Herpes B Treatment & Management

Updated: Dec 17, 2018
  • Author: Sowmya Nanjappa, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Treatment

Medical Care

The guidelines for medical treatment of individuals exposed to herpes B virus are complex. Refer to the most recently published guidelines for a detailed discussion. [3] The substance of these guidelines is delineated below. Prompt attention to a potential exposure is vital to minimize the risk of this disease, which carries high morbidity and mortality rates.

Wound decontamination

Cleansing of the exposed area within minutes of the episode is the only means of preventing a contaminated wound from progressing to actual infection. The herpes B virus is likely to enter host cells within 5 minutes.

At least 15 minutes of scrubbing and/or irrigating the exposed area is recommended. Sterile saline or rapidly flowing water is used for the eye, and decontaminants (eg, soap solution, povidone-iodine, chlorhexidine) can be used at other sites.

Dakin solution (0.25% hypochlorite) has been suggested for high-risk deep lacerations or needle sticks. The solution must be fresh, and standard decontaminants should be used after a 5-minute treatment. Dakin solution should never be used to wash the eyes or mucous membranes.

Antiviral therapy

Antiviral therapy is clearly indicated for suspected clinical cases of human herpes B virus infection; use of prophylactic antiviral therapy is problematic.

The decision regarding postexposure prophylaxis should be individualized and made by a health care provider experienced with the evaluation, treatment, and prevention of herpes B virus infection. Early prophylaxis may prevent either overall or symptomatic infection; on the other hand, infection is quite rare compared with the number of exposures.

The ability of therapy to prevent herpes B virus infection is not documented, and therapy can suppress shedding and seroconversion, further complicating diagnosis. In addition, the length of therapy is undefined. [3]

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Surgical Care

Incision of wounds directed at diagnosis or treatment is usually of little benefit and can increase the risk of secondary bacterial infection. Therefore, it is not generally recommended. [3]

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Consultations

For prevention protocol and specimen testing, obtain appropriate consultation from occupational health personnel of primate centers. In addition, the National Institute of Health’s National Center for Research Resources funds the National B Virus Resource Center, which is an excellent resource for numerous topics related to herpes B virus, including both diagnostic testing and education. Other resources include the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health.

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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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