What happens if monkey bites

The course of rabies vaccine is relatively expensive. On the plus side, no booster is required — ever — in the future unless you will be at risk of regular exposure. HRIG is notoriously difficult to obtain overseas and always very expensive when you can.

For regular travellers, rabies vaccination is a life-long investment in peace-of-mind travel. You can also make an appointment for a pre-travel medical consultation at a Travelvax clinic to receive vaccines, any medication required, accessories, and personalised advice tailored to your itinerary and your medical history.

Home Latest News. Things to know about rabies Rabies is present in almost every country on earth, but most human cases occur in South Asia — particularly India. Vaccination provides lifelong protection Discuss pre-travel rabies vaccination with your travel doctor or GP if you are: — Staying in an infected country for longer than a month, especially children.

Risks and illnesses. This is just one of a myriad of Balinese temple complexes attracting tourists. Yet, no cases of B virus have ever been reported from any of these encounters. The same holds for India and Nepal where feral macaques frequently come into contact with humans.

One explanation given for the absence of reports of monkey-related encephalitis cases is that monkeys shed B virus infrequently, thus minimizing the opportunity for infection. But none of the countries that are home to indigenous macaque populations have conducted simian herpesvirus surveillance programs among undiagnosed encephalitis cases, raising the possibility that B virus cases are being missed.

Could infection be occurring without disease? Among monkey handlers in clinical laboratories and zoological gardens, there is no significant documentation of asymptomatic infection, 7 yet one review cites unpublished results from Jones-Engel and Eberle in which serologic analysis of monkey temple workers indicates that infection without disease may occur. The lack of more extensive data on outcomes from NHP injuries that occur outside of the occupational setting paints a picture that is far from complete and remains somewhat enigmatic.

In the absence of reports of B virus infections among travelers and given that human infection is thus far known to have occurred only in research employees handling captive monkeys, we seem to be left with the question of whether the risk in exposed travelers is zero or close enough to it to decline making any treatment recommendations.

Given the unknowns that are likely to persist surrounding this issue and because of the remote possibility of a catastrophic infection should PEP be neglected, the consensus among experts allows that when practitioners are confronted with travelers injured by macaques, they should think of the possibility of infection, however unlikely, and in all candor discuss treatment options with their patients and allow this discussion to dictate implementation of therapy.

Monkey bites may also share a risk profile for bacterial infection similar to human bites. Amoxicillin clavulanate and moxifloxicin offer reasonable coverage and should be continued orally for 3 to 5 days, whether or not a parenteral first dose is administered.

Returning to our year-old patient, what should be done? This patient has had the pre-exposure vaccination series, so immunoglobulin is not indicated, although she will require two additional doses of rabies vaccine.

Verification of tetanus status and administration of antimicrobial therapy effective against primate oral flora should be considered, such as amoxicillin clavulanate; although it is now 2 days since the bite and with no sign of infection, some may opt for close observation. As for CeHV-1, the conundrum alluded to above is that in injuries from macaques, B virus infection is rare and treatment, therefore, is usually unnecessary.

But if infection occurs, as in rabies, the risk of death is high. And, for antiviral therapy to be most effective, it should be administered prior to the development of neurological symptoms. Whether adequate and timely wound cleansing advised for 15 minutes had occurred is difficult to consider reliably as a criterion for antiviral therapy. It did not, in the case of our patient.

Thus, as the context here is that of broken skin, there is a good case for initiating PEP with an antiviral drug such as valacyclovir CDC: 1 g by mouth every 8 hours for 14 days , which has a more reasonable dosing schedule than acyclovir CDC: mg by mouth five times daily for 14 days , an alternative drug. This course of action is consistent with current CDC guidelines already cited.

If adequate wound cleansing occurred shortly after the bite, a specimen for PCR testing might have been taken, but only after, not before, adequate cleansing. Because B virus is classified as a biosafety level 4 pathogen, culturing requires a specialized facility, which is often not available. Given the French report cited above, monkey injuries among travelers may not be rare.

Until more data are available, there may be few alterations in the existing guidelines on CeHV-1 exposure in humans. Due to the infrequency of human infections, new data will be difficult to obtain.

In the interim, despite the lingering questions, one key feature of managing monkey bites successfully will be for the clinician to consider B virus exposure, discuss interventions with their patient, and then act in concert with current guidelines.

When engaged in pre-travel counseling, medical providers should take into account the availability and proximity of reliable medical care that dispense trustworthy pharmaceuticals. Rabies in nonhuman primates and potential for transmission to humans: a literature review and examination of selected French national data. Google Scholar. Centers for Disease Control and Prevention. Travelers' health. Chapter 3: Infectious diseases related to travel: rabies.

Accessed May. Acute ascending myelitis following a monkey bite, with the isolation of a virus capable of reproducing the disease. J Exp Med ; 59 : — Hilliard J Monkey B. Virus, Chapter Only five of them received injections of neural tissue vaccine NTV. The main conclusion is that rabies can be successfully prevented but education of the community and health care professionals is of great importance. Shetty et al.

Out of cases recorded in the study, the biting animals involved were dog Children of the age group were victims in cases. Ichpujani et al. The authors conclude that there is the need to upgrade awareness regarding epidemiology and at-home and hospital management of animal bites among service providers and general community.

Monkey bites are frequently reported among children travelling to distant and exotic countries and can be associated with transmission of zoonoses. Besides rabies and other bacterial and viral diseases, there is the risk of potential fatal transmission of herpes B virus infection from macaque bites.

Although the risk for travelers is still unknown, such cases have been well documented in medical facilities 17 , 21 , Ritz et al. The bite occurred when the girl picked up a banana from the ground to feed one of the monkeys. This resulted in an open wound at the site of the bite with subsequent scab formation. She received PEP with antirabies vaccine on human diploid cells i. The monkey species later on identified by the girl on photos provided by the family were pigtail macaque Macaca nemestrina and rhesus macaque Macaca mulata.

The authors conclude that there are currently no guidelines for the management of possible herpes B exposure after monkey bites in travelers; however, most important of all is the fact that all travelers should be warned about the hazards associated with monkeys and importance of wound cleansing immediately after exposure.

Tregle et al. After consultation with animal authorities, the child received proper treatment, which included wound care, rabies prophylaxis, irrigation with sodium hypochlorite solution, and treatment with antiviral medication. In this article, the authors give recommendations what to do after being bitten by a monkey.

These include appropriate wound treatment which has to be started immediately; the site of the wound should be cleansed for 15 minutes using a solution containing a detergent soap e. Postexposure prophylaxis for bacterial, rabies and herpesvirus infections must be initiated, preferably in the first 5 days.

Blood samples and wound swabs should be sent as soon as possible to a reference laboratory for herpesvirus serology and specific polymerase chain reaction PCR assays. Follow up visits should be scheduled at 6 weeks postexposure, along with follow up serology and PCR assays. Johnston et al. Except for PEP with antirabies vaccine and human rabies immunoglobulin, she also received acyclovir for prophylaxis against herpes B virus, which is a deadly zoonotic agent that is endemic among macaque monkeys.

The authors also discuss the necessity of antiviral prophylaxis based on recommendations of the Centers for Disease Control and Prevention Mills et al. This mostly happened in travelers aged years.

Most injuries occurred in Bali, Indonesia and Thailand, and the most common animals responsible for injuries to 65 travelers were monkeys and dogs. They also discuss the pre-exposure rabies vaccination and postexposure prophylaxis. Only one traveler had received pre-exposure rabies vaccination. Some travelers received RIG after they returned to Australia, and those who presented more than 7 days from their first rabies vaccine did not receive RIG.

The authors conclude that all travelers who are travelling to rabies endemic countries should be well informed about the risk of animal bites and getting pre-exposure rabies vaccination and postexposure prophylaxis in case of exposure.

Riesland and Wilde 40 in their article discuss the potential threats to travelers suffering injuries inflicted by non-human primates, and that clinicians should inform them about the potential threats and discuss published recommendations with their patients prior to arriving to treatment plan. They are discussing rabies, herpes B virus, and other possible threats that monkeys can transfer to humans.

The main conclusion is that travelers should receive detailed counseling prior to their departure to distant destinations, and check whether appropriate medical facilities are in their proximity and are available to perform and follow current medical published recommendations. Besides travelers, monkey bites were recorded among professional soldiers. Mease and Baker 41 in their article discuss monkey bites among US military members in Afghanistan in Out of animal bites and exposures, 10 were monkey bites.

All cases involved different monkeys, 8 of which were kept as pets. For 2 monkeys, ownership data were not available. All these cases were evaluated and treated according to current medical recommendations which include wound care, antiviral medications for herpes B-virus, antimicrobial drugs for oral bacteria, verification of up-to-date tetanus vaccination status or vaccine administration in accordance with Advisory Committee on Immunization Practices ACIP guidelines 39 , and rabies PEP.

In their article, Leung et al. A year-old patient was bitten by a macaque monkey in Ubud Monkey Forest in Bali, and after returning to Australia he developed Zika virus infection with fever, rash and conjunctivitis, with onset five days after the monkey bite. Although Zika virus infection is usually transmitted to humans by mosquitoes, the authors suggest that macaque monkey bite should be considered as a plausible route of Zika virus transmission.

The WHO discusses monkey bites on their official web site about animal bites No matter what kind of exposure happened to travelers, in almost every country, medical staff should follow the official WHO guide for postexposure prophylaxis. Every country is free to choose which of the WHO recommended schedules will use for postexposure prophylaxis in humans The best possible way to avoid any contact or injury by monkeys is to stay home and watch them on TV in your living room.

However, in case that people decide to travel to a distant and exotic destination, they should check all relevant data and follow official recommendations. In case of any bite or claw-scratch injury after contact with monkeys, it is essential to cleanse the wounds with soap and water for 15 minutes and seek for medical assistance in the nearest medical facility.

National Center for Biotechnology Information , U. Journal List Acta Clin Croat v. Acta Clin Croat. Radovan Vodopija 1 Find articles by Radovan Vodopija. Kruno Sokol 1 Find articles by Kruno Sokol. Aleksandar Racz 2 Find articles by Aleksandar Racz. Nikolina Baranj 1 Find articles by Nikolina Baranj. Branko Ulaga 1 Find articles by Branko Ulaga. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Nov 15; Accepted Dec 5. Copyright notice.

This article has been cited by other articles in PMC. Abstract SUMMARY — Travelling around the world and visiting distant places and countries especially national parks, parks of nature, natural resorts, etc.

Results Case 1 A year-old man, a professional animal handler, was bitten by a capuchin monkey at the Zagreb ZOO while microchipping the animal. Macaque bites and scratches are of particular concern 1 , 4. Wounds from macaque bites should be scrubbed with soap, detergent, or iodine for 15 minutes and irrigated with running water for an additional 15—20 minutes before seeking medical attention.

Rabies from nonhuman primate bites is uncommon because primates are not primary rabies reservoirs. Nonetheless, rabies postexposure prophylaxis for victims of nonhuman primate bites in countries where rabies is enzootic should be considered 5. Persons visiting areas with free-ranging macaques should avoid close contact with these animals 1.

Macaque bites or scratches should be thoroughly washed, and medical treatment should be sought immediately. Corresponding author: Alexander C. Wu, ohh5 cdc. All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.

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