Download Zika Virus ERP - Office of the Vice Provost

Tufts University / Tufts Medical Center
Exposure Response Plan for the Laboratory Handling of
Zika virus
BACKGROUND INFORMATION:
The agent:
Zika virus is a member of the flaviviridae family and genus Flavivirus. It is
an enveloped, icosahedral virus containing ssRNA + sense. It is related to
Dengue virus and West Nile Virus.
Clinical Presentation:
Zika virus disease is characterized by mild headache, rash, fever, malaise,
conjunctivitis and joint pain. The incubation period is unknown but
estimated to be a few days to a week. Zika is generally a mild disease with
80% of infected persons remaining asymptomatic. Symptoms last from 2-7
days. Recovery is thought to be complete in the overwhelming majority,
however there is a suggestion of connection with Guillain-Barre
Syndrome. After someone has been infected, Zika virus can be present in
blood and body fluids, including semen, urine, and saliva.
Teratogenic effects: Risks associated with fetal exposure to Zika virus
include loss of pregnancy, microcephaly, and brain, hearing, and/or vision
abnormalities. At this time, the magnitude of risk is not able to be
quantified due to limited data. It not entirely clear at what time(s) in fetal
development that exposure to Zika virus presents the highest risk, but
some evidence suggests highest risk exists during the first trimester. The
mechanism(s) by which Zika virus causes these problems remains
unknown at the present time.
Natural and other routes of exposure:
Transmission typically occurs via mosquito bite. The two known species
responsible for Zika virus transmission are the Aedes albopictus, known
as the Asian Tiger mosquito, and the Aedes aegypti species. The latter
species also transmits dengue fever and chikungunya.
Aside from mosquito bites, Zika virus can be transmitted via sexual
contact, and transplacentally from mother-to-fetus. Exposure to infected
blood has also resulted in transmission. Zika virus transmission has been
reported following blood transfusion, and was recently transmitted to a
researcher via needlestick.
Infectious Dose: Unknown
HEALTH SCREENING REQUIREMENTS FOR LAB WORKERS:
Prior to initiation of work with Zika virus in the laboratory, workers must have a
health screen/questionnaire and receive reproductive counseling. At this
screening, employees will be educated on the risks of working with Zika virus,
and symptoms of Zika virus disease by Occupational Health Nurse or Physician.
Employees will meet privately with the clinician, and have opportunity to ask
questions.
HOW TO HANDLE EXPOSURES:
Before an Exposure Incident Occurs:
There is no prophylaxis, treatment or vaccine to protect against Zika virus
infection. Therefore, preventive measures are recommended.
Recommendations for Laboratory Workers:
PPE: At a minimum, lab coat or gown should be worn along with gloves
and safety glasses. For procedures with the potential for splashes or
spills, a surgical mask or face shield should be worn. Although Zika virus
is designated as a risk group 2 agent, some procedures may require
biosafety level 3 precautions including respiratory protection, depending
on the nature of the work being done.
Sharps: Strict adherence to safe sharps usage is recommended. Safety
sharps should be used whenever possible; alternatively syringes with
integral needles or luer-lock needles may be used. Needles should never
be re-used or re-capped.
Training: Workers should be familiar with the laboratory procedures and
practices involving this agent prior to working unsupervised.
Exposure Incidents:
Exposure to Zika virus in the laboratory setting may occur in a number of
ways.
The highest risk of illness is following exposure to Zika virus via
needlestick.
Exposure to Zika virus may also occur via ingestion (mouth) contact with
mucous membranes (mouth, nose, and eyes), absorption through nonintact skin (i.e. skin wound) and through inhalation (lungs). The risk of
infection following these routes of exposure is thought to be low, with no
known instances occurring.
Post-exposure Actions:
Immediate Actions:
o Needlestick or scratch: Wash the area with soap and running
water for 15 minutes. Do not apply bleach, alcohol or other
disinfectant to the skin. Hypodermic needle or contaminated sharps
injection into blood will have fastest effect.
o Mucous membranes (eye, nose, mouth): If contaminated
material is splashed or sprayed into the face contaminating the
eyes, nose or mouth: flush the eyes for 10-15 minutes, rinse mouth
out with clean water and be sure not to swallow, and wash down
face being sure that the nasal cavities have been rinsed as much
as possible.
o Inhalation: If contaminated materials are aerosolized outside of
primary containment and potentially inhaled, rinse mouth twice
expelling the rinsate. Do not swallow.
o Contact with intact skin and clothing: Remove contaminated
clothing using gloves either discard as biological or medical waste
or autoclave prior to laundering and re-use. Wash contaminated
skin with soap and water.
Medical Evaluation and Follow-up:
o You must be seen by a qualified medical professional following
exposure.
o For incidents involving major medical emergencies, activate
Emergency Medical Services:
At TU, call the University Police at x66911
At TMC, call Public Safety at x65100
o For all other incidents:
Following immediate actions, contact the campus occupational
health services and arrange for medical diagnosis and treatment.
Boston Tufts MC Employee Health Clinic: 617-636-5480
Grafton TCSVM Occupational Medical Clinic: 508-887-4241 (limited
hours) or 866-360-8100 (on-call physician for Exposure Response
Call Center)
Medford Mt. Auburn Occupational Health Services: 617-354-0546
Reporting of Exposure Incidents:
All exposure incidents must be reported within 24 hours to the Principal
Investigator and the Biosafety Office. The Biosafety Office may be
reached by phone (617-636-3569) or email ([email protected]).
Post-Exposure Treatment: There is no vaccine or specific treatment.
Patients who develop Zika virus disease should rest, stay hydrated, and
use acetaminophen (Tylenol) for fever and pain. An antihistamine,
diphenhydramine (Benadryl), can be taken for rash symptoms. Avoid
aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
REFERENCES:
CDC, Zika virus web site: http://www.cdc.gov/zika/index.html
CDC, Interim Guidelines for Pregnant Women:
http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1er.htm?s_cid=mm6502e1er
CDC, travel notices: http://wwwnc.cdc.gov/travel/notices/
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