While on vacation at the Rock of Gibraltar, I was bitten by a monkey. This was three weeks ago, but now I've heard that there may be danger of a serious infection even up to 60 days or longer. The one I heard mentioned was herpesvirus simiae (B-virus). I am concerned about the possibility of contracting this, as I hear it is usually fatal. What kind of precautions could I take? What are my risk factors? Is there any supportive medication that could be used during this time that would eliminate my risk of getting this?

S.

More than 70 percent of macaque monkeys are latently infected with the herpes B virus. The preferred name of the virus currently is Cercopithecine herpesvirus 1. In the infected macaques, which include the laboratory rhesus monkey, this virus behaves much like oral herpes, causing recurrent oral blisters and ulcers. This virus can be passed to humans by bites as well as by exposure of the monkey's body fluids to a human's eye or mouth. When the monkeys are in a stressful situation, as would occur in a lab or in transport to the United States, the monkey's shedding of virus increases, making it more likely that a human will be infected.

There have been more than 40 reported cases in humans, usually the result of laboratory accidents. Most cases described in humans have been fatal. The incubation period (the time from infection to disease) is usually from two to five weeks. The first signs of the disease are nonspecific, including general ill feeling, fever, generalized pain and headache. Soon thereafter, neurologic signs develop, with seizures, paralysis, coma and then death.

Prevention of the disease is extremely important. The U.S. Centers for Disease Control recommends strict guidelines for the laboratory handling of macaques, including bite-resistant clothing and goggles. If a bite occurs, vigorous cleaning of the wound is recommended. The eye, if exposed, should be flushed with water for at least 15 minutes.

Studies in animals and humans suggests that acyclovir (trade name Zovirax), a drug used for herpes infections, is helpful. It should probably be given immediately if the injury is high risk -- for example, if the monkey had visible lesions, or if the wound is particularly severe. In other cases, many experts would start therapy only if cultures of the wound and/or the monkey were positive. If any early symptoms develop, acyclovir should definitely be given. There are many case reports of the disease being halted in such circumstances.

What should you do? Well, first, I have no idea what kind of monkey bit you, or how deep your wound was. At this writing, you are probably closer to five weeks out from the injury, making the likelihood of you becoming ill quite small. One approach would be to relax, but be wary of any early signs such as fever or body aches. If you have these signs, they would probably not be related to the monkey bite, but you never know. I would see a physician immediately with these symptoms, reminding him or her of your monkey bite.