30. NHP OHSP - Occupational Health and Safety in the Care and Use of Nonhuman Primates

Common AAALAC findings in relation to hazards

• not based on hazard identification/risk assessment

• failure to include general hazards

• inadequate training

• not covering all at risk personnel

• disconnected IACUC and safety personnel

This person has the following responsibilities - understand, support development and implementation of policies, communicate importance, ensure suitable funding, designate staff, identify office or individual that will manage it

Senior official responsibilties

This program is responsible for radiation and chemical safety, waste management, and monitoring of the OHSP

Environmental Health and Safety

What external organizations will review the OHSP

OSHA, OLAW, AAALAC

General behaviors of prosimians in relation to occupational health and safety

• Tarsiers and lemurs 

• Most removed taxonomically from humans 

• No published report of dz transmission from prosiminans to humans 

  • Not aggressive 

• Inquisitive – may leap onto people to investigate – be prepared for this behavior

General behaviors of NWM in relation to occupational health and safety

• Central and south America 

• Callitrichids and Cebids

• In general – not aggressive and will not respond aggressive to direct eye contact 

  • Vigorously resist restraint

General behaviors of Callitrichids in relation to occupational health and safety

• Claws on most digits 

• Arboreal

• Highly territorial 

• Well developed visual, olfactory, and auditory – LONG memories 

• Threatening behavior – arching of back, full body piloerection, stiff legged walk, chest display, swaying from side to side 

• Hand raised – become very aggressive to people when reaching puberty 

• Procumbent incisors (marmosets) and long canine teeth (tamarins) – bite wounds

General behaviors of Cebids (squirrel monkeys, capuchins, owl monkeys) in relation to occupational health and safety

• excellent dexterity – escape cages 

• Bite in self defense 

• Climb onto person – may bite when pushed away or frightened 

• May defend person it likes from other people

General behaviors of OWM (Cercopithines) in relation to occupational health and safety

• (carcopithines) – macaques, baboons, mandrills, mangabeys, African greens 

  • Social animals – human removing infant – aggressive response

• Strong, skilled manipulation – animals escape from enclosures 

• Macaques – visual capabilities, visual signals 

• Mild threats – direct eye contact, jerky arm movement – response aggressively 

• To mitigate – train to cooperate

General behaviors of OWM (Apes) in relation to occupational health and safety

• Strong, highly developed cognitive abilities, can recognize themselves in mirror 

• Do not trust unfamiliar people 

• Enclosures should not allow them to reach out and grab people 

• Can trains for cooperations w/ food

Common infectious agents of Macaques

Common infectious hazards of baboons

Common infectious hazards of squirrel monkeys

Precautionary measures that can be taken for animal bites, needle stick, slips, overexertion, traumatic crushing and laceration

Precautionary measures that can be taken for thermal burns, noise ,allergens, heat stress

Precautionary measures that can be taken for chemical disinfectants and cleaning solutions, volatile anesthetics

change in amount, intensity, or duration of exposure is associated with a change in the risk of the outcome

dose response relationship

 based on observation, experience, published reports, professional judgement (review worker injury and exposure logs)

qualitative process of hazard assessment

• Quantitative level of a hazard and probability of adverse response

• Single-event exposures usually of primary concern (agents), though cumulative-dose effects relevant for chemical toxicants

• Threshold and non-threshold models of risk for various health conditions

Dose response assessment

• Estimates the exposures or contact between a hazard and a person

• Take into account numerous modes of possible contact (splashes, bites, aerosols)

• Determine extent of contact, along with job duties and use of PPE

• Must include evaluation of experience and skill levels of people at risk for exposure

• Under-reporting of occupational injuries and exposures is common

Exposure assessment

• Combine the dose-response relationship and exposure assessment to describe the risk to subject persons

• Need knowledge of risks, principles of safety, appreciation of workflow, and knowledge of regulations

• Initially focus on greatest hazards

• Put into quantitative terms when possible

• Determine incidence rates (person work days)

• Understand uncertainties involved

Risk estimation and characterization

How is the ABSL level of a study determined at a primate facility? Who has ultimate authority?

-collaboration between study director/PI, IACUC, BSO, primate center director

Senior institutional official

What is the most common physical hazard in primate centers? What has lowest incidence? Where are the most common site for bite injuries? Who is most likely to report an injury and who has the highest overall injury rates?

• scratches and bites

• cut and mucous membrane exposure

• fingers and thumbs

• full time employees

• veterinary residents

At primate centers one new B virus infection is reported every ____. What has been the most influental in reducing risk?

60 years

PPE used, improved lab procedures, increased post exposure wound disinfecting efficiency

There is an increased likelihood of injury with ____

increasing years of experience

What act created OSHA and NIOSH?

Occupational Safety and Health Act of 1970

What CFR handles bloodborne pathogens?

OSHA Standard 29 CFR Part 1910

What vaccines is required when handling blood, organs, or tissues from experimental NHPs?

Hepatitis B vaccine

Limit of exposure to formaldehyde time weighted average (TWA) and short term

0.75ppm and 2.0ppm

Federal facilities must establish and maintain ____ program similar to OSHA

OHS

Inspectors of OHS program for federal facility must be ___ or ____ to recognize hazards and suggest general abatement procedures. All federal agency work places must be inspected ____.

safety/occupational health specialicist or enough training or experience

annually

Responsibility for oversight of federal OHS programs are assigned to the _____ which functions as a mini OSHA

Office of Federal agency Program (OFAP)

Federal research facilities must comply with same ___ standards. It’s inspected by ___ rather than OSHA and are not subject to _____ penalties.

• OSHA

• OFAP

• monetary

What policy requires that institutes receiving federal funding must have OHS program as part of overall animal care and use program.

PHS policy

This important documents includes OHS guidelines related to hazard identification and risk assessment personnel training, personal hygiene, facilities/procedures/monitoring, personal protection, medical evaluation, and preventative medicine

the guide

What CFR - prevent introduction, transmission, and spread of communicable diseases for foreign countries into the states

42 CFR 71

What CFR - specifically addresses importation of live NHPs, restricts activity to registered importers

42 CFR 71:53

Who is responsible for preventing the importation and spread of zoonotic illness capable of causing serious outbreak of communicable dz in humans (like marburg/ebola, monkey pox, yellow fever, TB)

Division of Global Migration and Quarantine in the National Center for Infectious Diseases at the Centers for Disease control and prevention

All imported NHPs have a mandatory ___ quarantine

31d

NHP importers must register with the ___, certify that NHPs will only be used for science, education, or exhibition

CDC

Who has regulatory authority over importation of human or NHP material that is produced in tissue culture or is a potential or actual zoonotic pathogen

National Center for Import and Export (NCIE) of USDA and APHIS

Who has jurisdiction over all human and NHP material

USPHS (US Public Health Service)

Who provides regulations regarding transportation of hazardous materials which includes infected live animals or tissues

US Department of Transportation (DOT)

Private, non-profit organization that administers & coordinates the US voluntary standardization & conformity assessment systems

ANSI - American National Standards Institute

ANSI Standard for  “Emergency Eyewash & Shower Equipment”

Z358.1-1998

ANSI Standard for Occupational and Educational Eye and Face Protection

Z87.1-1989

•  largest voluntary standards development organizations in the world

• Mission- be foremost developer & provider of voluntary consensus standards, related technical info, & services having internationally recognized quality & applicability that promote public health & safety, & the overall quality of life, contribute to reliability of materials, products, systems, & services, & facilitate national, regional, & international commerce

ASTM International - American Society for Testing and Materials

ATSM is most known for providing what standards?

fluid resistance and permeability standards in PPE clothing

“advances worker health & safety through education & the development & dissemination of scientific & technical knowledge”

American Conference of Governmental Industrial Hygienists (ACGIH)

ACGIH provides resources on what?

Threshold limit values (TLVs) and Biological Exposure Indices (BEIs)

Provides live animal regulations for transporting live animals by commercial airlines

IATA - International Air Transport Association

To be effective risk management must have 2 elements

specific OHSP plan

AND appropriate safety culture and working environment

It is or is not essential that each institution have a full time occupational health professional on staff

not essential

What can an institution do if a full time Oc Health professional is not on staff?

establish relationship with professional who can provide necessary expertise for plan development and operation

It is recommended that “personnel who work w/ NHPs should wear ____ & other protective garments & equipment appropriate for circumstances & species involved” (NRC)

face shields

What PPE should be mandatory for individuals working w/ macaques (CDC)

protective eyewear and face protection

What PPE is highly recommended for working with other OWM and apes

eyewear and face protection

What health surveillence is usually conducted on individuals working in NHP facility?

health screening for wearing respiratores rated by NIOSH

vaccines

serum banking

tuberculosis testing

Per the occupational and health administration blood born pathogens standards vaccinations must be offered to personnel working with experimental pathogenic agents such as ____

hepatitis B virus

How often should IACUC and OH professional review OHS plan?

semiannually

What two laws require that staff are provided training?

• Health Research Extension Act of 1985 (required compliance with PHS for PHS-funded research)

• Food Security Act of 1985 (amended AWA)

Who is ultimately responsible for determining qualifications of facility employees, contract staff, support-services staff, program inspectors, and visitors

facility director

Who are responsible for verification of the qualifications of research assistants, collaborators, and guests?

PIs

How should training be presented to ensure maximum efficiency

only 7 major concepts or less per training session

each major concept should be presented 3 times

5 principles of adult learning

• Principle of Readiness

• Principle of Association

• Principle of Involvement

• Principle of Repetition

• Principle of Reinforcement

OSHA requires that training records be kept for _____

3 years

First aid for skin exposures or mucous membrane exposure to NHP

skin exposure - flushing & scrubbing with detergent and water for 15 minutes

mucous membrane exposure - eyes flushed for 15m at eyewash station

CDC recommend that occupational exposures to SIV & hybrid strains of HIV-SIV be managed according to ____

PHS postexposure prophylaxis guidelines for HIV

Guidelines recommend that lab animal workers be vaccinated for ___ if they handle cultures or animals contaminated or infected w/ vaccinia virus, recombinant-vaccinia virus vectored vaccines, or other orthopoxviruses that infect humans (e.g. monkeypox & cowpox)

vaccinia

When is the B virus post exposure prophylaxis recommended, considered, and not recommended

• Recommended:

  • Skin exposure with loss of skin integrity or mucosal exposure to high-risk source

  • Inadequately cleaned skin exposure with loss of skin integrity or mucosal exposure

  • Head, neck, or torso laceration

  • Depp puncture bite

  • Needle stick associated with tissue or fluid from CNS

  • Lesions suspicious for B virus on animal’s eyelids or mucosa

  • Puncture or laceration after exposure to an object likely to be contaminated with fluid from oral or genital lesions, CNS tissues, or tissues known to contain virus

  • Post-cleaning culture positive for B virus

  • Immunocompromised status

• Considered: 

  • Mucosal or eye splash even if adequately cleaned

  • Laceration with loss of skin integrity

  • Needle stick with blood from ill/immunocompromised macaque

  • Puncture or laceration after exposure to an object contaminated with body fluid

  • Potentially infected cell culture

• Not recommended

  • Exposed skin is intact

  • NHP other than macaque

What is the agent that is recommended for post exposure prophylaxis?

Valcyclovir (acyclovir also possible, but val is what is recommended)

What is the occupational safety risk associate with a Slow Loris (Nycticebus)?

Bite is a "poisonous" mix of saliva and glandular secretions

(Really causes more of an allergic reaction than being an actual poison/venom)

B virus, Macacine herpesvirus 1, alphaherpesvirus

most significant infectious occupational health hazard in the conduct of NHP research

-Naturally only in macaques

-Human exposures: bites/scratches, splashes, needle stick injuries, but viability not expected to be prolonged (<24hrs in most cases)

-Latency mostly in trigeminal & lumbosacral sensory ganglia (Incubation period (humans), ~2-3wks)

Dx: serology, virus isolation, & PCR

Simian Immunodeficiency Virus

Lentivirus

-Natural reservoirs - mangabeys, guenons, mandrills & chimps

-Infections: splashes onto mm, open cuts/abrasions, & needle stick

-Experimental studies typically conducted under ASBL 2 or 2/3 conditions ( 2 facilities w/ 3 practices & procedures), post exposure prophylaxis involves antiretroviral agents

Simian Foamy Virus

Spumaviruses

Found frequently in cell cultures

Presumed transmission via saliva & bites

-Usually involves macaques, baboons, guenons and chimps, but some species specific isolates have been found in squirrel monkeys and spider monkeys

Ebola, Marburg, Filoviruses

Imported macaques (Ebola-R)

Ebola transmission: droplets & body fluid fomites, filoviruses form infectious aerosols

-Marburg - contact with infected tissues

-Marburg incubation in NHP 4-16d; incubation period for humans unknown

Pox Viruses

-Monkeypox - vesicular exanthema leads to pox-like lesions** human to human

-Yaba virus & tanapox - multiple papules or masses on skin; monkey to human

-Molluscum contagiosum - umbilicated papules that can persist for up to 2 years; monkey to human

Yellow Fever

Yellow fever virus (flavivirus) - African Old World primates & New World primates

-Bite of infective mosquitoes

-Clinical signs: mild or absent in African species but New Worlds show high mortality

Human - accidental exposure with needle sticks

Dengue

Dengue fever viruses

Mosquitoes

Human cases from NHP not documented - possible sharps

-Both NHPs & humans competent reservoir hosts

-Infective mosquitoes Aedes aegypti & Ae. albopictus

Lymphocytic Choriomeningitis Virus

Marmosets & tamarins have succumbed to callitrichid hepatitis after feeding on infected mice ("pinkies")

Transmission b/w callitrichids not demonstrated

Transmitted to humans presumably from oral & respiratory exposure through urine, saliva, or feces

Incubation ~8-13d, biphasic febrile illness, second phase - meningitis or encephalitis, possible fetal teratogen

Hepatitis A

Only chimps have been implicated in transmission to humans

Fecal-oral route

No evidence of human disease associated with simian hepatitis A

Hepatitis B

Can occur in great apes

No cases of transmission to humans documented (NHP origin)

Vaccines for public are required of OSHA for individuals in research on this agent

Tuberculosis

Mycobacterium tuberculosis & M. bovis

Old World are more susceptible than new world

Transmission: Aerosols, fomites, & fecal-oral route

Remember concurrent measles infection can cause false neg TB test

Pseudotuberculosis

Yersinia enterocolitica or Y. pseudotuberculosis

Birds & rodents thought to be primary reservoir

Fecal-oral route

Shigellosis

Contact with infected humans (S. flexneri)

Fecal-oral route

Humans, can cause arthropathy (Reiter's syndrome) esp. with HLA-B27 genetic background

Salmonella

Probably acquired by NHPs in captivity from exposure to infected humans; unlikely to transferred back to humans

Fecal-oral route

Campylobacteriosis

C. jejuni & C. coli

Fecal-oral

Often acquired in captivity but can be transferred back to humans

Melioidosis (Burkholderia pseudomallei)

macaques, chimps w/ nonspecific C/S- supp lesions (pulmonary, cerebrospinal, & SC tissues)

Ingestion or inhalation or via breaks in skin

Humans - vary from asymptomatic to pneumonia & septicemia

Leprosy

M. leprae (Macaques, mangabeys, & chimps)

Months to years following exposure before C/S in humans

Suspect: inhalation transmission

Armadillo scientific name: Dasypus novemcinctus

NHP Protozoal Parasites that post hazard to human

Amoebiasis (Entamoeba histolytica)

Balantidiasis (Balantidium coli)

Cryptosporidiosis (C. parvum)

Giardia (G. intestinalis)

Malaria

Plasmodium cynomolgi, P. knowlesi, P. inui, & P. simium

Accidental exposure through penetrating injuries from needles & other sharps, mosquito bite (Macaques, baboons, squirrel monkeys, mangabeys)

Trypanosomiasis

T. cruzi

New World species - lifelong infections

Accidental exposure through mm, non-intact skin, or penetrating injuries

Propagated among monkeys via trauma, blood-to-blood exposure, saliva, sexual activity & transplacentally

Myocarditis most common C/S

Hymenolepsiasis

H. nana (Rodentolepsis nana)

Direct & indirect life cycle

Fecal-oral; Most asymptomatic, but catarrhal enteritis, diarrhea, & abdominal signs reported

polar filament in egg

Oxyuriasis - pinworm

Enterobius vermicularis

Old World

Contaminated soil, passed between species in either direction

Fecal-oral

Strongylodiasis

Strongyloides fullerbornie - Old World

S. stercorales - Apes

Fecal-oral

Direct skin penetration for larval stages

Trichuriasis

NW & OW & great apes

Fecal-oral, but req's 10-14d of incubation in warm, moist soil to become infective

typically asymptomatic; severe infections can cause anorexia, diarrhea, enteritis, and occasionally death.

Which of the following diseases is quite debilitating in New World primates but rather mild in Old World species where the disease in endemic?

a. Yellow Fever

b. Hepatitis A

c. Measles

d. LCMV

e.Monkeypox

a. Yellow Fever

Insects of the genus Aedes are primarily responsible for naturally transmitting which of the following microorganisms?

a. Plasmodium knowlesi

b. West Nile Virus

c. Dengue

d. Trypanosoma cruzi

e. Kyasanur Forest disease

Answer: c. Dengue

A - Anopheles mosquito

B - Culex mosquito

C - Aedes

D - Reduviid bug

E. - Hard ticks (Hemaphysalis spinigera)

The liver pathology seen along with the Callitrichid is most likely due to what disease?

a. Helicobacter pylori

b. No pathology - normal for age and species

c. Idiopathic hemochromatosis

d. Lymphocytic choriomeningitis virus

d. Lymphocytic choriomeningitis virus. (Disease is Callitrichid hepatitis)

Although variable, what is the typical incubation period prior to the onset of clinical signs of Macacine herpesvirus 1 in humans?

a. 2-3 weeks

b. 5-7 weeks

c. 10-12 weeks

d. 16-18 weeks

e. 10-12 months

a. 2-3 weeks