Herpes B Follow-up

  • Author: Sowmya Nanjappa, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: May 06, 2016
 

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

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.

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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.

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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.

Reported cases seem to have a lower case-fatality rate, possibly because of earlier diagnosis, earlier treatment, and/or better supportive care.

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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.

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Contributor Information and Disclosures
Author

Sowmya Nanjappa, MD Assistant Member, Department of Internal Medicine, Moffitt Cancer Center; Assistant Professor of Medicine, Department of Internal Medicine and Department of Oncologic Sciences (Joint Appointment), University of South Florida Morsani College of Medicine

Sowmya Nanjappa, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Physicians, American Medical Association, Infectious Diseases Society of America, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

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, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Thomas J Marrie, MD Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Association of Medical Microbiology and Infectious Disease Canada, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Brian Hogan, MD, MPH MPH&TM, Fellow in Infectious Diseases, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium

Disclosure: Nothing to disclose.

Acknowledgements

Robert O Deaner, PhD Assistant Professor, Department of Psychology, Grand Valley State University

Disclosure: Nothing to disclose.

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.

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This is a photo of long-tailed macaques socializing in the wild. The long-tailed macaque, Macaca fascicularis, is a major reservoir for the herpes B virus. (Photo courtesy of Carel van Schaik)
 
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