HETA 98-0061-2687

Yerkes Primate Research Center

Lawrenceville, Georgia

Max Kiefer, MS, CIH

Scott Deitchman, MPH, MD

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 of 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 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.

The Hazard Evaluations and Technical Assistance Branch 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 the National Institute for Occupational Safety and Health.

ACKNOWLEDGMENTS AND AVAILABILITY OF REPORT

This report was prepared by Max Kiefer, of the Hazard Evaluations and Technical Assistance Branch,

Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS), and Scott Deitchman, of the

Office of Extramural Programs. Technical assistance was provided by Tom DeMarcus, Louisa Chapman,

and Stephanie Ostrowski of the Centers for Disease Control and Prevention, National Center for Infectious

Diseases, and the CDC and NIOSH Offices of General Counsel. Desktop publishing was performed by Pat

Lovell. Review and preparation for printing was performed by Penny Arthur.

Copies of this report have been sent to employee and management representatives at Yerkes and the OSHA

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

Technical Assistance Report 98-0061-2687

Yerkes Primate Center

Lawrenceville, Georgia

April 1998

Max Kiefer, MS, CIH

Scott Deitchman, MPH, MD

SUMMARY

On December 16, 1997, The National Institute for Occupational Safety and Health (NIOSH) received a request

for technical assistance from the Atlanta East Area Office of the Occupational Safety and Health Administration

(OSHA). The request asked NIOSH to assist OSHA during an investigation of an incident involving an employee

of the Yerkes Regional Primate Research Center (Yerkes PRC) Field Station, in Lawrenceville, Georgia. The

employee contracted Cercopithecine herpesvirus 1 (Herpesvirus simiae, or B virus) from an ocular exposure to

primate body fluids that occurred on October 29, 1997, while working with Rhesus Macaque monkeys at the Field

Station and subsequently died on December 10, 1997. 

On December 12, 1997, an animal technician working at the Yerkes PRC Main Station was splashed in the eye

with an unknown fluid while moving a macaque from a cage to a transfer box. The worker was wearing a

combination surgical mask/face shield at the time of the exposure. The employee reported the incident 14 days

later after her eye became bloodshot and began to hurt. She was subsequently evaluated for B virus infection, but

no evidence of infection was found. 

On December 17, 1997, a NIOSH investigator accompanied OSHA compliance officers during their program

review investigation at the Yerkes PRC Field Station. During this site visit, NIOSH conducted a limited review

of policies and procedures pertaining to working with nonhuman primates (NHP) and B virus, discussed training

and work practices with the Yerkes PRC Associate Director for Scientific Programs, and inspected specific areas

of the facility where NHPs are handled and captured. On February 11-12, 1998, NIOSH and NCID investigators

conducted a site visit to the University of California at Davis Regional Primate Center to learn about the relevant

practices and policies at other primate facilities.

Follow-up site visits to the Yerkes PRC Field and Main station were not conducted because Emory University

(which operates the Yerkes PRC) declined to allow NIOSH investigators access to their facility, records, and

personnel. Additional information necessary to complete the NIOSH investigation was obtained by reviewing

information obtained from OSHA compliance officers. 

A review of Yerkes PRC animal handling procedures and health and safety guidelines provided to NIOSH indicate

that the policy on eye protection was not clear. Some Yerkes PRC policies require eye protection for all personnel

in direct contact with animals or animal wastes, while others specify tasks requiring eye protection, or include no

eye protection requirement. A consistent program to ensure that exposures (e.g., mucosal membrane contact with
iv

primate body fluids) are systematically recorded, tracked, and investigated did not appear to have been

implemented at the time of the fatal exposure.

Existing Emory-wide safety and health training programs may not provide sufficient specific information to

employees that addresses the unique safety and health concerns associated with NHPs in general and B virus

specifically. The apparent contradictions in policies and unclear definition of when they apply likely resulted in

inconsistent application of precautions. 

Actions taken after the exposure were not consistent with the 1995 B virus working group guidelines for workers

handling NHPs potentially infected with B virus. After the exposure, immediate irrigation of the eyes and

consultation with medical personnel knowledgeable about the hazards of B virus and the symptoms of B virus

infection did not occur. Although knowledgeable medical personnel had been previously identified by Yerkes

PRC, the need to consult or notify these medical experts for occurrences of ocular exposures to primate body fluids

had not been effectively communicated to all personnel. As a result, there were delays between the exposure and

the employee’s first time seeking medical care.

This incident is the first report of B virus infection and death resulting from an ocular exposure to macaque

body fluids. The employee was not wearing protective eye wear at the time of the exposure because the

activities conducted were considered to carry a low risk of exposure to B virus-containing body fluids.

As such, precautions regarding eye protection were not emphasized or enforced despite published

information indicating that mucous membrane exposure was a potential route of infection. Treatment

immediately after the exposure, and subsequent follow-up, were not consistent with existing B virus safety

guidelines.

The death of this worker from B virus contracted from an ocular splash exposure to nonhuman primate

body fluid, and the subsequent ocular exposure at the PRC Main Station despite the use of a face shield,

indicate that protective eye wear conforming to established standards for eye and splash protection should

be part of the protective equipment ensemble worn by all personnel who come in contact with nonhuman

primates.

Keywords: SIC 8733 (Noncommercial Research Organizations). Nonhuman primate, rhesus macaque, herpes B

virus, Cercopithecine herpesvirus 1, Herpesvirus simiae, infection, ocular exposure.
TABLE OF CONTENTS

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

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

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Introduction ......................................................................... 2

Background ......................................................................... 2

Yerkes Regional Primate Research Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Yerkes Field Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Yerkes PRC Main Station . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

B Virus Exposure at Yerkes .......................................................... 3

Methods ........................................................................... 4

Evaluation Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Cercopithecine herpesvirus 1 (B virus) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Prevention of B virus and Other Zoonotic Infections When Working with Nonhuman Primates ....... 5

Health and Safety in Animal Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

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

Protective Eyewear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Employee Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Policies and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Safety and Health Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Facility Inspection ................................................................. 9

Post Exposure Actions ............................................................. 9

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Page 2 Health Hazard Evaluation Report No. 98-0061

INTRODUCTION

On December 16, 1997, the National Institute for

Occupational Safety and Health (NIOSH) received a

request from the Atlanta East Area Office of the

Occupational Safety and Health Administration

(OSHA) for technical assistance during the

investigation of a worker fatality at the Yerkes

Regional Primate Research Center (PRC) Field

Station in Lawrenceville, Georgia. The worker had

sustained a splash to the eye of body fluid from an

unidentified monkey on October 29, 1997, while

participating in a group capture of Rhesus Macaque

monkeys, and was subsequently infected with

Cercopithecine herpesvirus 1 (Herpesvirus simiae,

or B virus). B virus is endemic in the macaque

species. The worker, who was not wearing eye

protection at the time of the exposure, died as a result

of this infection on December 10, 1997. On

December 12, 1997, an animal technician at the

Yerkes PRC main station at Emory University was

splashed in the eye during the transfer of a monkey;

the incident was reported on December 26. The

employee was wearing a combination surgical

mask/face shield at the time of the incident. This

worker did not become infected with B virus. The

Yerkes PRC is administered by Emory University. 

On December 17, 1997, a NIOSH investigator

accompanied OSHA compliance officers during a

site visit to the Yerkes PRC Field Station. During

the site visit, information about the activities of the

worker who died was obtained from Yerkes PRC

personnel, a limited review of existing procedures

was conducted, and the area where the exposure

occurred was inspected. Emory University declined

to allow NIOSH to conduct additional data gathering

activities (interview workers, obtain copies of

procedures, observe work practices) at the Yerkes

PRC during this site visit. Emory also declined to

allow NIOSH to conduct additional site visits.

On February 11-12, 1998, NIOSH investigators and

a representative from the Centers for Disease Control

and Prevention, National Center for Infectious

Diseases (CDC-NCID), Division of Quarantine,

visited a Regional Primate Center funded by the

National Institutes of Health (NIH) and operated by

the University of California at Davis. The purpose of

this site visit was to learn about the relevant practices

and policies at other primate facilities.

BACKGROUND

Yerkes Regional Primate

Research Center

The Yerkes Regional Primate Research Center

(PRC) is part of a national network of seven primate

centers funded by the National Institutes of Health

(NIH); it is administered by the Emory University

Woodruff Health Sciences Center, Atlanta, Georgia.

There are two Yerkes PRC facilities: the Main

Station, located on the Emory Campus, and the Field

Station, located in Lawrenceville, Georgia. The

Yerkes PRC was accredited by the American

Association for the Accreditation of Laboratory

Animal Care (AAALAC) in 1985. AAALAC

accreditation indicates the facility adheres to the

highest standards of animal care. The Institutional

Animal Care and Use Committee (IACUC), required

by the United States Department of Agriculture

(USDA) for all institutions performing animal

research, approves research protocols and inspects

the facility. Health and Safety Support for the

Yerkes PRC is provided by the Emory University

Environmental Health and Safety Office.

Yerkes Field Station

The Yerkes PRC Field Station was established in

1965 and is located on 117 acres of wooded and

open land. Approximately 35-40 full-time

employees work at the Field Station, including four

veterinarians. The mission of the Field station is to

provide a facility for breeding and study of large

social living groups of nonhuman primates (NHP).

A primary function of the Field Station is to provide

a domestic supply of NHPs, and this facility allows

the primate center to be self-sufficient in its primate

resources. Only behavior-related research is
Health Hazard Evaluation Report No. 98-0061 Page 3

conducted at the Field Station, including studies of

social organization, aggression, social dominance,

maternal-infant relationships, and reproductive

behavior. No infectious disease studies are

conducted at the Field Station. 

Approximately 1800 NHPs are housed at the Field

Station, including 3 great ape species, 1 lesser ape

species, and 5 monkey species. There are about

600 rhesus macaques, 250 pigtail macaques, and

30 stumptail macaques at the Field Station. All of

these animals were born and raised at the Field

Station. The facilities at the Field Station are

designed for housing and socializing, and consist of

25 outdoor compounds, the largest of which are

about 15,600 ft2

 in size, where the colonies live. A

typical macaque colony will consist of 80-

100 animals. Each compound is surrounded by a

10 ft high chain link fence, with an additional solid

wall extending upward approximately 10 ft above

that, to prevent the animals from escaping. In

addition to the animal compounds, the Field Station

also has an administrative and data processing office,

a veterinary hospital, isolation and quarantine

facilities, food preparation and storage facilities, and

a cage washing facility.

Adjacent to every compound are indoor corridors

that are accessible to the NHPs. These corridors are

climate conditioned and serve to provide shelter and,

because the animals are nocturnal prey species, a

night sleeping area. The corridors also serve as a

capture and handling facility. 

Yerkes PRC Main Station

The Yerkes PRC Main Station is located

approximately 5 miles from downtown Atlanta on

25 acres on the Emory University campus.

Approximately 120 employees work at the Main

Station. The Main Station consists of administrative

offices, research laboratories, and medical support

for research activities. Approximately

1100 monkeys and 160 great apes are housed at the

Main Station.

B Virus Exposure at Yerkes

On October 29, 1997, a 22 year old female

researcher at the Yerkes PRC Field Station was

assisting with a routine group capture of rhesus

macaques in compound A-4. Personnel conducting

the capture wore uniforms, disposable latex gloves,

and surgical masks. Eye protection was not required

by Yerkes PRC for this activity, and employees

participating in this capture did not wear eye

protection. During the transfer of a macaque from a

transfer (or capture) cage into a squeeze cage, the

worker sustained a splash to the right eye. The

worker reported the onset of a foreign body sensation

in her eye as she looked down at the caged macaque.

The worker suspected the substance that entered her

eye was monkey feces, although this could not be

confirmed. The worker wiped the exposed eye and,

approximately 45 minutes later, flushed the eye with

tap water for two to three minutes. The incident was

not formally reported, and there was no medical

consultation at the time of the exposure. The cage

had been used to transport many monkeys that day

and the monkey in the cage at the time of exposure

was returned to a larger group and was not identified.

The researcher subsequently developed a B virus

infection and died from associated complications on

December 10, 1997.

Compound A-4 is one of the largest (15,600 ft2

)

compounds at the Field Station and houses

approximately 90 adult and 15-20 young macaques.

In addition to the worker who sustained the eye

splash, 4 other persons (including a veterinarian)

participated in the capture, which was conducted

over a period of two days. The purpose of the

capture was to conduct routine health examinations

and tuberculosis tests on all animals. 

According to a Yerkes PRC representative, the

procedures for conducting a group capture of

macaques at the Field Station have been well

established and in place for approximately 25 years.

When an animal handler enters the compound, the

macaques are conditioned to enter the indoor

corridor through small doors (approximately 2ft x

2ft) leading into an area that has been sectioned off
Page 4 Health Hazard Evaluation Report No. 98-0061

by a floor-to-ceiling chain link fence. When the

animals are inside the corridor, a transfer cage is

placed by a floor level guillotine door in the chain

link fence. When the doors are opened, the animal

exits the chain link compound into the transfer cage.

The animals are individually captured and identified

by tattoos. After capture, the transfer cage is hand

carried to a squeeze cage mounted on a table 3-4 feet

above the floor. The transfer cage is married to the

squeeze cage, and the animal exits into the squeeze

cage for the health examination. After the

examination, the process is reversed and the animals

exit into the compound. The animals are not sedated

during this activity.

On December 12, 1997, an animal technician

working at the Yerkes PRC Main Station was

moving a monkey from a cage to a transfer box when

she was splashed in the eye with an unknown fluid.

At the time of the incident, the employee was

wearing a combination surgical mask/face shield.

The technician reported the incident on December

26, 1997, after her eye became bloodshot and began

to hurt. Follow-up tests reportedly did not indicate a

B virus infection. Specific medical information was

not available to the NIOSH investigators.

METHODS

On December 17, 1997, a NIOSH investigator

accompanied OSHA during a visit to the Yerkes

PRC Field Station. During this site visit, descriptive

information about the Yerkes PRC Field Station was

obtained, and procedures for handling NHPs, B virus

specific precautions, and employee safety training

were discussed with Yerkes PRC officials. A limited

review of procedures and policies was conducted.

The facility where the exposure resulting in the B

virus infection occurred was inspected, and

procedures for conducting group captures of

macaques were reviewed with the Yerkes PRC

Associate Director. Emory University declined to

allow NIOSH to participate in employee interviews,

obtain copies of pertinent procedures and policies, or

observe a live group capture during this visit.

Following the initial site visit, a meeting was held on

January 7, 1998, with scientists from the Centers for

Disease Control and Prevention (CDC) National

Center for Infectious Disease (NCID) and the CDC

Office of Health and Safety (OHS), and OSHA Area

and Regional Office representatives. The purpose of

this meeting was to review both incidents, identify

information still needed, and determine what

revisions to existing guidelines might be necessary

given the recent Yerkes PRC exposure(s). 

On February 11-12, 1998, NIOSH investigators and

a representative from the CDC-NCID, Division of

Quarantine, visited an NIH-funded Regional Primate

Center operated by the University of California at

Davis. The purpose of this site visit was to learn

about the relevant practices and policies at other

primate facilities. At the request of the CDC visitors,

the staff reviewed existing policies and procedures

for handling macaques at these facilities, and in

particular those associated with captures and those

intended to protect worker from exposure to B virus

and other zoonoses. The physical facility where the

monkeys are housed and captured was inspected.

The employee training program, and provisions for

providing medical support for suspected exposures,

were also reviewed.

Subsequent visits to the Yerkes PRC Field and Main

station were not conducted because Emory declined

to allow NIOSH investigators access to their

facilities, records, or personnel. Additional

information necessary to complete the NIOSH

investigation was obtained by reviewing information

obtained from OSHA compliance officers. 

EVALUATION CRITERIA

General

When assessing workplace conditions where

environmental evaluation criteria has not been

developed or is not applicable, NIOSH field staff

may utilize guidelines and recommendations

developed by public health agencies or professional

associations, accepted industry practice, or criteria
Health Hazard Evaluation Report No. 98-0061 Page 5

for safe work practices published by standard setting

organizations. In some situations, workplace

evaluations and recommendations may be based on

“state of the art” industrial hygiene and occupational

medicine concepts, principles, and practices, or by

analogy to other industrial settings. Note that

evaluation criteria may change over the years as new

information on the toxic effects of an agent, efficacy

of control systems, or safe work practices become

available.

Cercopithecine herpesvirus 1

(B virus)

Cercopithecine herpesvirus 1, also known as B virus

or Herpesvirus simiae, is a member of the herpes

group of viruses. B virus frequently infects Old

World primates of the genus Macaca, including those

used in research such as rhesus, Japanese,

cynomologus, pig-tailed, and stump-tailed macaques.

B virus infection in captive adult macaque

populations apparently is quite common, as the

seroprevalence of neutralizing antibodies to B-virus

is 73% to 100%.1

 Like Herpes simplex virus

infection in humans, B-virus infection in monkeys is

characterized by lifelong infection with intermittent

reactivation and shedding of the virus in saliva or

genital secretions, particularly during periods of

stress or immunosuppression.2

 B virus infection is

transmitted among monkeys primarily through

sexual activity or bites. Antibody titer to B virus

indicates infection in the animal but can neither

confirm nor rule out actual viral shedding at the time

a human is exposed through a bite or other

exposure.2

There are approximately 40 known cases of human

B virus infection.2

 B-virus disease in humans

usually results from macaque bites or scratches,

contaminated needle sticks, or contact with

infectious products from the macaques. Incubation

periods may be as short as 2 days, but more

commonly are 2 to 5 weeks. Most documented

infections have occurred among biomedical research

employees who had occupational exposure to

macaques, although laboratory workers handling

only infected central nervous system or primary

monkey kidney cell lines have been exposed and, in

at least one instance, infected.3

 One case of personto-person transmission has been reported. The

source case was a monkey handler who apparently

became infected through a bite or scratch; his wife,

who applied hydrocortisone cream to his wound

before his infection with B virus was recognized,

was apparently infected while applying the same

cream to a rash on one of her own fingers.4

Prevention of B virus and

Other Zoonotic Infections

When Working with

Nonhuman Primates 

The occurrence of four cases of B virus infection in

1987 in Pensacola, Florida, resulted in the

development of guidelines for preventing B virus

infections in monkey handlers.5,6 These guidelines,

published by the CDC, provide specific information

and recommendations regarding the handling of

macaques, including personal protective equipment

such as gloves and eye protection.6

 In 1990, a group

of experts (B virus Working Group) was convened

by the Robert W. Woodruff Health Sciences Center

of Emory University and the CDC to develop

guidelines for the detection and medical management

of B virus infection in humans.2

 The

recommendations from this effort were published in

1995.2

 

Item 3 of the CDC guidelines recommends that “all

macaque monkeys not known to be free of B virus

infection should be regarded as infected.” Item 4 of

these guidelines recommends that macaque handlers

be protected with a “face shield (or surgical mask

and goggles or glasses) to prevent exposure of eyes

and mucous membranes to macaque secretions.”

Both the CDC and B virus Working Group

guidelines also recommend that primate facilities

identify a local physician, or group of physicians,

knowledgeable about the infectious risks of exposure

to nonhuman primates to serve on an on-call basis in

the event of an exposure.2,6
Page 6 Health Hazard Evaluation Report No. 98-0061

In addition to B virus specific recommendations,

guidelines addressing safety precautions for working

with NHPs to prevent worker infection with NHPborne viruses, tuberculosis, and other agents have

been developed by the CDC.7,8,9,10 Criteria for eye

protection and information regarding eye and

mucosal contact as potential routes of exposure are

addressed in several of these published guidelines.

A worker protection checklist developed in June

1990, to comply with CDC Special Permit

Requirements for NHPs provides a description of the

necessary elements of a program for infectionprevention, worker communication, worker training,

and medical surveillance.10 This guideline, provided

to all NHP importers, specifies that a written

infection control plan should stipulate that workers

entering NHP rooms with potential exposures wear

appropriate protective clothing, including face

shields or other eye protection. In July 1993, CDC

published interim guidelines for NHPs during

quarantine.7

 These guidelines recommend that

because of the potential for aerosol transmission of

certain pathogenic bacteria and viruses, face shields

or eye protection should be worn by workers whose

faces may come within 5 feet of the NHPs.7

Health and Safety in Animal

Research

Although specific regulatory criteria have not been

established, guidelines and recommendations for

occupational safety and health programs associated

with the care and use of research animals are

available from a number of sources. The National

Research Council has published a report prepared by

the Committee on Occupational Safety and Health in

Research Animal Facilities, under the auspices of the

Institute of Laboratory Animal Resources.11 This

report provides recommendations for implementing

a safety and health program in animal research

facilities, includes information about B virus and

NHPs, and recommends that personnel working with

NHPs wear face shields and other protective

garments.11 The report also recommends that sharp

edges on cages and ancillary equipment should be

identified and eliminated.

Criteria for activities involving infectious disease

work with experimental animals is described in a

joint CDC-National Institutes of Health publication,

Biosafety in Microbiological and Biomedical

Laboratories (BMBL).12 Recommendations in this

guide include four combinations of work practices,

safety equipment, and facilities, that are based on the

hazard presented by the infectious agent under study.

The four animal biosafety levels (ABSL 1-4)

described in this document provide for increasing

protections, based on the level assigned.12

According to the BMBL, Biosafety Level 2

practices are recommended for tasks entailing the

manipulation of tissues, body fluids, or primary

tissue culture materials from macaques. More

stringent Biosafety Level 3 practices are

recommended when the use or manipulation of

material known to contain B virus is conducted.

Biosafety Level 4 criteria applies to the propagation

and manipulation of production quantities of the

virus.12

Most of the regulatory effort and recommendations

regarding laboratory animal research address the

care and well-being of the animals and research

protocols.11 Regulatory or research funding agencies

(USDA, NIH) may not include detailed occupational

safety and health criteria as part of their oversight

activities.

Personal Protective

Equipment

Protective clothing and equipment is designed to

shield or isolate individuals from the chemical,

physical, or biological hazards that may be

encountered during their work.13 Personal protective

equipment (PPE) is generally considered the last line

of defense, and is utilized after every effort to

eliminate the hazard through feasible engineering or

administrative controls has been implemented. PPE

places the burden of protection on the employee, and

if the equipment fails, exposure could occur. PPE

can be an effective control technique for

occupational hazards; however, PPE effectiveness

depends on proper use by the wearer.14 PPE is also
Health Hazard Evaluation Report No. 98-0061 Page 7

appropriate in some situations as a backup in the

event of an engineering control failure or for jobs of

short duration. Selection of PPE appropriate for a

given task should be made from assessments of the

worksite hazards, which includes an evaluation of

each activity. Hazard assessments require a good

understanding of the work tasks, knowledge of the

potential routes of exposure, the opportunities for

exposure in the task assessed (nature and extent of

worker contact), and the potential for adverse health

outcomes if exposure were to occur. Accident and

incident reports should be reviewed to identify those

injuries or exposure incidents (whether or not

infection occurred) that could have been prevented

by the proper use of PPE. Most approaches for

selecting the appropriate PPE incorporate the

following process:14

1. Determination of the hazards most likely to

occur

2. Assessment of the adverse effects of unprotected

exposure

3. Identifying other control options that can be

used instead of protective clothing

4. Determining the performance characteristics

needed for protection

5. Evaluating the need for decontamination

6. Assessing any constraints that may hinder the

use of PPE (ergonomics, safety, vision, dexterity)

Once it is determined that PPE is required for a task,

its use should be mandatory. PPE should be

individually assigned whenever possible. Written

procedures should be in-place to ensure consistent

selection and use of PPE. Affected users must be

informed of the need for PPE, consequences of not

wearing the appropriate PPE, and how to properly

inspect, wear, maintain, and store the PPE. Users

must also be informed of all limitations associated

with the use of PPE and must be aware that the

equipment does not eliminate the hazard. Finally,

periodic inspections and evaluations of the PPE

program should be conducted to ensure that

procedures are consistently followed, to identify any

process changes that may have occurred, and that the

selected PPE is still appropriate for the given task.

Protective Eyewear

There is a wide variety in the types of protective

eyewear, and appropriate selection should be based

on a number of factors, the most important of which

is the nature and extent of the hazard. For example,

protection against eye impact hazards generated

during chipping, grinding, or masonry work may

dictate a specific type of protection. For splash

hazards, goggles and face shields should be used.

Face shields are considered a secondary protector

and are only designed to provide limited protection

to the face and front part of the neck.15 Face shields

should always be used with suitable primary eye

protection such as safety glasses or goggles. Most

protective goggles and eyewear are available with an

anti-fog lens option to prevent clouding in humid

environments. Lens cleaning supplies and anti-fog

materials should be available for employee use. Eye

protection must be comfortable, allow for sufficient

peripheral vision, and be adjustable to ensure a

secure fit. It may be necessary to provide several

different types, styles, and sizes. Protective eyewear

should meet or exceed the criteria established by the

American National Standard Institute (ANSI)

Standard Practice for Occupational and Educational

Eye and Face Protection (ANSI Z87.1-1989).15 

FINDINGS

Yerkes representatives indicated that prior to the B

virus death that occurred on December 10, 1997,

personal protective equipment required for

conducting routine captures of NHPs included a

complete uniform, disposable gloves, and a surgical

mask. A “dual-focus” approach was utilized because

of the concern that workers may carry infections that

could harm the animals; thus, for example, surgical

masks served to protect the animals from possible

respiratory infections of the personnel. In the event

that handling of the animal was required, heavy

gloves were worn.

Yerkes PRC representatives indicated that eye

protection was not required for group captures

because the risks were considered to be low, the
Page 8 Health Hazard Evaluation Report No. 98-0061

humid environment created eye wear fogging

problems, and there was concern that eye protection

may impair vision and create animal handling

difficulties. Yerkes PRC representatives indicated

that many of the policies and procedures at the other

six regional primate centers were the same.

Although a comprehensive review of eye-protection

policies and B virus precautions at all primate centers

was not conducted, discussions with representatives

at two other regional primate centers suggest that eye

protection during the capture and transport of NHPs

in other centers may not have been routinely required

until the death of the Yerkes PRC employee.

Information about this incident was apparently

widely circulated throughout the primate research

industry and increased awareness of the risk of

infection from this route of exposure.

Employee Training

Training and safety requirements for Yerkes

personnel were developed using a “universal

precautions” approach, which presumes that all

macaques are infected with B virus. According to

Yerkes PRC representatives, employees receive

4-5 levels of training. At the pre-employment stage,

personnel are made aware of the risks associated

with working with NHPs, including B virus. During

orientation, Yerkes PRC employees are shown a

biosafety video, which includes a discussion of B

virus. A review of the orientation slide narratives

shows that standard operating procedures (SOPs)

regarding safety and health when working with

NHPs are discussed. This orientation also includes

a section on personal protective clothing

requirements for anyone who has contact with

animals. The orientation narrative states that eye

protection is required if an aerosol is created or when

working with bodily fluids. Prior to commencement

of employment, workers are required to sign a form

indicating that they have received information on a

Yerkes PRC policies and procedures, including B

virus precautions. Employees are also required to

sign a “Release and Assumption of Risk for

Participation in Research Programs” form

acknowledging awareness of the risks of working

with laboratory animals.

Additional employee training includes sections on

animal welfare and biosafety, in addition to on-thejob training. Periodically, Emory safety and health

personnel provide seminars on various safety and

health topics to Yerkes PRC employees.

Policies and Procedures

Several of the Yerkes PRC written policies and

procedures that were available for review contained

information and precautions regarding B virus and

NHP safety. In September 1996, the Center

distributed a one-page “Guidelines for Working in

Animal Areas” signed by the Yerkes PRC Director

and the Associate Director for Research Resources.

This directive states that “all personnel in direct

contact with animals or animal waste, and in

situations where aerosols may be created will... wear

proper eye protection (safety glasses, goggles, or face

shield).” Although “direct contact” is not defined,

this appears to conflict with the policy of not

requiring eye protection when conducting captures.

Yerkes PRC has developed written procedures for

management of bites or scratches. These procedures

include wound treatment, isolation of the animal, and

drawing blood to determine the animal’s B virus

status. These procedures call for reporting any injury

that breaks the skin, identifying the animal in the

event of a bite or scratch, immediate cleansing of the

wound, and referral to a physician. The procedures

indicate that medical personnel with expertise in B

virus should be consulted to determine the need for

further treatment.

Safety and Health Program

Emory University safety and health staff support the

Yerkes PRC, and Yerkes PRC personnel are

included in existing campus-wide safety and health

programs and training. According to Emory

representatives, walk-through inspections of the

primate center are conducted annually, and refresher

training is provided on an as-needed basis. The

content of these walk-through inspections was not

provided to NIOSH. At the time of the NIOSH
Health Hazard Evaluation Report No. 98-0061 Page 9

investigation, no safety and health personnel were

specifically assigned to provide support solely to the

PRC. An internal Emory safety and health

committee has been established, which includes a

Yerkes PRC Field Station representative. One

memorandum from the Yerkes PRC Employee

Health and Safety Committee was available for

review. This May 23, 1997, document included a

reminder to all personnel to use universal precautions

when handling all animal or human specimens. No

other meeting minutes or reports from this safety

committee were available for review.

A review of the Emory incident logs for

1997 showed that out of a total of 86 reported

incidents (combined Field and Main Station),

20 (23%) were categorized as “eye exposures.”

Eight (9%) needle sticks, 20 (23%) scratches, cuts,

lacerations, and 11 (13%) monkey bites were

reported in this same time period. Details regarding

the circumstances associated with these eye

exposures, or whether Emory investigated these

incidents and implemented changes (procedural,

engineering control, training, strengthened eye

protection requirements) to prevent recurrence were

not available. No information was provided to allow

NIOSH to determine whether Yerkes PRC conducts

systematic hazard assessments or detailed job safety

analyses to assess risks and determine appropriate

precautions for the various tasks at the primate

center.

Facility Inspection

Emory officials declined to allow NIOSH

investigators access to the Yerkes PRC Field and

Main Station after the initial site visit on December

17, 1997. As such, only limited information

regarding the facility, work practices, etc., was

gathered. Information on protective equipment

availability at various work stations, access to

emergency eyewash stations, or signage describing

the required safety precautions, etc. was not

obtained. 

A transfer cage reportedly similar to the one used

during the exposure incident on October 29, 1997,

was briefly examined on December 17, 1997. This

transfer cage was approximately 2 ft x 1 ft x 1 ft, and

constructed of metal. The top and bottom of the cage

were solid, with a guillotine-style door at the front.

Numerous holes, about 0.5" in diameter covered the

sides of the transfer cage.

Post Exposure Actions

Following the death of the infected employee on

December 10, 1997, the Yerkes PRC Associate

Director for Research Resources issued an internal

memorandum on December 12, 1997, to all

employees reiterating the statement noted in the

September 1996 directive: “when in direct contact

with nonhuman primates or animal waste, or in

situations where aerosols or droplet splashes may be

created, appropriate eye protection is required

(safety glasses, goggles, or face shield).”

Additionally, each employee was provided a

laminated card with B virus exposure information to

give to a health care provider if medical attention

was necessary. However, specific eye wear designed

for splash protection was not specified or required

after the incident. For example, the technician who

experienced the second eye exposure to primate body

fluids that occurred on December 12 at the Yerkes

PRC Main Station was wearing a combination

surgical mask/face shield at the time of the exposure.

Although she was wearing this combination mask,

she sustained the exposure in the right eye while

moving a monkey from a cage into a transfer cage.

As previously noted, face shields are considered

secondary protectors and are not appropriate for

primary splash protection.

DISCUSSION

Although the risk of acquiring a B virus infection via

a mucosal exposure to primate body fluids has been

acknowledged and addressed in published

guidelines, prior to this incident a B virus infection

resulting from an ocular exposure had never been

reported. As such, it is likely that exposed workers

considered the risk of acquiring an infection from

this route of exposure to be remote. Investigators
Page 10 Health Hazard Evaluation Report No. 98-0061

reporting a 1987 outbreak of four cases of B virus

infection among primate handlers in Pensacola,

Florida, concluded that because of the time between

human infections (at that time it had been 14 years

since the previous reported case) many persons who

worked with monkeys tended to take fewer

precautions.4

 The investigators further concluded

that existing guidelines may have been increasingly

disregarded because the perceived risks were small

and the protective clothing was cumbersome.4

Maintaining vigilance and avoiding complacency to

ensure that precautions and established guidelines

are fully met when dealing with a rare outcome

requires significant commitment on the part of

management. This is especially true if the safety

requirements represent a real or perceived burden.

There is evidence suggesting that eye exposures to

NHP body fluids are not uncommon occurrences. A

review of injury records for 1988-1993 at a regional

primate research center found that of the 17 reported

mucous membrane exposures to primate body fluids

(blood, urine), 16 (94%) involved the eye.16 A

questionnaire survey at two regional primate research

centers reported in this same study found that 50% of

the mucous membrane exposures went unreported.

The investigators concluded that increased training

and expansion of existing policies requiring routine

use of eye protection could reduce these exposures.16

The Yerkes PRC orientation and policy materials on

occupational health and safety provided inconsistent

direction regarding specific activities requiring eye

protection and the specific types of splash protection

necessary. Some of the Yerkes PRC policies

indicate that eye protection is required for all

personnel in direct contact with animals or animal

wastes. For example, the Yerkes PRC orientation

narrative describes a requirement to utilize universal

precautions when working with animals, and the

September 1996 Yerkes PRC “Guidelines for

Working in Animal Areas” includes cautions that

nonhuman primate body fluids should be considered

infectious. Other documents (Appendix 20, Yerkes

PRC Policy) specify that “procedures resulting in

aerosol production (spraying cages, dental work, or

opening the skull)” should be done with a face shield

or goggles. One reviewed document (Yerkes PRC

Standards for Working with Nonhuman Primates)

does not address eye protection, although other types

of personal protective clothing is described. Despite

cautions in the Yerkes PRC training and published

guidelines that mucous membrane contact was a

potential route of exposure for infection, Yerkes

PRC representatives indicated that conducting a

group capture and health examination of monkeys

was not an activity requiring the use of eye

protection.

It does not appear that Yerkes PRC has a consistent

program to ensure that exposures (e.g., mucosal

membrane contact with primate body fluids) are

systematically recorded, tracked, and investigated.

Thorough investigations of all incidents, including

“near misses,” are necessary to ensure that

appropriate actions are taken to prevent future

occurrences. Simply tracking incidents without

adequate follow-up is insufficient. Twenty eye

exposures were reported in 1997, which suggests that

a problem exists regarding eye protection. Details

about these incidents were not made available to

NIOSH, so the extent of investigations, if any, is not

known.

Existing Emory-wide safety and health training

programs may not provide employees with sufficient

specific information that addresses the unique safety

and health concerns associated with NHPs in general

and B virus in particular. The apparent

contradictions in policies and unclear definition of

when they apply likely resulted in confusion about

which tasks required eye protection.

Actions taken after the exposure were not consistent

with the 1995 B virus working group guidelines for

workers handling NHPs potentially infected with B

virus. After the exposure, immediate irrigation of the

eyes and consultation with medical personnel

knowledgeable about the hazards of B virus and the

symptoms of B virus infection did not occur.

Although knowledgeable medical personnel had

been previously identified by Yerkes PRC, the need

to consult or notify these medical experts for

occurrences of ocular exposures to primate body
Health Hazard Evaluation Report No. 98-0061 Page 11

fluids had not been effectively communicated to all

personnel. As a result, there were delays between

the exposure and the employee’s first time seeking

medical care.

Initial medical evaluations, which did not occur until

after the exposed worker developed symptoms, did

not result in a diagnosis of, and treatment for, B virus

infection. The physician conducting the initial

examination in the emergency room specifically

looked for dendritic lesions characteristic of ocular

Herpes simplex and Varicella zoster infections and

did not demonstrate them. Although a previous

report describes a dendritic corneal lesion associated

with a fatal B virus infection, the present case

indicates that the absence of a dendritic lesion can

not reliably rule out B virus infection as a cause of

conjunctivitis after a possible ocular exposure.17

The diagnosis of rare infections is often delayed,

especially when there are no unusual signs or

symptoms. However, the likelihood of early

recognition and appropriate intervention can be

maximized if animal facilities identify a local

medical consultant who is or can become

knowledgeable about B virus infection, symptoms,

and treatment. Animal handlers should be instructed

to immediately and throughly cleanse all bites,

scratches, and/or exposures of mucosal surfaces or

abraded skin to macaque biologic materials, and to

report these immediately. 

CONCLUSIONS

This is the first reported case of B virus infection

resulting from an ocular exposure to macaque body

fluids. Although the true risk of infection from

exposure to NHP body fluids is not known, the

report of a second exposure at another station of the

same facility within months and other reviews of

injuries among workers exposed to nonhuman

primates suggest that mucocutaneous exposure to

nonhuman primate body fluids may be more

common than appreciated among exposed

workers.16,18

The employee was not wearing protective eye wear

at the time of her exposure. Yerkes PRC

management did not require eye protection while

transporting caged macaques or conducting routine

group captures, although the Yerkes PRC written

guidelines were inconsistent on this issue.

Precautions regarding eye protection were not

emphasized or not enforced despite information

indicating that mucous membrane exposure was a

potential route of infection. The death of this worker

from an ocular exposure to B virus and the

subsequent ocular exposure at the Main Station

despite the use of a face shield indicate that

protective eye wear that conforms to established

standards for eye and splash protection should be

part of the protective equipment ensemble worn by

all personnel who come in contact with nonhuman

primates. 

Opportunities for early intervention were missed.

The B virus Working Group Guidelines recommend

flushing the eye with water for 15 minutes

immediately after an exposure, but among Yerkes

PRC staff an eye splash without additional injury

was apparently not recognized as an exposure posing

a risk of infection. As a result, cleansing did not

occur at the time of exposure.

RECOMMENDATIONS

Recommendations are provided to improve health

and safety practices when working with NHPs.

Although some of these recommendations

specifically apply to the Yerkes PRC facility, many

are applicable to all NHP facilities and activities.

1. Develop a comprehensive personal protective

equipment (PPE) program. The program should

include specific details regarding tasks and areas

where PPE is required so there is no room for

misinterpretation. Proper eye protection should be

part of the mandatory PPE ensemble when working

with NHPs, including entering animal areas. The

elements of a PPE program include:
Page 12 Health Hazard Evaluation Report No. 98-0061

- Written procedures and assigned responsibility

for the program

- Defining the necessary PPE and ensuring it is

properly and consistently selected, used, and

maintained

 - PPE should be obtained and individually

assigned

- Inspection and Maintenance. PPE should be

inspected before and after each use, cleaned

prior to removal, and discarded frequently.

After cleaning, PPE should be stored properly. 

- Employee training

- Periodic assessments of the effectiveness of the

PPE program.

Protective eyewear should meet or exceed the

criteria established by the American National

Standard Institute (ANSI).15

For splash hazards, goggles and face shields

should be used. Face shields are considered to be

secondary protectors and are only designed to

provide limited protection to the face and front part

of the neck. Face shields should always be worn

with suitable eye protection such as safety glasses or

goggles.

2. Conduct a comprehensive review of all policies

and procedures and ensure that they are consistent

with the most current recommendations regarding

NHP safety.6,2,7,10,11 A checklist detailing specific

safety precautions for working with or around NHPs

should be developed and used prior to all NHP

handling and capture activities. Periodic program

and facility reviews that are specific to NHP safety

should be conducted. 

3. Ensure that emergency eyewash stations are

accessible to employees near primate handling areas

and that personnel are trained on proper eye flushing

technique. Employee training should include

information on the importance of initiating thorough

cleansing within minutes of injury or exposure as

described in the 1995 guidelines (e.g., irrigate for at

least 15 minutes).2

 

4. Because of the unique activities and hazards

present, specific safety and health programs and

objectives should be developed for the Yerkes PRC,

and safety and health staff with specific expertise in

biosafety and primate safety issues should provide

dedicated support to the PRC.

5. Conduct comprehensive hazard assessments

(e.g., job safety analyses) for all job descriptions and

activities involving NHPs. Workers responsible for

these tasks should participate in the assessments.

The assessments should include a review of all

activities where NHP contact occurs, all illness and

injury reports, and a detailed determination of the

necessary precautions. The assessments should also

be used to identify areas or situations where

handling or contact with the animals could be

reduced or eliminated. Revise procedures

accordingly.

6. Ensure all opportunities to minimize contact

with NHPs are investigated and implemented where

feasible. These may include engineering controls

such as improved cage designs (elimination of sharp

corners, providing a solid surface on the side of the

transfer cage adjacent the side of the worker), and

monkey identification (e.g., unique dye markers for

remote identification).

7. Ensure required safety precautions are

consistent in all facility policies and procedures. 

8. Review all employee training materials and

revise as necessary to ensure the most current NHP

safety guidelines and Yerkes PRC procedures are

effectively communicated. The results of the hazard

assessments should be included in this training. 

9. Tracking incidents (bites, scratches, eye

exposures, etc.) is a good method to monitor the

effectiveness of a safety program. However, each

incident should be thoroughly investigated to ensure

that the circumstances are well understood and
Health Hazard Evaluation Report No. 98-0061 Page 13

1. Ostrowski SR, Leslie MJ, Parrott T, Abelt

S, Piercys PE [1998]. B-virus from pet macaque

monkeys: an emerging threat in the United

States? Emerging Infectious Diseases. 4(1):117-

121.

2. Holmes, GP, Chapman LE, Stewart JA,

Straus SE, Hilliard JK, Davenport DS. [1995].

Guidelines for the Prevention and Treatment of

B-Virus Infections in Exposed Persons. Clinical

Infectious Diseases, 20:421-439.

3. Wells DL, Lipper SL, Hilliard JK, Stewart

JA, Holmes GP, Herrmann KL, Kiley MP,

Schonberger LN [1989]. Herpesvirus simiae

contamination of primary rhesus monkey kidney

cell cultures: CDC recommendations to

minimize risks to laboratory personnel. Diagn

Microbiol Infect Dis. 12:233-336.

4. Holmes GP, Hilliard JK, et.al. [1990]. B

virus (herpesvirus simiae) infection in humans:

epidemiologic investigation of a cluster. Annals

of Internal Medicine, 112(11):833-839.

5. CDC (Centers for Disease Control) [1987]. 

B-virus infection in humans - Pensacola,

Florida. Morbidity and Mortality Weekly

Report (MMWR). 36 (19) 289-290, 295-296;

May 22, 1987.

6. CDC (Centers for Disease Control) [1987]. 

Guidelines for the Prevention of Herpesvirus

Simiae (B-Virus) Infection in Monkey Handlers. 

Morbidity and Mortality Weekly Report

(MMWR). 36 (41):680-683, 687-689; October

23, 1987.

7. CDC (Centers for Disease Control and

Prevention) [1993]. Tuberculosis in Imported

Nonhuman Primates - United States, June 1990-

May 1993. Morbidity and Mortality Weekly

Report (MMWR). 42 (29):572-576; July 30,

1993.

8. CDC (Centers for Disease Control) [1990]. 

Update: Ebola-related Filovirus Infection in

nonhuman Primates and Interim Guidelines for

Handling Nonhuman Primates during Transit

and Quarantine. Morbidity and Mortality

Weekly Report (MMWR). 39 (2):22-24, 29-30,

January 19, 1990.

9. CDC (Centers for Disease Control) [1990]. 

Guidelines to prevent simian immunodeficiency

virus infection in laboratory workers and animal

handlers. Morbidity and Mortality Weekly

Report (MMWR). 37 (45) 698-704, November

18, 1988.

10. NIOSH [1990]. Checklist for worker

protection plan to comply with CDC special

permit requirements [55 FR 15210 C(1)]. 

Cincinnati, OH: U.S. Department of Health and

Human Services, Public Health Service, Centers

for Disease Control, National Institute for

Occupational Safety and Health. 

11. NRC [1997]. Occupational health and

safety in the care and use of research animals. 

National Research Council, National Academy

of Sciences. National Academy Press,

Washington, D.C.

appropriate interventions are implemented. Each and

every exposure should be reported to the Emory

safety and health department for appropriate

investigation and follow-up.

10. Employee training should include a discussion

of appropriate exposure management. This training

should emphasize the need for immediate care of the

exposure (wound cleansing, eye irrigation, etc.)

followed by medical assessment, and should be

reinforced at appropriate intervals. Yerkes PRC

administrators should identify medical consultants

with appropriate knowledge and skills regarding the

care of workers potentially exposed to B virus and

other primate zoonoses, and develop a contact

system to ensure that an exposed worker is referred

directly to these consultants. This system should

include provisions for referrals after normal working

hours and on weekends.

REFERENCES
Page 14 Health Hazard Evaluation Report No. 98-0061

12. DHHS [1993]. Biosafety in microbiological

and biomedical laboratories. 3rd. Ed.U.S.

Department of Health and Human Services,

DHHS Publication no. (CDC) 93-8395. 

Washington, D.C. 

13. U.S. Department of Labor, OSHA [1995].

OSHA Industrial Hygiene Technical Manual.

Section VII Chapter 1 -- Chemical Protective

Clothing. OSHA Instruction TED 1.15.

14. Mansdorf S [1997]. Personal protective

clothing. In: The Occupational Environment -

its Evaluation and Control. AIHA Press,

Fairfax, Virginia.

15. ANSI [1989]. Practice for Occupational

and Educational Eye and Face Protection, Z87-

1.1989. American Society of Safety Engineers,

Des Plaines, Ill.

16. Zakaria M, Lerche N, Chomel B, Kass P

[1996]. Accidental injuries associated with

nonhuman primate exposure at two regional

primate research centers (U.S.A.): 1988-1993. 

Laboratory Animal Science. 46(3):298-304.

17. Frier J, Bazreley P, Braude A [1973].

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225-8.

18. Sortir M, Switzer W, Schable C, Schmitt J,

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233-40. 
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