For an excellent flow chart of a coordinated response plan to exposure, go to www.haz-map.com/Flowchar.htm .

1. Macaque monkeys should be used only for research when clearly indicated needs are present.

2. All persons who work with macaques or in the necrology of macaques, macaque cages, or who could handle medical implements used with macaques should be properly trained and must be aware of possible B virus exposure.

3. The use of Personal Protection Equipment (PPE) is essential for macaque workers. The veterinarian and safety director should ensure that all workers understand the proper use of gloves, clothing and safety glasses. Arm-length reinforced leather gloves should be used if direct handling is required. Other essential equipment includes long-sleeved protective clothing, surgical masks and goggles and latex or vinyl gloves.

4. Acquire macaque monkeys from colonies that are B-virus free. All macaque monkeys not known to be free of B virus infection should be regarded as possible shedders of the virus. Viral shedding is intermittent and can occur in the absence of visible lesions.

5. The routine screening of macaques for B virus presence is not recommended. Unnecessary screening may increase the risk of exposure to workers. Macaques with oral lesions suggestive of active B virus infection should be quarantined until the lesions have healed.

6. Macaque handlers should remove physically active animals from cages only with long-sleeved protective clothing and leather reinforced gloves to protect from scratches and a face shield or surgical mask and goggles to protect exposure of macaque secretions to the eyes and mucous membranes.

7. Capturing or restraining fully awake macaques by hand is not recommended. Caging should be arranged so that individual macaques can be separated before handling. Cages of macaques that are regularly handled should be squeeze-back cages that permit physical restraint of the macaques prior to handling. When appropriate, chemical restraint by injection should be used prior to removing animals from cages, especially for larger animals and those difficult to handle.

8. Cages and other equipment that may be contaminated with the virus should be free of sharp edges and corners that may cause scratches or wounds to workers. Cages should be designed and arranged so that the risk of workers being exposed by accidental secretion exposure or aggressive contact is minimized.

9. Access to all areas where macaques are maintained and used should be limited to workers who are properly trained in procedures to avoid risk of infection or to persons properly accompanied by trained personnel.

10. Keep research and boarding areas neat, clean, and well organized. Make sure these work areas are equipped with proper soaps, detergents, and saline solutions to immediately cleanse exposures.

11. Information and protocol regarding instructions to follow after an exposure should be conspicuously posted in all macaque work areas. Copies of written exposure protocol and sampling procedures must be available for workers who have possible exposures and who are referred to off-site medical personnel for examination and treatment.

12. In the event of exposure, follow all appropriate precautions. Never underestimate an exposure. Treat every exposure as if B virus exposure is probable, not just possible! For more information regarding B virus exposure and research, go to www.gsu.edu/~wwwvir/index.html .