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Vesicular Stomatitis Virus

Vesicular Stomatitis Virus

PATHOGEN SAFETY DATA SHEET – INFECTIOUS SUBSTANCES

SECTION I – INFECTIOUS AGENT

NAME: Vesicular stomatitis virus (VSV)

SYNONYM OR CROSS REFERENCE: Vesiculovirus(1,2), vesicular stomatitis(1,2,3,4,5), VS(1,2,3,4,5,6), vesicular stomatitis virus disease(3,7), vesicular stomatitis fever, and Indiana fever(3).

CHARACTERISTICS: A member of the Vesiculovirus genus, in the family Rhabdoviridae(3,6). VSV is a bullet-shaped, enveloped virus, approximately 70 nm in diameter and 170 nm in length(3), and has a single-stranded, negative-sense RNA genome(5,8). VSV has two main serotypes: VSV serotype Indiana (with its subtypes Cocal virus and Alagoas virus), and VSV serotype New Jersey(1,2,3,5,6,8).

SECTION II – HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Most human infections with VSV appear to be subclinical(1,6,8). In patients that show clinical manifestations, the initial symptom is high fever that is often biphasic. Subsequent symptoms are “flu-like” including severe malaise, headaches, myalgia, arthralgia, retrosternal pain, eye aches, and nausea(1,3,6,7). Occasionally a disease course with haemorrhages similar to dengue fever has been seen(6). Vesicle formation on the oral mucosa, lips, and nose is possible, but these are rare symptom of vesicular stomatitis (VS)(3,6,7). Most human cases of VS have been diagnosed in laboratory workers(3). In the laboratory, VSV has been engineered to target cancer cells or to stimulate immunity against diseases such as AIDS or influenza(8).

EPIDEMIOLOGY: VS exists in North and South America, Africa and Asia but not in central Europe(6). Serological surveys indicate that the prevalence of infection may be high among some populations in enzootic areas. For example, in a rural locality in Panama, more than 90% of the adult population is affected(3); however, the precise frequency of VS is not well established, as the disease often goes unnoticed due to its benign course.

HOST RANGE: Humans(1,2,4,5,6,8), horses(2,4,6,8), cattle, pigs, mules(2,6), sand flies(5,6), grasshoppers(4), and rodents(2).

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: Bite of an infected sand fly(1,5,7,8); by direct contact with abrasions on the skin; by contact with infected domestic animals; or by inhaling aerosols via the nasopharyngeal route(1,3). The virus has also been transmitted via accidental autoinoculation or inhalation of aerosols in a laboratory setting(3,8).

INCUBATION PERIOD: A wide range of incubation periods have been reported from 30 hours(1,6) to 6 days(7).

COMMUNICABILITY: There is no documented evidence of person-to-person transmission of VSV.

SECTION III – DISSEMINATION

RESERVOIR: The main reservoir is the sand fly, although arboreal rodents and non-human primates may also harbour VSV(7). Grasshoppers have also been implicated as a potential reservoir for VSV(4).

ZOONOSIS: Yes, humans can contract VSV through direct contact with infected animals, or indirectly through the bite of an infected fly(1,5,7,8).

VECTORS: Sand fly ( Phlebotomus spp.) appears to be the most important vector for VSV(2,6,8). Black flies ( Simuliidae )(2,5,6), midges ( Culicoides spp.), mosquitoes ( Aedes spp.)(2,5,8) and other diptera(2,5,6) have also been implicated.

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Unknown.

SUSCEPTIBILITY TO DISINFECTANTS: VSV is inactivated by 1% cresylic acid, phenolics, chlorinated phenol, 2.5% phenol, 0.4% HCl, 2% sodium orthophenylphenate(9), and sodium hypochlorite(1,9).

PHYSICAL INACTIVATION: Inactivated at low pH (1.5)(9), and immediately upon heating to 60 °C(10,11). VSV in stroma-free haemoglobin can also be inactivated by phototreatment (for example, with red light-emitting diode (655 nm), 1,9-dimethylmethylen blue (DMMB), or methylen blue (MB))(11).

SURVIVAL OUTSIDE HOST: VSV can survive for 3 to 4 days in infected saliva on milking pails, mangers and hay(1).

SECTION V – FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Human VSV infections are confirmed by virus isolation from throat swabs or blood(1,2,6). Other methods of detection include PCR(1,2,6), ELISA(1,2), neutralisation(2), compliment fixation, immunofluorescence, and electron microscopy(1).

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: No specific therapy is currently available. Symptomatic treatment and prevention of secondary infections is important(6).

IMMUNIZATION: None currently available for use in humans.

PROPHYLAXIS: None.

SECTION VI – LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: 46 recorded cases (with no deaths) until 1980(12).

SOURCES/SPECIMENS: Blood(3,4,6), throat secretions(1,3,6), saliva(1,3,4), exudates, or epithelium from open vesicles(1,3,4).

PRIMARY HAZARDS: Exposure of skin and mucous membranes to VSV via infectious aerosols and/or droplets(3).

SPECIAL HAZARDS: Handling infected livestock is a well documented hazard(1,2,3,6,7).

SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 3.

CONTAINMENT REQUIREMENTS: Containment Level 3 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.

PROTECTIVE CLOTHING: Personnel entering the laboratory should remove street clothing and jewellery, and change into dedicated laboratory clothing and shoes, or don full coverage protective clothing (i.e., completely covering all street clothing). Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Eye protection must be used where there is a known or potential risk of exposure to splashes(13).

OTHER PRECAUTIONS: All activities with infectious material should be conducted in a biological safety cabinet (BSC) or other appropriate primary containment device in combination with personal protective equipment. Centrifugation of infected materials must be carried out in closed containers placed in sealed safety cups, or in rotors that are loaded or unloaded in a biological safety cabinet. The use of needles, syringes, and other sharp objects should be strictly limited. Open wounds, cuts, scratches, and grazes should be covered with waterproof dressings. Additional precautions should be considered with work involving animals or large scale activities(13).

SECTION VIII – HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up (30 min)(13).

DISPOSAL: Decontaminate all materials for disposal by steam sterilisation, chemical disinfection, and/or incineration(13).

STORAGE: In sealed, leak-proof containers that are appropriately labelled and locked in a Containment Level 3 laboratory(13).

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: September 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

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

This MSDS / PSDS document, provided by Public Health Agency of Canada (PHAC), is offered here as a FREE public service to visitors of www.EHS.com. As outlined in this site’s Terms of Use, VelocityEHS is not responsible for the accuracy, content or any aspect of the information contained therein.\

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

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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