Varicella-zoster Virus
Varicella-zoster Virus
MATERIAL SAFETY DATA SHEET – INFECTIOUS SUBSTANCES
SECTION I – INFECTIOUS AGENT
NAME: Varicella-zoster virus
SYNONYM OR CROSS REFERENCE: VZV, Human Herpesvirus 3, Herpes Zoster, Chickenpox, Shingles
CHARACTERISTICS: Herpesviridae, Alphaherpesvirinae; dsDNA, 100nm diameter, enveloped, icosahedral capsid
SECTION II – HEALTH HAZARD
PATHOGENICITY: Chickenpox (Varicella) – acute generalized disease with sudden onset of fever and vesicular eruption of the skin and mucous membranes; rarely fatal except to immunocompromised who are at increased risk. Shingles (Zoster) – local mainfestation following reactivation of varicella present in latent form in sensory ganglia; inflammatory reaction of the posterior nerve roots and ganglia, accompanied by crops of vesicles over skin supplied by the affected nerves
EPIDEMIOLOGY: Worldwide; Varicella chiefly a disease of children (75% of population by age 15 and 90% of young adults had disease) and more frequent In winter and early spring in temperate zones; Zoster occurs more commonly in adults
HOST RANGE: Humans
INFECTIOUS DOSE: Unknown
MODE OF TRANSMISSION: By direct contact, droplet or airbone spread of secretions of respiratory tract (varicella) or vesicle fluid (zoster); indirectly via contaminated fomites; scabs are not infective
INCUBATION PERIOD: From 2-3 weeks (usually 13-17 days); may be prolonged after passive immunization to varicella or in immunodeficient individuals
COMMUNICABILITY: Chickenpox is highly communicable 1-2 days before onset of rash and 6 days after appearance of vesicles; herpes zoster not as infectious but is source of infection 1 week after appearance of lesions
SECTION III – DISSEMINATION
RESERVOIR: Humans
ZOONOSIS: None
VECTORS: None
SECTION IV – VIABILITY
DRUG SUSCEPTIBILITY: Vidarabine and Acyclovir are effective
SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to disinfectants – 1% sodium hypochlorite, 70% ethanol, 2% glutaraldehyde, formaldehyde
PHYSICAL INACTIVATION: Inactivated by heat
SURVIVAL OUTSIDE HOST: Virus can survive in secretions on inanimate surfaces for short periods
SECTION V – MEDICAL
SURVEILLANCE: Monitor for symptoms; confirmation by recovery of virus or serology
FIRST AID/TREATMENT: Drug therapy for severe cases of herpes zoster in immunocompromised
IMMUNIZATION: Live vaccine licensed in North America
PROPHYLAXIS: Varicella-zoster immune globulin (VZIG) indicated after exposure to chickenpox or zoster in individuals with risk of serious morbidity or mortality
SECTION VI – LABORATORY HAZARDS
LABORATORY-ACQUIRED INFECTIONS: Not a demonstrated cause of lab infections
SOURCES/SPECIMENS: Vesicular fluids, extract of crusts, respiratory secretions and other clinical materials
PRIMARY HAZARDS: Direct contact with broken skin or mucous membranes; accidental parenteral inoculation, inhalation of infectious aerosols
SPECIAL HAZARDS: None
SECTION VII – RECOMMENDED PRECAUTIONS
CONTAINMENT REQUIREMENTS: Biosafety level 2 practices, containment equipment and facilities are recommended for activities utilizing known or potentially infectious clinical materials or cultures
PROTECTIVE CLOTHING: Laboratory coat; gloves when direct contact with infectious materials is unavoidable
OTHER PRECAUTIONS: None
SECTION VIII – HANDLING INFORMATION
SPILLS: Allow aerosols to settle; wearing protective clothing, gently cover spill with paper towels and apply 1% sodium hypochlorite, starting at perimeter and working towards the centre; allow sufficient contact time before clean up (30 min)
DISPOSAL: Decontaminate before disposal; steam sterilization, incineration, chemical disinfection
STORAGE: In sealed containers that are appropriately labelled
SECTION IX – MISCELLANEOUS INFORMATION
Date prepared: September, 1996 Prepared by: Office of Biosafety
LCDC
Although the information, opinions and recommendations contained in this Material Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.
Trichomonas vaginalis
PATHOGEN SAFETY DATA SHEET – INFECTIOUS SUBSTANCES
SECTION I – INFECTIOUS AGENT
NAME: Trichomonas vaginalis
SYNONYM OR CROSS REFERENCE: Trichomoniasis, vaginitis.
CHARACTERISTICS: Trichomonas vaginalis is a parasitic protozoan flagellate, and organisms vary in size but are usually around 10 μm in length and 7 μm in width(1,2). It usually has an oval or pear-like shape, but can assume an amoeboid form when attached to vaginal epithelial cells. T. vaginalis has a total of 5 flagella, four of which are located at its anterior portion. The fifth flagellum is incorporated within the undulating membrane(1,3). The anaerobic parasite can only exist as a trophozoite and lacks a cystic stage, reproducing by longitudinal binary fission. Growth is optimized at 37°C at pH 6.0 – 6.3, but can survive at up to pH 7(4).
SECTION II – HAZARD IDENTIFICATION
PATHOGENICITY/TOXICITY: T. vaginalis is generally restricted to the genitourinary tract by the host’s immune system, and is the etiological agent of human trichomoniasis(2). Infection has been associated with an increased risk of human immunodeficiency syndrome in both sexes(4).
In women: Symptoms of infection include vaginal secretion that is scanty and mixed with mucus; malodorous discharge that is frothy, yellow or green, mycopurulent, and copious(4). The protozoan can be found in the vagina, cervix, bladder, Bartholin’s, Skene’s, and periurethral glands. Complications may result in cervical erosion, cervical cancer, infertility, adnexitis, pyosalpinx, and endometritis. Premature rupture of the placental membranes can occur in pregnant women, resulting in premature birth and low-birth weight(5). Acute infections are characterised by severe pruritus, vaginitis, vulvitis with dysuria and dyspareunia, and hemorrhagic spots on the mucosa (in 2% of patients) which results in colpitis macularis or petechiae (strawberry cervix). In females, 50% of cases are asymptomatic. Infection can persist for long periods of time in the urogenital tract of women. 25 – 50% are asymptomatic for the first 6 months of infection, and organisms can survive indefinitely in the lower urogenital tract if left untreated(1,6).
In men: Prevalence is lower in men, and infection is often asymptomatic(7). Infection in men can be present in the prostate, seminal vesicles, and epididymis. Complications are rare, but can potentially lead to genitourinary inflammation disease, sterility, scanty, clear to mucopurulent discharge, dysuria, non-gonococcal urethritis, prostatitis, balanoposthitis, epididymitis, and urethral disease(4). Infection is usually mild with no symptoms, thus making men potential carriers. Spontaneous resolution of infection is common as the oxidative nature of the male genital tract is speculated to be inhibitory to pathogenic factors of infection, which usually remains for 10 days or less(1).
EPIDEMIOLOGY: Worldwide – trichomoniasis caused by T. vaginalis is one of the most common non-viral sexually transmitted diseases with an estimated 170 million cases occurring annually (no seasonal variability)(1), and incidence has been found to be high in non-hispanic black women(5). Infection usually occurs in women during reproductive years, and occurrence before menarche or after menopause is rare(4). Fourteen to 60% of male infections are associated with known infected female partners(1).
HOST RANGE: Humans(1).
INFECTIOUS DOSE: Experimental studies have shown that urogenital inoculation with 10,000 to 120,000 organisms has resulted in transmission, although epidemiological examinations have shown that the infective dose in women is low and the infection rate is high(8-10).
MODE OF TRANSMISSION: Commonly spread through sexual contact with vaginal or urethral discharges of infected persons(1), and transmission of organisms via artificial insemination of infected cryobanked semen is also possible(11). Non-sexual transmission is rare but has been observed in cases involving contaminated douche nozzles, moist wash-clothes, specula, or toilet seats(1,12,13). Transmission to newborn infants from infected mothers is possible and is observed in 2 – 17% of cases, and can result in urinary tract or vaginal infections(1).
INCUBATION PERIOD: Ranges from 3 – 28 days with an average of 7 days(4,14).
COMMUNICABILITY: Infection can persist for a significant period of time in asymptomatic cases(14), from months to years. SECTION III – DISSEMINATION
RESERVOIR: Humans, typically females, while men may act as a reservoir for infection(4).
ZOONOSIS: None.
VECTORS: None.
SECTION IV – STABILITY AND VIABILITY
DRUG SUSCEPTIBILITY: The only drugs that have been approved by the FDA for use in the United States are metronidazole (although the use of this drug can increase the incidence of preterm birth)(15), and Tinidazole (trade name known as Tindamax)(16). Ornidazole, secnidazole, and nimorazole can be used in countries outside of the US. In vitro testing has shown that nitroimidazole EU11100 also has similar efficacy as metronidazole(15).
DRUG RESISTANCE: Studies have shown that at least 5% of clinical cases of trichomoniasis are caused by metronidazole-resistant T. vaginalis, and cross-resistance to tinidazole is a concern as the two drugs are similar in modes of action (4).
SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 1% sodium hypochlorite, and 70% ethanol(17).
PHYSICAL INACTIVATION: Inactivated below pH 5(4). Organisms cannot survive long (several hours) in dry conditions(1).
SURVIVAL OUTSIDE HOST: The organism grows best at 37°C, and specimens in urine should be considered viable for only 30 minutes to avoid false negatives (2 hours if PCR is used)(18). Live T. vaginalis have been found in swimming pool water, in urine, and semen after up to 6 – 24 hours, and up to 30 – 45 minutes when exposed to air(1,19,20). Studies have also shown that T. vaginalis organisms are able to survive through the cryopreservation process of human semen, making infection via artificial insemination possible(11).
SECTION V – FIRST AID / MEDICAL
SURVEILLANCE: Monitor for symptoms. Current laboratory diagnoses include direct microscopic observation, cell culture, immunological techniques, PCR assay, nucleic acid probe test, immunochromatographic capillary-flow dipstick technology, DNA probing and gene amplification, and in situ hybridization(2,9,16).
Note: All diagnostic methods are not necessarily available in all countries.
FIRST AID/TREATMENT: Topical vaginal medications and pessaries (such as clotrimazole, povidone-iodine, nonoxynol-9, and arsenical pessaries) may be prescribed for treatment in women to lessen the effects of symptoms; however, these do not consistently cure disease(4). Topical paromycin has been found to be effective, but side effects can be mild to severe(21). There are no topical medications available for men. Metronidazole can be administered orally or intravenously, with cure rates of 85-95%(1); Metronidazole should not be used by pregnant women in their first trimester as it has been linked to higher prevalence of preterm birth(22).
IMMUNISATION: No vaccinations are currently available. Two vaccines have progressed to the human clinical trials stage in the past 50 years (a heat-killed T. vaginalis vaccine, and SolcoTriovac), although they have not been proven to be effective against T. vaginalis(4).
PROPHYLAXIS: Since many males are asymptomatic and may be carriers, it is important to concurrently treat male partners of infected women to prevent re-infection(4).
SECTION VI – LABORATORY HAZARDS
LABORATORY-ACQUIRED INFECTIONS: None reported to date.
SOURCES/SPECIMENS: Vaginal and urethral secretions, urine, human semen(4,11,18).
PRIMARY HAZARDS: Droplet exposure to mucous membrane, accidental parenteral inoculation and sexual transmission(1,23).
SPECIAL HAZARDS: None.
SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION
RISK GROUP CLASSIFICATION: Risk Group 2(24).
CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infected or potentially infected materials, animals, or cultures.
PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes(25).
OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities(25).
SECTION VIII – HANDLING AND STORAGE
SPILLS: Allow aerosols to settle and, while wearing protective clothing, cover spill with absorbent paper towel. Apply appropriate disinfectant, and starting from perimeter and wipe towards the center. Allow sufficient contact time with the disinfectant before cleaning up.
DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration(25).
STORAGE: Properly labelled and sealed containers.
SECTION IX – REGULATORY AND OTHER INFORMATION
REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.
UPDATED: November 2010
PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada
Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.
Copyright © Public Health Agency of Canada, 2010 Canada
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