintaining and

analyzing the medical data were no longer

working at APHIS, and their positions had not

been filled at the time of this report. In addition,

the Eastern Regional Office was in the process of

moving during the course of the NIOSH

evaluation. Despite these constraints, it was clear

that medical surveillance data were not located in

a central or easily retrievable location, and

surveillance policies were not well established.

CONCLUSION

The draft OSH/AESP document prepared by the

CDSHOs and safety committee members provides

useful information on the prevention of several

important zoonotic diseases. In addition to

finalizing and implementing the policies within

this document, a more comprehensive hazard

assessment of other zoonotic disease hazards not

covered in the draft document should be initiated.

This assessment should include consideration of

work procedures and associated biohazards,

potential routes of exposure, and potential adverse

health outcomes. Specific recommendations for

minimizing or eliminating exposures and for

medical surveillance of all potentially exposed

employees can then be developed.

Recommendations are offered below to strengthen

the zoonotic disease prevention program for

employees participating in animal welfare

inspections. 

RECOMMENDATIONS

Work Practices

21.

Minimize direct contact with animals.

Examples of work practices that can be employed

include ensuring that, when feasible, animals are

locked or otherwise restrained outdoors when

indoor enclosures are inspected, not touching

animals or their enclosures, viewing animals

outdoors (or from a safe distance) whenever

possible, and asking facility employees to turn

cages for viewing animals (but only if these

employees are adequately trained and protected).

Also, facility personnel should be required to

restrain loose animals, including household pets,

before the inspection is conducted. Periodic

training programs should emphasize these
Page 6 Health Hazard Evaluation Report No. 98–0339

practices, and AC employees should be

encouraged to share their experiences about other

work practices that have been found to be

effective. If an inspection cannot be done safely,

then inspectors should be allowed to stop an

inspection or skip an area until it can be made

safe. Employees should be encouraged to consult

with supervisors should this situation arise.

22.

To prevent hand–to–mouth contact or direct

skin contact with potentially infectious materials,

employees should be reminded to wash their

hands after removing gloves, at the conclusion of

the site inspection, and as needed during the

course of the inspection.

23.

To minimize inhalation of infectious aerosols,

employees should not enter areas where aerosol

generating activities (e.g., cleaning, necropsies,

surgery, cage washing) are being conducted.

24.

The responsible party at the inspected facility

should be questioned about any changes that have

occurred since the previous APHIS inspection,

including any new animals housed on–site. This

should be done on–site, prior to conducting the

inspection.

Personal Protective

Equipment

1. In accordance with the OSHA regulation on

PPE, a written, comprehensive PPE program

should be established that clearly identifies the

PPE required for specific tasks.3

 The required

PPE should be selected based on a thorough

worksite hazard assessment that considers work

procedures, hazards, routes of exposure, and

potential adverse health outcomes. 

2. Where respirators are used for protection

against airborne hazards such as Mycobacterium

tuberculosis, a respirator program that is

consistent with the requirements of the OSHA

Respiratory Protection Standard for general

industry should be established.4

 This standard

requires the development of a written program,

employee training, annual fit testing, and medical

clearance before respirators are assigned to

employees. Employees with beards or other facial

hair that prevents a tight face seal should not be

allowed to wear tight–fitting respirators.

Loose–fitting, powered air purifying respirators

(PAPRs) are an option for these employees. AC

employees should not rely on the use of

respirators provided by the inspection facility,

although they may use such a respirator if they

have been properly fit–tested on the specific size

and model respirator that is supplied.

3. A PPE “kit” should be created and provided to

all AC personnel who conduct animal welfare

inspections. This kit should contain at least the

following items: a respirator (minimum of an

N95), disposable gloves, a face shield that

prevents droplet splashes to the head from running

down into the eyes and prevents mucous

membrane exposure around the edges, safety

glasses or goggles, non–slip boots or other shoe

coverings, spray disinfectant, sunscreen, insect

repellent, disposable towels, water bottle, and a

biological/infectious waste bag. In addition, a

first aid kit that includes items needed for

immediate cleansing of wounds or splashes to

mucous membranes should be included. The kit

should contain at least the following items: scrub

brush, povidone–iodine solution, bandages, and

eye care kit. A sufficient supply of replacement

items should be available to all field personnel. 

4. Although the draft OSH/AESP manual

provided phone numbers for two medical

personnel to contact in the event of a potential

exposure to B virus, only daytime work phone

numbers were listed. Because emergencies could

occur outside of the typical 8:00 a.m. to 4:30 p.m.

workday, especially for employees outside the

Eastern Time Zone, emergency contacts must be

available 24 hours a day on an on–call basis and
Health Hazard Evaluation Report No. 98–0339 Page 7

current phone numbers should be provided to all

applicable personnel.

Medical Surveillance

1. A multidisciplinary team involving

occupational medicine, industrial hygiene,

CDSHOs, and other health and safety

professionals should be involved in the design of

the medical surveillance program. These

individuals should be familiar with the

occupational risks and exposure hazards

(biological, physical, and chemical) affecting AC

inspectors. Routine visits to the work site are

needed to understand the work duties and

potential exposures. These individuals should be

familiar with the CDC recommendations

regarding zoonotic diseases (Herpes B Virus

infection, Lyme Disease, etc.)5,6 and other

applicable guidelines and recommendations.

These guidelines should be incorporated into

formal policy documents which are specific for

each issue being addressed.

2. Copies of preplacement, periodic, and episodic

physical examination records, as well as medical

records documenting occupational illness and

injury care, should be maintained in a centralized

location by an occupational health and safety

specialist who is familiar with maintenance of

medical records and issues of medical record

confidentiality. 

3. Recommendations for immunizations should

be based on the results of the hazard assessment.

In general, like everyone, AC employees should

be up to date on tetanus and diphtheria

immunization.7

 Other immunizations should be

considered for certain subgroups of employees if

they have an identifiable risk, and a safe and

effective vaccine is available. This may include

AC employees who perform additional duties

such as animal necropsies that may put them at

risk for diseases acquired through bloodborne or

airborne routes of exposure. Pre–exposure

prophylaxis for rabies is recommended for

persons at high risk of exposure as defined by

occupation and level of endemicity in the animal

population.2

 For those individuals working in

outdoor environments which pose an increased

risk for acquisition of vector–borne disease such

as Lyme disease, guidelines outlining measures

designed to minimize arthropod bites (including

avoidance, minimizing skin exposure through the

use of adequate protective clothing, and use of

appropriate repellants) should be provided. Lyme

disease vaccine should be considered for persons

at high risk of exposure to ticks in areas where the

disease is endemic.

4. A comprehensive TB surveillance program

should be maintained, and results of periodic

tuberculin skin testing should be maintained in a

centralized computer database. Such a database

will allow medical personnel to track PPD

conversions and take appropriate action. NIOSH

investigators support the recommendation in the

draft OSH/AESP document that TB screening be

provided annually for all AC employees, with

more frequent testing (i.e., semiannually) as

required for entry into specific research facilities.

Employees who convert their skin test should be

further evaluated by a health care professional to

determine possible risk factors for conversion and

the need for changes in prevention practices to

minimize future exposures. Non–routine duties

that may place inspectors at risk for TB infection

such as participating in animal necropsies with

Veterinary Services employees or conducting

elephant inspections and training, as well as

exposures outside the workplace, must also be

considered.

5. Employee participation in the brucellosis and

psittacosis screening program should be clarified

and the need for such screening should be further

evaluated to determine its value.

Training

1. AC inspectors should undergo routine

occupational health and safety training that

describes hazards and risks, stresses the
Page 8 Health Hazard Evaluation Report No. 98–0339

1. Hart CA, Trees AJ, Duerden BI [1997].

Zoonoses. J Med Microbiol 46:4–33.

2. Weber DJ and Rutala WA [1999]. Zoonotic

Infections. Occupational Medicine: State of the

Art Reviews 14 (2), Apr–June, p. 247–284.

3. CFR [2000]. 29 CFR 1910.132. Personal

Protective Equipment. Code of Federal

Regulations. Washington, DC: U.S. Government

Printing Office, Office of the Federal Register. 

4. CFR [2000]. 29 CFR 1910.134. Respiratory

Protection. Code of Federal Regulations.

Washington, DC: U.S. Government Printing

Office, Office of the Federal Register.

5. CDC [1998]. Fatal cercopithecine

herpesvirus 1 (B virus) infection following a

mucocutaneous exposure and interim

recommendations for worker protection. U.S.

Department of Health and Human Services, Public

Health Service, Centers for Disease Control and

Prevention. Morbidity and Mortality Weekly

Report 47(49):1073–1076, 1083.

6. CDC [1999]. Recommendations for the use of

Lyme disease vaccine: recommendations of the

advisory committee on immunization practices

(ACIP). U.S. Department of Health and Human

Services, Public Health Service, Centers for

Disease Control and Prevention. Morbidity and

Mortality Weekly Report 48(RR–07):1–17.

7. CDC [1991]. Diphtheria, tetanus and

pertussis: recommendations for vaccine use and

other preventive measures: recommendations of

the immunization practices advisory committee

(ACIP). U.S. Department of Health and Human

Services, Public Health Service, Centers for

Disease Control. Morbidity and Mortality

Weekly Report 40(RR–10):1–28.

importance of timely reporting of all injuries and

illnesses of suspected occupational origin,

emphasizes the importance of receiving

appropriate immunizations and screening tests,

and provides a thorough review of proper PPE use

and maintenance.

REFERENCES
Health Hazard Evaluation Report No. 98–0339 Page 9

APPENDIX

Leptospirosis

Leptospirosis is a bacterial disease caused by organisms in the Leptospira genus. Many animals carry the

bacterium, including rodents, dogs, cattle, pigs, horses, and other wild animals. Approximately 100 – 200

human cases are reported annually in the U.S., about 50% of which occur in Hawaii.1

 The organisms are

excreted in the urine of infected animals and can survive in soil or water for weeks under favorable

conditions. The bacterium can enter the body via cuts or other openings in the skin, or through contact with

the conjunctiva and mucous membranes. Occupationally acquired infections are usually caused by accidental

parenteral inoculation, direct or indirect contact with cultures or infected animals (especially urine), and

animal bites.2

 Infection can also occur from inhalation of aerosols containing the organism, such as during

cage cleaning.3

 Although rare, transmission may also occur through ingestion of food contaminated with the

urine of infected rats.

The time between exposure to a contaminated source and illness ranges from two days to four weeks.1

 The

infected individual typically presents with a sudden onset of fever, headache, chills, muscle aches, vomiting,

diarrhea, and sometimes rash. The illness may present in two phases with the first phase having the

symptoms described above. The second phase, if present, is more severe and may result in kidney or liver

failure, or meningitis. This later phase is also called Weil’s disease.1

 The severity and duration of symptoms

are shortened with timely administration of antibiotics. A vaccine is not currently available for humans. 

Q fever

Q fever is caused by the rickettsia, Coxiella burnetti. This organism infects mainly cattle, sheep, and goats,

and is considered highly infectious (estimated human infectious dose by inhalation [ID25–50] is 10

organisms).4

 It is also resistant to drying and environmental conditions.5 The organism is usually transmitted

to humans via aerosols; however, direct contact with animals and contaminated materials has also been

associated with infections.6

 The rickettsia are shed in the urine, feces, milk, and birth products (placental

tissues, amniotic fluids, etc.) of infected animals.7

 Most of the outbreaks reported in the United States have

involved sheep.

Most patients with Q fever are asymptomatic. For individuals who do become symptomatic, Q fever can

manifest as either an acute or chronic infection. Symptoms of acute Q fever include chills, high fever,

headache, myalgia, fatigue, anorexia, chest pain, cough, and abdominal pain. Chronic Q fever may involve

endocarditis or hepatitis.8

 Treatment for Q fever involves administration of antibiotics. Although an

investigational Q fever vaccine is available, CDC and National Institutes of Health (NIH) guidelines

recommend that use of this vaccine be limited to those at high risk of exposure (and with no demonstrated

sensitivity to the Q fever antigen).9

Brucellosis

Brucellosis is a disease caused by bacteria of the genus Brucella. Brucella species known to cause human

disease (and their usual reservoir hosts) are B. abortus (cattle), B. melitensis (goats and sheep), B. suis

(swine), and B. canis (dogs). Brucellosis is a nationally notifiable disease in the U.S. (with the exception
Page 10 Health Hazard Evaluation Report No. 98–0339

of Texas). Infection can occur from inhalation of aerosols containing the organism, by direct conjunctival

or skin contact (breaks in the skin), or ingestion.

In 1998, 79 cases were reported to CDC. A large percentage of reported brucellosis cases in the U.S. are

associated with ingestion of unpasteurized dairy products containing B. melitensis from the Mediterranean

countries and Mexico.10 Brucellosis is predominantly an occupational disease of those working with infected

animals or their tissues, especially dairy farm workers, veterinarians, and abattoir workers. Because the

uterus of infected animals contains a high concentration of Brucella organisms, the risk for exposure to the

organism is increased for individuals exposed during the birthing process and to birthing products.

The incubation period for brucellosis varies from five days to several months, with more than 30 days being

typical. The signs and symptoms of brucellosis are nonspecific; thus there may be considerable

underreporting of this disease. Onset may be acute or insidious, and usual symptoms include weakness,

fever, chills, sweats, headaches, myalgia/arthralgia (muscle/joint pain), anorexia (decreased appetite), and

weight loss. The course of illness is variable. Symptoms often last months without treatment and may be

very debilitating. Even with appropriate treatment, a patient may be ill for a month or longer, with

approximately 2–10 % having one or more relapses.11 The relapse rate is higher if the prescribed course of

antibiotic therapy is discontinued before six weeks. Cases of brucellosis resulting from B. canis are similar

to those caused by other Brucella species, although the symptoms are generally not as severe.3

Tetanus

Tetanus is an acute disease caused by an exotoxin produced by Clostridium tetani bacteria. C. tetani spores

are ubiquitous in the environment and can be found in soil, dust, and animal feces.

Although not a zoonotic disease, tetanus may result from spores introduced into the body through a puncture

wound (animal bite or scratch or other environmental injury). Under anaerobic conditions (low oxygen

content), the spores germinate and produce the toxin. 

The incubation period generally ranges from 3 to 21 days. There are three clinical forms of the disease, with

generalized tetanus occurring most commonly. This form is characterized by generalized rigidity and painful

muscular contractions of the neck and jaw muscles. Other complications and death may result from tetanus

infections. The case–fatality rate ranges from 10–90%.6

 Active immunization with tetanus toxoid is

universally recommended. Guidelines for initial immunization and booster doses have been published.12

Rabies

Rabies is a disease caused by a rhabdovirus of the genus Lyssavirus. Rabies infection usually occurs through

the introduction of saliva from the bite of a rabid animal. It is also possible, though rare, for infection to

result from direct contact with infectious materials such as saliva, in the eyes, nose, mouth, or a wound.13

Airborne transmission from exposure to infectious aerosols has been reported in a laboratory setting and in

a cave, though this is believed to occur very rarely.2

Initial symptoms include headache, fever, malaise, and sensory changes around the wound. In the latter

stages, paralysis, muscle spasms, delirium and convulsions can occur, followed by death due to respiratory

paralysis. Because there is no treatment for the disease once symptoms appear, prompt administration of post

exposure prophylaxis (PEP) is recommended after exposure to rabies to prevent development of the disease.
Health Hazard Evaluation Report No. 98–0339 Page 11

CDC has recently published guidelines for PEP and recommendations for pre–exposure vaccination for

persons at high risk of exposure, as defined by occupation and level of endemicity in the animal population.14

The CDC guidelines also include recommendations for the immediate cleaning of wounds with soap and

water, irrigation with a virucidal agent such as povidone–iodine solution, and flushing with copious amounts

of water. 

Lyme Disease

In the U.S., Lyme disease is transmitted by deer ticks and western black–legged ticks that are infected with

Borrelia burgdorferi bacteria. It is the most common vector–borne infection in the U.S. The number of

cases of Lyme disease reported annually has increased approximately 25–fold since national surveillance

began in 1982. During 1993–1997, a mean of 12,451 cases were reported annually to CDC.15

Under–reporting of the disease is believed to be significant. Although almost all states have reported cases

of Lyme disease, the majority have come from New England and the mid– and south Atlantic regions.16

Infections generally occur during the late spring and early summer months.

Lyme disease is a multistage, inflammatory illness that affects multiple systems. Stage I normally involves

the development of a “bull’s eye” rash (erythema migrans) around the area of the bite, followed by general

tiredness, fever, headache, stiff neck, muscle aches, and joint pain. If untreated, some persons may later

develop arthritis, neurologic abnormalities, and rarely, cardiac problems (stage II). Late Lyme disease (stage

III) occurs more than four months after disease onset and may include a skin condition referred to as

acrodermatitis chronica atrophicans, chronic arthritis, and chronic neurologic disorders.16 Antibiotics are used

to treat all stages of Lyme disease, with the specific regimen dependent on the stage of the disease being

treated and its manifestations.16

Prevention and control of Lyme disease can be accomplished by avoiding tick–infested habitats, minimizing

skin exposure through the use of adequate protective clothing, and use of appropriate repellants.15

Vaccination for Lyme disease is currently available. The current CDC recommendations take into account

both geographic risk and activities and behaviors relating to tick exposure.15

Psittacosis

Psittacosis is caused by infection with Chlamydia psittaci bacteria. It is a nationally reportable disease in

the U.S. While most cases have resulted from exposure to infected pet birds such as parakeets, parrots,

cockatiels, and macaws, transmission has also been documented from free–ranging birds.17 Infection is

usually acquired by inhaling the organism which has been aerosolized from respiratory secretions or dried

feces of infected birds. It has an incubation period of about 5–14 days, although longer periods have been

reported. The severity of the infection ranges from inapparent illness to systemic illness with severe

pneumonia.17 Symptomatic infection usually begins with a sudden onset of fever, chills, headache, tiredness,

and muscle aches, followed by a dry, nonproductive cough. C. psittaci infection can also result in

endocarditis, myocarditis, and occasionally, neurological complications.18 Antibiotics are used to treat the

disease. Recommendations for controlling human infection from birds have recently been published by the

American Veterinary Medical Association (AVMA).17
Page 12 Health Hazard Evaluation Report No. 98–0339

B Virus

Cercopithecine herpesvirus 1, also known as B virus, is a lifelong infection in at least 70% of captive adult

macaques (monkeys of the Macaca genus),19 but not other primates. The virus may be shed during

intermittent reactivations from saliva, urogenital secretions, and conjunctival fluid.20 Viral shedding may

or may not be accompanied by overt symptoms;20 thus, macaques should always be regarded as potentially

infectious. There are approximately 40 known cases of human B virus infection.21 B virus disease in humans

usually results from macaque bites or scratches, needlestick injuries, or contact with infectious products from

the macaques. However, B virus infection and subsequent death of a primate researcher resulting from

ocular exposure to an undetermined fluid was recently reported.20 One case of person–to–person

transmission has also been reported. Incubation periods may be as short as two days, but more commonly

are two to five weeks. Viral infection in humans rapidly progresses to ascending encephalomyelitis, with

a high case fatality rate.21 Prompt diagnosis and initiation of therapy are crucial in preventing death or

permanent disability in surviving patients.22 Guidelines for preventing B virus infections have been

published and focus on preventing exposure through engineering, administrative and work practice controls,

and use of personal protective equipment.20,21,23

Tuberculosis

Mycobacterium tuberculosis, M. Africanum and M. bovis, etiologic agents of human tuberculosis, are closely

related organisms of the M. tuberculosis complex. While there are many other mycobacterial species that

have been isolated from animals,24 some of which can represent an infection hazard for humans (such as

those in the M. avium complex), they are not discussed further here.

Humans are considered the main reservoir for M. tuberculosis, but there are many animal species that can

become infected, including nonhuman primates, dogs, cats, and elephants.16 Recently, a case of zoonotic TB

infection in a marmoset was reported; the source of the exposure was believed to be a person living in a

house with this companion animal who had been treated for pulmonary TB eight years previously.25 Cattle

are considered the main reservoir of M. bovis infection in mammals, but infection has been found in many

other animals, such as nonhuman primates, deer, elk, seals, elephants, rhinoceroses, lions, cheetah, leopards,

and buffalo.26,27,28,29,30,31,32,33 TB transmission involving M. tuberculosis and M. bovis from infected animals

(seals, rhinoceroses, elk, and elephants) to humans has been reported, although rarely, between zoological

workers and other animal handlers.26,28,30,33 TB transmission was believed to occur via aerosols, such as those

generated from coughing, cleaning of animal areas, slaughtering, and necropsy.

TB infection occurs when a person inhales aerosolized M. tuberculosis (or related species) and the bacteria

become established in the alveoli of the lungs and spread throughout the body. The body’s immune system

is usually able to prevent further multiplication and spread of the bacteria; however, some of the bacilli

remain dormant and viable for many years. At this point, a person will usually have a positive tuberculin

skin test. The dose required to initiate infection is not known. In general, people who become infected with

M. tuberculosis have about a 10% risk for developing active TB during their lifetime.34 This risk is greatest

during the first 2 years after infection. Immunocompromised persons have a greater risk for the progression

of latent TB infection (LTBI) to active TB disease. CDC recommends that persons with LTBI be evaluated

and, if appropriate, prescribed drug therapy to prevent the progression from LTBI to active TB disease.34
Health Hazard Evaluation Report No. 98–0339 Page 13

1. CDC [1999]. Leptospirosis. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_t.htm. U.S.

Department of Health and Human Services, Public Health Service, Centers for Disease Control and

Prevention. December 1999. 

2. Sewell DL [1995]. Laboratory–associated infections and biosafety. Clinical Microbiology Reviews

8:389–405.

3. Fox JG, Lipman NS [1991]. Infections transmitted by large and small laboratory animals. Infectious

Disease Clinics of North America 5:131–163.

4. Wedum AG, Barkley WE, Hellman A [1972]. Handling of infectious agents. J Am Vet Med Assoc

161:1557–1567.

5. Wedum AG and Kruse RH [1969]. Assessment of risk of human infection in the microbiology

laboratory. Misc Pub 30, Industrial Health and Safety Directorate, Fort Detrick, Frederick, MD.

6. Benenson AS, ed. [1995]. Control of communicable diseases manual. 16th ed. Washington, DC:

American Public Health Association, pp. 71–74, 267–270, 275–279, 379–382, 383–390. 459–463.

7. NRC [1997]. Occupational health and safety in the care and use of research animals. National Research

Council. Washington DC: National Academy Press. pp. 81–82. 

8. Raoult D, Marrie T [1995]. State of the Art Clinical Article – Q fever. Clinical Infectious Diseases,

20:489–96.

9. CDC/NIH [1999]. Biosafety in Microbiological and Biomedical Laboratories. U.S. Department of

Health and Human Services, Public Health Service, Centers for Disease Control and Prevention and National

Institutes for Health, 4th Edition, HHS Publication No. (CDC) 93–8395.

10. Kaufmann AF and Wenger JD [1992]. Brucellosis. In: Last JM and Wallace RB, eds. Public health

and preventive medicine. Norwalk, CT: Appleton and Lange, p. 263.

11. Moyer NP and Holcomb LA [1988]. Brucellosis. Chapter 14. In: Balows A and Hausler WJ, eds.

Diagnosis of infectious diseases – principles and practice. Bol. 1. Springer Verlag, p. 143. 

12. CDC [1991]. Diphtheria, tetanus and pertussis: recommendations for vaccine use and other preventive

measures: recommendations of the immunization practices advisory committee (ACIP). U.S. Department of

Health and Human Services, Public Health Service, Centers for Disease Control. Morbidity and Mortality

Weekly Report 40(RR–10):1–28.

13. CDC [2000]. Rabies question & answer. http://www.cdc.gov/ncidod/dvrd/rabies/Ques&Ans/q&a.htm

U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and

Prevention.

14. CDC [1999]. Human rabies prevention – United States, 1999: recommendations of the advisory

committee on immunization practices (ACIP). U.S. Department of Health and Human Services, Public

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48(RR–01):1–21.

15. CDC [1999]. Recommendations for the use of Lyme disease vaccine: recommendations of the advisory

committee on immunization practices (ACIP). U.S. Department of Health and Human Services, Public Health

Service, Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report

48(RR–07):1–17.

16. Weber DJ, Rutala WA [1999]. Zoonotic infections. Occupational Medicine: State of the Art Reviews

14: 247–284.

17. AVMA [2000]. Compendium of measures to control Chlamydia psittaci infection among humans

(Psittacosis) and pet birds (avian chlamydiosis), 2000. http://www.avma.org/pubhlth/psittacosis.htm

18. C D C [ 1 9 9 9 ] . P s i t t a c o s i s T e c h n i c a l I n f o r m a t i o n .

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/psittacosis_t.htm. U.S. Department of Health and Human

Services, Public Health Service, Centers for Disease Control and Prevention.

19. Weigler BJ [1992]. Biology of B virus in macaque and human hosts: a review. Clin Infect Dis

14:555–67.

20. NIOSH [1999]. NIOSH Hazard ID: Cercopithecine herpesvirus 1 (B virus) infection resulting from

ocular exposure. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease

Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication

No.99–100.

21. Holmes GP, Chapman LE, Stewart JA, Straus SR, Hilliard JK, Davenport DS [1995]. Guidelines for

the prevention and treatment of B–virus infections in exposed persons. Clin Infect Dis 20:421–439. 

22. Ostrowski SR, Leslie MJ, Parrott T, Abelt S, Piercy PE [1998]. B–virus from pet macaque monkeys:

an emerging threat in the United States? Emerg Infect Dis [serial online] 1998 Jan-Mar; Vol 4(1). Available

from: URL: http://www.cdc.gov/ncidod/EID/eid.htm. 

23. CDC [1998]. Fatal cercopithecine herpesvirus 1 (B virus) infection following a mucocutaneous

exposure and interim recommendations for worker protection. U.S. Department of Health and Human

Services, Public Health Service, Centers for Disease Control and Prevention. Morbidity and Mortality

Weekly Report 47(49):1073–1076, 1083.

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Med Assoc, May 1;170(9):987–90.

25. Michel AL, Huchzermeyer HF [1998]. The zoonotic importance of Mycobacterium tuberculosis:

transmission from human to monkey. J S Afr Vet Assoc, Jun; 69(2):64–5.

26. Thompson PJ, et al. [1993]. Seals, seal trainers, and mycobacterial infection. Am Rev Respir Dis, Jan;

147(1):164–7.
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27. Stetter MD, et al. [1995]. Epizootic of Mycobacterium bovis in a zoologic park. J Am Vet Med Assoc,

Dec 15;207(12):1618–21.

28. Dalovisio JR, Stetter M, Mikota–Wells S [1992]. Rhinoceros’ rhinorrhea: cause of an outbreak of

infection due to airborne Mycobacterium bovis in zookeepers. Clin Infect Dis Oct; 15(4):598–600.

29. Liss GM, et al. [1994]. Occupational exposure to Mycobacterium bovis infection in deer and elk in

Ontario. Can J Public Health Sep–Oct; 85(5):336–9.

30. Fanning A, Edwards S, Hauer G [1991]. Mycobacterium bovis infection in humans exposed to elk in

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32. Wilson P, Weavers E, West B, Taylor M, Kavanagh J, Jones P [1984]. Mycobacterium bovis infection

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33. Michalak K, Austin C, Diesel S, Bacon MJ, Zimmerman P, Maslow JN [1998]. Mycobacterium

tuberculosis infection as a zoonotic disease: transmission between humans and elephants.

34. CDC [1994]. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health–care

facilities. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease

Control and Prevention. Morbidity and Mortality Weekly Report 43(RR–13).
For Information on Other

Occupational Safety and Health Concerns

Call NIOSH at:

1–800–35–NIOSH (356–4674)

or visit the NIOSH Web site at:

www.cdc.gov/niosh

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