eMedicine Specialties > Infectious Diseases > Viral Infections

Herpes B: Follow-up

Author: Brian Hogan, MD, MPH&TM, Fellow in Infectious Diseases, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium
Coauthor(s): Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center; Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus; Robert O Deaner, PhD, Assistant Professor, Department of Psychology, Grand Valley State University
Contributor Information and Disclosures

Updated: Mar 24, 2009

Follow-up

Deterrence/Prevention

  • Developing herpes B virus–free colonies
    • The endeavor to develop virus-free colonies has found some success, especially in the United States, where the National Center for Research Resources took a leading role in the 1990s by promoting experimental strategies in husbandry and management.
    • Achieving completely herpes B virus–free colonies has proven difficult because some macaques may show no antibodies but may retain latent herpes B virus particles. Furthermore, the B virus may become reactivated and shed without any visible symptoms.
    • Because of the relative ease of monkey-to-monkey transmission, even a single animal infected with herpes B virus may compromise the virus-free status of an entire facility.
    • Current research focuses on the development of techniques (eg, PCR) to reduce false-negative results and the implementation of regular screening protocols that quickly identify infected monkeys.
  • Accepting moderate to high infection rates in macaques but minimizing human exposure to herpes B virus
    • Minimizing social, nutritional, pharmacological, and psychological stress (especially overcrowding and shipping) can reduce viral shedding by monkeys. Promoting good veterinary care and immunocompetence also can reduce shedding.
    • Eliminating transmission pathways can prevent human exposure. Some means of prevention include the use of protective suits, gloves, eye shields, and similar devices. Given the difficulties and costs of achieving herpes B virus–free colonies, these methods may remain the reality at most facilities, at least for the near future.
    • Nonmacaque species are highly susceptible to herpes B virus infection. The risk of infection in these animals can be easily minimized by housing macaques in separate nonadjacent cages. A failure to follow this precaution has sometimes led to cross-species infection and fatalities.
  • Immunoprevention has been attempted in animal studies using several different vaccines. Most recently, a recombinant vaccinia virus that expresses herpes B glycoprotein D appears promising in preventing infection and/or latency.

Complications

  • Aseptic meningitis results in a moderate lymphocyte pleocytosis and erythrocytes, moderately elevated cerebrospinal fluid (CSF) protein level, and normal CSF glucose. In humans, herpes B virus can be grown from CSF, skin lesions, and urine.
  • Nonfatal cases of human herpes B virus infection may result in complete recovery, but residua are common and include the following:
    • Extremity paresis or plegia
    • Aphasia
    • Dysarthria
    • Residual chorioretinitis
  • Because of prolonged or long-term use of antiviral therapy in surviving patients, the frequency of asymptomatic or symptomatic reactivation and/or viral shedding occur is unclear.

Prognosis

  • Historically, human herpes B virus infection carries a case fatality rate of approximately 70%, a rate similar to that of untreated HSV encephalitis.
  • As with HSV encephalitis, many survivors of herpes B virus infection have substantial residua.
  • Recently reported cases seem to have a lower case fatality rate, possibly because of earlier diagnosis, earlier treatment, and/or better supportive care.

Patient Education

  • Until a vaccination is available or certified, herpes B virus–free colonies are the rule; educating primate workers on the avoidance of high-risk exposures is mandatory.
  • All workers should be aware of prevention and treatment protocols.

Miscellaneous

Medicolegal Pitfalls

  • Failure of any facility maintaining macaques to have an aggressive educational campaign to maximize protection for its workers

Special Concerns

  • Long-term therapy with antiviral drugs has been used in the few individuals who recovered clinically from overt herpes B encephalitis.
  • Asymptomatic shedding of HSV can occur despite drug treatment, but whether this occurs with herpes B virus is unclear.
  • The advisability of discontinuing antiviral therapy is unclear with regard to clinical reactivation or possible human-to-human spread of herpes B virus (one case documented).
  • Likewise, if clinical decisions to use antiviral prophylaxis with established protocols are made, the length of treatment is poorly defined.
    • Immediate antiviral treatment is usually instituted for deep wounds or wounds inflicted by symptomatic monkeys.
    • Many experts suggest prophylaxis only if surveillance cultures are positive for herpes B virus.
 


More on Herpes B

Overview: Herpes B
Differential Diagnoses & Workup: Herpes B
Treatment & Medication: Herpes B
Follow-up: Herpes B
Multimedia: Herpes B
References
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References

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Further Reading

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Keywords

herpes B virus, Cercopithecine herpesvirus 1, CHV-1, herpes B virus infection, herpes B infection, herpesvirus simiae, monkey B virus, herpes B encephalitis

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Contributor Information and Disclosures

Author

Brian Hogan, MD, MPH&TM, Fellow in Infectious Diseases, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium
Disclosure: eMedicine None None

Coauthor(s)

Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Robert O Deaner, PhD, Assistant Professor, Department of Psychology, Grand Valley State University
Disclosure: Nothing to disclose.

Medical Editor

Thomas J Marrie, MD, Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine
Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Charles V Sanders, MD, Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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