Monkey bites among US military members, Afghanistan, 2011

Infectious Disease Risk Across the Growing Human-Non Human Primate Interface: A Review of the Evidence

Most of the human pandemics reported to date can be classified as zoonoses. Among these, there is a long history of infectious diseases that have spread from non-human primates (NHP) to humans. For millennia, indigenous groups that depend on wildlife for their survival were exposed to the risk of NHP pathogens' transmission through animal hunting and wild meat consumption. Usually, exposure is of no consequence or is limited to mild infections. In rare situations, it can be more severe or even become a real public health concern. Since the emergence of acquired immune deficiency syndrome (AIDS), nobody can ignore that an emerging infectious diseases (EID) might spread from NHP into the human population. In large parts of Central Africa and Asia, wildlife remains the primary source of meat and income for millions of people living in rural areas. However, in the past few decades the risk of exposure to an NHP pathogen has taken on a new dimension. Unprecedented breaking down of natural barriers between NHP and humans has increased exposure to health risks for a much larger population, including people living in urban areas. There are several reasons for this: (i) due to road development and massive destruction of ecosystems for agricultural needs, wildlife and humans come into contact more frequently; (ii) due to ecological awareness, many long distance travelers are in search of wildlife discovery, with a particular fascination for African great apes; (iii) due to the attraction for ancient temples and mystical practices, others travelers visit Asian places colonized by NHP. In each case, there is a risk of pathogen transmission through a bite or another route of infection. Beside the individual risk of contracting a pathogen, there is also the possibility of starting a new pandemic. This article reviews the known cases of NHP pathogens' transmission to humans whether they are hunters, travelers, ecotourists, veterinarians, or scientists working on NHP. Although pathogen transmission is supposed to be a rare outcome, Rabies virus, Herpes B virus, Monkeypox virus, Ebola virus, or Yellow fever virus infections are of greater concern and require quick countermeasures from public health professionals.

MONKEY BITES AND INJURIES IN THE ZAGREB ANTIRABIES CLINIC IN 2014

SUMMARY – Travelling around the world and visiting distant places and countries (especially national parks, parks of nature, natural resorts, etc.) sometimes may result in animal bites and injuries from the species which are not usually represented as the source of human rabies cases, such as monkeys. In the last ten to fifteen years, monkey bites and injuries present an unpleasant experience and cause a lot of problems for travelers and tourists when travelling to India, Thailand, Indonesia or Bali because they have to seek a medical facility for wound treatment, tetanus prophylaxis, antimicrobial therapy and rabies postexposure prophylaxis (PEP). In 2014, 706 persons were registered at the Zagreb Antirabies Clinic as having sustained bites by various animals, ten of them reported to have been bitten or injured by monkeys. Nine of them sustained injuries during their travel to India, Thailand, Indonesia and Bali. All injuries occurred when they wanted to pet or tried to feed monkeys, or refused to give them food. Most of the monkeys were macaques, capuchins, or of unknown type. Only one monkey bite recorded in the city of Zagreb occurred in the Zagreb ZOO while a professional animal handler was feeding a capuchin monkey in the cage. He did not receive rabies PEP, but instead, the capuchin monkey was put under veterinary supervision. All other patients started with PEP in the countries where the injuries occurred and continued/completed it at the Zagreb Antirabies Clinic. They received antirabies vaccine only (PVRV, RABIPUR) upon 5-dose regimen (Essen scheme) and 2-1-1 (Zagreb scheme) regimen. None of them contracted rabies. After many years, monkeys were the animal species immediately following dogs and cats in the official report of the Zagreb Antirabies Clinic, which was quite surprising. Usually, monkey bites and injuries do not present a serious problem in daily routine because they occur sporadically.

Questioning the Extreme Neurovirulence of Monkey B Virus (Macacine alphaherpesvirus 1)

Monkey B virus (Macacine alphaherpesvirus 1; BV) occurs naturally in macaques of the genus Macaca, which includes rhesus and long-tailed (cynomolgus) monkeys that are widely used in biomedical research. BV is closely related to the human herpes simplex viruses (HSV), and BV infections in its natural macaque host are quite similar to HSV infections in humans. Zoonotic BV is extremely rare, having been diagnosed in only a handful of North American facilities with the last documented case occurring in 1998. However, BV is notorious for its neurovirulence since zoonotic infections are serious, usually involving the central nervous system, and are frequently fatal. Little is known about factors underlying the extreme neurovirulence of BV in humans. Here we review what is actually known about the molecular biology of BV and viral factors affecting its neurovirulence. Based on what is known about related herpesviruses, areas for future research that may elucidate mechanisms underlying the neurovirulence of this intriguing virus are also reviewed.

Understanding Primate Herpesviruses

Viruses related to the herpes simplex viruses of humans are present in all nonhuman primate (NHP) species tested and cross species transmission has been documented. The herpesvirus present in macaques, Herpes B virus (BV) rarely causes disease in its natural macaque host. However, when transmitted to a nonnative host, BV has occasionally caused severe and even fatal disease if not treated immediately. Here we present a comprehensive review of the taxonomy, molecular biology, physiology, epidemiology, diagnosis and treatment of BV. We also summarizes what is known about related herpesviruses of other NHP species and the zoonotic potential of these viruses.

The effectiveness of the department of defense's field manual 3-11 in detecting, deterring and degrading the breach of a combat base by a human-borne with bioagent (HBBA): perceptions of security personnel

BACKGROUND

The department of defense's FM 3-11 is among the military's field manuals for preparing for, reacting to and recovering from chemical, biological, radiological and nuclear attacks. Since post 9-11, U.S. military service members have been deployed in the global war on terrorism. This study attempted to determine the effectiveness of the FM 3-11 in detecting, deterring or preventing a human-borne with bioagent (HBBA) terrorist breach at an entry control point (ECP).

METHOD

This time-specific, cross-sectional study disseminated a validated survey tool with Cronbach's α > 0.82 to respondents who have had antiterrorism training and combat ECP experience. The return rate was greater than 75.0 %; however, many of the respondents failed to meet the inclusion criteria. Consequently, only 26 questionnaires were included in the sample.

RESULTS

The results revealed that while over 60.0 % of the respondents either strongly agreed or agreed that biointelligence, the deployment of biodetectors and the use of biowarning systems could be effective in preventing an ECP breach by a terrorist with a bioagent, the use of protective equipment and immunization to decontaminate service members or other TTPs would never prevent a breach. A large percentage of respondents claimed that soldiers at the ECP lacked the devices or the knowledge to detect an HBBA at an ECP, and 72.0 % suggested modifying current ECP TTPs to include education, training and equipment for security personnel at military base ECPs.

CONCLUSION

If obtained from appropriate sources and communicated to the personnel at the ECP in an effective or timely manner, the possible effectiveness of certain TTPs in the FM 3-11, specifically FM 3-11.86 (intelligence), might increase.

The possibility of a human-borne with bioagent (HBBA) terrorist at foreign FOB ECPs: the perceptions of U.S. military or security personnel, a preliminary report

BACKGROUND

The global war on terrorism has prompted an increase in the deployment of security personnel from multi-national forces on foreign lands, especially in places where known terrorist groups are based. The aim of this study was to obtain U.S. military and security personnel's perceptions of the possibility of encountering a human-borne with bioagent (HBBA) terrorist at an entry control point (ECP).

METHODS

This study was a mixed-method, cross-sectional, survey-based, time-limited study. A validated, five-option Likert scale questionnaire with Cronbach's alphas of 0.82 and 0.894 for Constructs 1 and 2 was distributed to over 113 respondents with combat experience.

RESULTS

The results indicated that 92.3 % of the respondents thought it was possible for a terrorist to employ a biological agent to cause terror; 61.5 % claimed it was either possible or very possible, and 26.9 % claimed it was somewhat possible for a terrorist carrying a biological agent to successfully breach a combat Forward Operating Bases (FOB) ECP undetected. 26.9 % of the respondents agreed that "ECP soldiers are knowledgeable about bioagents (BA)", only 15.4 % responded that ECP soldiers have effective devices for detecting a BA on a terrorist at an ECP.

CONCLUSION

Despite some limitations, this pre-study tends to indicate that while many U.S. military or security personnel acknowledge the possibility of an HBBA terrorist breach and the vulnerability of U.S. combat post ECPs to a BA breach, the soldiers at the ECPs lack adequate knowledge or devices to effectively detect a BA on a terrorist at an ECP.

Rabies in nonhuman primates and potential for transmission to humans: a literature review and examination of selected French national data

BACKGROUND

The nonhuman primate (NHP)-related injuries in rabies-enzootic countries is a public health problem of increasing importance. The aims of this work are to collect data concerning rabies transmission from NHPs to humans; to collate medical practices regarding rabies postexposure prophylaxis (PEP) in different countries, and to provide an evidence base to support the decision to apply rabies PEP in this context.

METHODOLOGY

To retrieve information, we conducted a literature search from 1960 to January 2013. All reports of rabies in NHPs and rabies transmission to humans by infected NHPs were included. Also included were studies of travelers seeking care for rabies PEP in various settings. Data collected by the French National Reference Centre for Rabies concerning NHPs submitted for rabies diagnosis in France and human rabies exposure to NHPs in travelers returning to France were analyzed for the periods 1999-2012 and 1994-2011, respectively.

PRINCIPAL FINDINGS

A total of 159 reports of rabies in NHPs have been retrieved from various sources in South America, Africa, and Asia, including 13 cases in animals imported to Europe and the US. 134 were laboratory confirmed cases. 25 cases of human rabies following NHP-related injuries were reported, including 20 from Brazil. Among more than 2000 international travelers from various settings, the proportion of injuries related to NHP exposures was about 31%. NHPs rank second, following dogs in most studies and first in studies conducted in travelers returning from Southeast Asia. In France, 15.6% of 1606 travelers seeking PEP for exposure to any animal were injured by monkeys.

CONCLUSIONS/SIGNIFICANCE

Although less frequently reported in published literature than human rabies, confirmed rabies cases in NHPs occur. The occurrence of documented transmission of rabies from NHPs to human suggests that rabies PEP is indicated in patients injured by NHPs in rabies-enzootic countries.