Attachment 7 ARS BARC Beltsville EAESP.pdf

Agricultural Research Service (ARS) Beltsville Location- BARC, BHNRC, USNA

EMPLOYEE ANIMAL EXPOSURE

SURVEILLANCE PROGRAM

FOREWORD

The purpose of this program is to provide an employee health program for a specific target group of Beltsville Location employees--those who have direct work contact with animals and animal products.

The Agricultural Research Service (ARS), BL has long had an occupational medical surveillance program for employees potentially exposed to substances capable of causing serious, acute, or chronic occupational disease. The program to be described here, the Employee Animal Exposure Surveillance Program (EAESP), is an OSHA mandated program. The ARS BL has a moral and legal responsibility to provide a safe and healthful working environment for its employees. The authorities for this program will be described in the following pages.

Mandatory Employee Animal Exposure Surveillance Program

(EAESP)

I. Introduction:

ARS Directive 635.1 (Humane Animal Care and Use) fully subscribes to the requirement for mandatory employee health plans for employees who work with animals.

A. For employees who work with laboratory animals, that requirement is stat ed in: The NIH

Guide for the Care and Use of Laboratory Animals (NIH Guide) including the portion concerning Occupational Health Programs (page 6) that states in part:

"An occupational health program is mandatory for personnel who work in laboratory animal facilities or have substantial animal contact."

B. For employees who work with farm animals, that requirement is stated in the Guide for the Care and Use of Agricultural Animals in Agricultural Research and Teaching (page 5) which makes substantially the same requirement for personnel who work with agricultural animals.

A satisfactory program must be adequate to protect the employees from health problems that can be developed or exacerbated as a consequence of animal contact and also should protect the animals from any diseases transmissible to them from humans.

Another important document is ARS DIRECTIVE 414.0 Occupational Medical Surveillance Program, supersedes the ARS 230.0, which states the ARS policy and responsibilities for providing an employee health program for employees potentially exposed to any substance capable of causing serious, acute, and/or chronic occupational disease. The manual also provides procedures for establishing and administering the program and states the ARS policy and responsibilities for the Employee Occupational Health Services Program.

The Beltsville Location (BL) Occupational Medical Surveillance Program (OMSP) aims to fulfill the above requirements through a Mandatory Employee Animal Exposure Surveillance Program whose goals are to minimize both the human suffering and monetary losses that accompany illness. Although any organization should take into consideration the high cost of uncontrolled accidents and illness among their personnel, particular attention must be given to this subject in any institution where job assignments may constitute specific health hazards.

There are standard components to the program for all employees who work with animals and more specialized components related to the type of work and species contacted.

https://www.ars.usda.gov/ARSUserFiles/80000000/SHE/Directive635-1.doc https://grants.nih.gov/grants/olaw/guide-for-the-care-and-use-of-laboratory-animals.pdf https://grants.nih.gov/grants/olaw/guide-for-the-care-and-use-of-laboratory-animals.pdf https://www.asas.org/docs/default-source/default-document-library/agguide_4th.pdf?sfvrsn=56b44ed1_2 https://www.asas.org/docs/default-source/default-document-library/agguide_4th.pdf?sfvrsn=56b44ed1_2 https://usdagcc.sharepoint.com/sites/REE-ARS-SOHESSAFETYPROGRAM/SiteAssets/SitePages/Centers%20Safety%20Programs/414.0-medical-surveillance-program.pdf?web=1 https://usdagcc.sharepoint.com/sites/REE-ARS-SOHESSAFETYPROGRAM/SiteAssets/SitePages/Centers%20Safety%20Programs/414.0-medical-surveillance-program.pdf?web=1

II. Eligibility and Organization:

A. Eligibility

Persons are to be included in this program if they are ARS employees whose animal studies are under surveillance of the BL Institutional Animal Care and Use Committee (IACUC) and also have direct contact with any of a variety of animals or their viable tissues, body fluids, wastes or their living quarters. Other Federal or non-Federal employees or students who have the same pattern of direct contact within the confines of the Belt sville Location (BL) are expected to be covered by a similar program in force at their own institution and signify to that by signing an assurance. [See example Assurance in Attachment 1.]

ARS employees are to be included in this program if:

1. They are "animal handlers," i e., they:

a. are involved in the direct care of animals or their living quarters on a regular basis (i.e., one or more times per week), or

b. have direct contact with animals (live or dead), their viable tissues, body fluids, or wastes on a regular basis (i.e., one or more times per week).

2. They are "casual animal handlers," i.e., they have only sporadic or episodic exposure to animals or their viable tissues, body fluids or wastes (e.g., temporary exposure due to a specific protocol).

NOTE: "Animal handlers" and "casual animal handlers" as used in the EAESP refer to anyone--scientists, animal care technicians, support staff--that qualifies for the program on the basis of animal contact.

B. Code Categories

Participants in the EAESP are organized into code categories that reflect the specific surveillance needs of the individual based on occupational exposure. Services provided during enrollment and subsequent visits are explained in subsequent Sections of this document. The codes are outlined in the following table:

Code Type of Animal Contact

Al Animal handlers working with small laboratory animals (e.g., rodents, rabbits, etc.)

A2 Animal handlers working with large animals (e.g., cats, livestock, including avian species)

A3 Animal handlers working with wildlife species, either in the field or in captive situations

A4 All casual animal handlers

C. Preemployment Health Actions

Preemployment health surveillance to determine fitness for duty for working with animals covers present and newly hired ARS employees.

1. For employees new to ARS.

The Preemployment physical examination is designed to determine physical fitness for working with animals. Persons determined to be physically unfit for such work will be eliminated from further consideration. Examples of medical conditions that would disqualify an applicant include, but are not limited to, severe and uncontrollable allergies to the animal species involved in the job, immunosuppression from any cause, and inability to lift equipment or animals involved in the job for which the applicant is being considered.

Before finalization of hiring procedures for employees who are to work with animals, a physical examination (at ARS expense) is required that includes a course of immunizations (the nature of which are determined by anticipated species contact).

A preemployment medical history and medical baseline interview is done to obtain an up-to-date history. Particular attention is given to chronic or debilitating diseases, sensitivity to antibiotics or animal products, or other conditions that might influence future emergency treatment.

For persons determined to be physically fit to work with animals and selected to fill the job, the preemployment physical examination is designed to establish baseline medical data needed to provide a basis for scheduling a program of surveillance and immunizations.

Preemployment blood samples are obtained for inclusion in the employee's serum bank. When necessary, during the period of employment, such samples are used to determine preemployment serological levels required to establish an early and accurate diagnosis of diseases that could constitute an occupational hazard to BA employees (preexposure serological levels provide comparison levels in the event of employment-connected infections).

2. For ARS employees seeking reassignment to an animal handling job from a non-animal handling job.

The same medical information and physical examination described in C.1. above is required. Persons determined to be physically unfit for work with animals will be eliminated from further consideration. Examples of medical conditions that would disqualify an applicant include, but are not limited to, severe and uncontrollable allergies to the animal species involved in the position, immunosuppression from any cause, and inability to lift equipment or animals involved in the position.

D. Records and Files

A confidential medical records jacket will be established for each EAESP participant in the control of the current Agency Physician. The results of all health examinations that are part of EAESP and clinical tests will be maintained in the medical records jacket and copies may be made available to a participant and/or his/her private physician upon request by the participant. Supervisors of participants will be provided with a summary evaluation of the participants' "fitness for duty." [See example in Attachment 2.]

Medical Removal

For employees working with animals who develop temporary medical reasons for suspension of work with animals (e.g., broken limb), temporary reassignment to other duties (for a finite term) will be utilized until the employee can resume the permanent animal work assignment.

In cases where permanent or long-term (more than 6-month) medical situations arise after assignment to duty working with animals (e.g., immunosuppression due to long-term chemotherapy), every effort will be made to accommodate the participant by reassignment to different duties not hazardous to his/her health; however, if that is not possible, retirement or dismissal may be necessary.

III. IDENTIFICATION OF EAESP PARTICIPANTS:

A. Sanctions for Participation

Ideally, enrollment in EAESP occurs prior to the participant's exposure to animals, their viable tissues, body fluids or wastes. To enhance the likelihood of timely enrollment:

1. All applicants for jobs requiring exposure to animals, their viable tissues, body fluids or wastes receive preemployment (or pre-reassignment) physical examinations that include questions regarding anticipated occupational exposure to animals.

Persons anticipating job exposure to large animals (Codes A2 & A3) may also receive the services listed in Section V below. All applicants also must complete ARS forms 182A, B, & C for enrollment in the ARS Occupational Medical Surveillance Program (Attachment 3). These forms are available from SOHU.

2. Institute/Center/Deputy Area Directors, RLs and the Attending Veterinarian are encouraged to refer employees with animal contact to EAESP for enrollment.

There are sanctions for nonparticipation (below).

B. Sanctions for nonparticipation

Current ARS employees employed in jobs that require exposure to animals, their viable tissues, body fluids or wastes at the time of initiation of the EAESP and therefore identified as eligible to partici pate in EAES P, and refuse to do so, will be required to sign a statement documenting their refusal.

1. Refusal to participate in the EAESP, at the time of EAESP initiation, by ARS employees who are at that time classified in Codes AI, A2, or A3 (See Section II.B for full description of code categories) may be grounds for disapproval of authorization to work with animals.

2. After EAESP has been established, no persons seeking new employment or reassignment to jobs that require exposure to animals, their viable tissues, body fluids or wastes will be assigned to such jobs if they refuse to participate in

EAESP.

3. After establishment of EAESP, supervisors who anticipate addition of exposure to animals, their viable tissues, body fluids or wastes to the responsibilities of one of their current ARS employees are responsible for assuring that the employee is enrolled in EAESP prior to the assignment of these responsibilities. Supervisors are expected to inform these employees of the need to participate in EAESP.

Supervisors are expected to WITHHOLD ASSIGNMENT of exposure to animals, their viable tissues, body fluids or wastes to any employee who would attain classification as either Code A1, A2, or A3 if that employee refuses to participate in EAESP.

IV. SERVICES FOR ALL PARTICIPANTS:

A. Education and Training

Education in the form of informational handouts (for example concerning specific zoonotic diseases and health hazards concerning BL animal use), and counseling is provided to participants at the time of enrollment, during interval physical examinations, and when injuries are reported.

B. Physical examination

At the time of enrollment in EAESP, the components of the examination are based upon the functional requirements of the job, the type of animal( s) contacted and the individual's prior medical record (see Table 1).

C. Serum Storage

At the following times, a 5 ml serum sample is obtained from all EAESP participants and stored in two equal aliquots at -20o C:

1. Enrollment physical examination,

2. Interval physical examination,

3. Examination following report of bite or scrat ch injury,

4. At the discretion of the medical examiner, during the report of an illness that may be job-related.

D. Tetanus Prophylaxis

Immunization with tetanus toxoid vaccine is updated according to recommendations of the Public Health Service Immunization Practices Advisory Committee (IPAC) of the Centers for Disease Control. Booster doses may be administered as needed during any of the following:

1. enrollment physical examination,

2. interval physical examination, or

3. the repo rt of an injury.

E. Tuberculosis Screening

1. Enrollment tuberculin skin testing (PPD) is administered to individuals without a prior history of a reactive test. A chest x-ray is required in the initial evaluation of new reactors and for:

(a) tuberculin reactors (10 mm or greater of induration at 48 hours) or persons with history of a tuberculin reaction but who have not had a chest x-ray in the preceding year.

(b) EAESP participants with history of BCG vaccination and a reactive tuberculin test who have not had a chest X-ray in the preceding year.

2. In the event of a work exposure to active pulmonary tuberculosis, a contact study will be conducted.

F. Evaluations of work-related injuries and illnesses

Should be reported as soon as possible to the supervisor.

1. Injuries resulting from direct animal contact are of particular interest due to potential concomitant infection, e.g., tetanus etc.

(a) blood sample is drawn for purposes of serum storage at the time of report of an animal bite or scratch injury.

(b) wound evaluation and treatment are performed by the Agency Physician in accordance with wound care guidelines found in ARS DIRECTIVE 414.0 Occupational Medical Surveillance Program

2. Infectious diseases. Many of the agents responsible for viral, bacterial and parasitic infections in animals are capable of infecting humans. Some of these agents are covered in this surveillance document; many are not. Participants in EAESP are counseled to report to their supervisors any gastrointestinal, respiratory or dermal illnesses which may resemble the signs or symptoms of infections in the animals for which they are caring.

3. Allergies. Employees at risk of developing work related allergies include those with a history of preexisting allergies, asthma, seasonal rhinitis or eczema.

EAESP participants with suspected work related allergies are encouraged to seek evaluation and treatment.

https://usdagcc.sharepoint.com/sites/REE-ARS-SOHESSAFETYPROGRAM/SiteAssets/SitePages/Centers%20Safety%20Programs/414.0-medical-surveillance-program.pdf?web=1 https://usdagcc.sharepoint.com/sites/REE-ARS-SOHESSAFETYPROGRAM/SiteAssets/SitePages/Centers%20Safety%20Programs/414.0-medical-surveillance-program.pdf?web=1

V. SERVICES FOR PARTICIPANTS WITH LARGE ANIMAL CONTACT:

Codes A2 and A3 EAESP participants receive all the services listed in Section IV plus the following:

A. Rabies prophylaxis

1. Based on current IPAC recommendations, rabies preexposure prophylaxis with human diploid cell rabies vaccine (HDCV) should be considered for the following classes of participants:

(a) those working directly with rabies virus

(b) those having large animal contact (i.e. Code A2 personnel)

(c) those having exposure to potentially infected animal body organs or performing post mortem examinations on animals with a history of poorly defined neurological disorders

(d) Code A3 personnel (this Code includes any BL personnel responsible for capturing or destroying wild animals that invade BL).

2. Serological monitoring and booster doses

(a) Serological monitoring is performed annually on all HDCV recipients with the exception of the first year after completion of the primary series.

(b) Booster doses are administered to participants with inadequate titers.

Inadequate titer is defined as less than 5.0 IU/ml for individuals working with live rabies virus and less than 0.5 IU/ml for all others.

3. Hypersensitivity Reactions

All participants receiving HDCV booster doses are questioned regarding type I or type III allergic reactions to previous doses of HDCV.

(a) Type I reaction (immediate hypersensitivity) is characterized by bronchospasm, laryngeal edema, generalized pruritic rash, urticaria and/or angioedema. Participants with possible type I reactions should not receive further doses of HDCV.

(b) A type III reaction (delayed allergic reaction) occurs 2 to 21 days after a dose of HDCV is received.

A type III reaction is characterized by a generalized pruritic rash or urticaria, arthralgia, arthritis, angioedema, nausea, vomiting, fever and/or malaise. Participants with a presumed type III hypersensitivity reaction should not receive further doses of HDCV unless:

(1) they are exposed directly to rabies (bite by a rabid animal)

(2) they are likely to be inapparently or unavoidably exposed to the rabies virus.

B. Toxoplasmosis

At risk employees are female Code A2 participants of childbearing age (15-45) who are occupationally exposed to cats or their feces.

1. Toxoplasmosis antibody titers are determined on EAESP participants who fit the description in the last paragraph. A titer of less than 1:16 by immunofluorescent testing is indicative of the absence of immunity.

2. Females of childbearing capacity who lack immunity and who plan to work with cats are informed of their potential susceptibility and provided additional education and information on toxoplasmosis.

3. Every effort should be made by the supervisor for a temporary job reassignment while a susceptible participant is pregnant. When this is not possible, consultation with the BL Safety Office and/or the OHMP contractor is encouraged to identify other ways to protect the susceptible participant.

C. Q Fever

Code A2 employees at risk of exposure to Q fever are either those who have direct contact with the organism Coxiella burnettii in an occupational capacity, i.e., through research or by handling or using products of parturition (placenta, amniotic fluid, blood or soiled bedding) of infected sheep, goats or cattle.

1. At the time of enrollment physical examination, and again if animal care duties change from exposure to rodents and lagamorphs only to exposure to farm animals and direct contact with the organism Coxiella burnettii in an occupational capacity, i.e., through research or by handling or using products of parturition (placenta, amniotic fluid, blood or soiled bedding) of infected sheep, goats or cattle. EAESP participants with valvular or congenital heart defect, those who are receiving immunosuppressant drugs or those allergic to tetracycline (the drug of choice for treating Q fever) are advised of the potential risks involved and medical clearance for duty will be determined by the examining physician on a case by case basis.

2. Acute Illness

(a) Signs and symptoms

Q fever is an acute systemic illness that is characterized by sudden onset of severe headache, high spiking fever to 104OF or greater, chills, and myalgia. The patient may present with pneumonitis or clinical hepatitis.

The incubation period averages 20 days, with a range from 14 days to a high of 39 days.

(b) Diagnosis

Diagnosis is made serologically. Serum is sent for ELISA testing at the time of presentation, in two weeks and then every 30 days for three months. Serological testing is performed by U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD.

(c) Treatment

Treatment consists of tetracycline: 500 mg every six hours for a minimum of seven days and is initiated as soon as diagnosis is suspected. With treatment there is a sharp fall in the temperature within 48 hours.

(d) Work Status of Q Fever Patients

Since there has been no documented human-to-human transmission of Q fever, the EAESP participant's work status depends upon the severity of symptoms.

D. Brucellosis

1. Brucellosis is an infectious disease of livestock that can cause infections in humans and potentially result in a chronic disease with recurrent bouts of high fever and flu-like symptoms. It is especially important that persons administering live-vaccine to livestock be aware of the fact that some vaccine products can cause clinical brucellosis in humans and that infection may be caused by exposure to aerosols of the vaccine (e.g., as may occur if a needle comes off of a syringe during injection and the resulting aerosol splashes into the operator's eyes).

2. Persons administering brucellosis vaccines should be counseled in the use of appropriate safety procedures (e.g., how to minimize the potential for self-inoculation) and equipment (e.g., the use of safety glasses or goggles) and advised to report any onset of fever or flu-like symptoms to their supervisors and/or physicians. Physicians should also be informed of the fact that animal contact is a part of the patient's work.

E. Other Livestock Zoonoses

Numerous other infectious diseases of livestock may cause clinical human diseases.

However, no specific prophylactic procedures, such as vaccination, are available. Persons working with livestock should be counseled to the fact that such potential hazards exist;

in the use of general preventive measures (e.g., the use of appropriate protective gear and personal hygiene procedures), and to report any illness that may be related to their animal exposure to their supervisors and/or physicians. Physicians should also be informed of the fact that animal contact is a part of the patient's work.

VI. COMPONENTS OF EAESP SPECIFICALLY FOR PARTICIPANTS WITH

WILDLIFE CONTACT:

A. Infectious Agents

1. Rabies

(a) All persons in contact with wild mammals in the area surrounding BL (including Maryland, Virginia and the District of Columbia) are at risk for exposure to rabies endemic in the area and should be encouraged to participate in the rabies vaccination program (see Section V.A. above).

(b) All persons working with wild mammals should be counseled to avoid any direct interaction with an animal behaving abnormally since abnormal behavior may be the only overt clinical signs of rabies infection (e.g., a normally nocturnal animal abroad and active in mid-day or an apparently docile animal that normally would be aggressive or elusive).

(c) All persons sustaining a bite from a wild animal, or who contaminate an open wound with body fluids from a wild animal, should inform their supervisor and seek advice from a physician on the necessity for rabies prophylactic treatment.

2. Tularemia

(a) Persons handling wild rabbits and other infected mammals and birds, especially skinning them or doing post-mortem dissections are at risk for exposure to tularemia (Francisella tularensis).

(b) All persons working in tularemia endemic areas, or directly involved with skinning or doing post-mortem examinations of wild animal carcasses, should be counseled about the potential danger of tularemia.

In addition, they should be counseled about the signs and symptoms of human tularemia and advised to seek medical advice if they develop local lesions on their hands, sore lymph nodes, or flu-like symptoms within two weeks of engaging in such activities.

(c) All persons anticipating engaging in theactivities described in the preceding paragraph should be counseled on the use of appropriate procedures to minimize potential exposure to themselves.

3. Psittacosis

(a) Persons working with wild birds, especially pigeons, or in environments where they may inhale dust from the birds' feces or feathers (e.g., in pigeon roosts), are at risk for exposure to psitticois (Clamydia psittaci is the causative agent). Since the is danger of infecting BL flocks with psitticosis from feral birds, no work with wild birds is permitted on BL.

(b) Persons who work with avian species on BL should avoid exposure to wild birds.

B. Insect Borne Diseases

1. Tick Borne Diseases

(a) The following are representative of the diseases that can be transmitted from wild and domestic animals via tick vectors:

(1) Lyme disease is caused by the spirochete, Borrelia burgdorferi and transmitted by the minute tick, Ixodes dammini: [Futher information on this disease is in Section B.1.c.(1)]. EAESP participants potentially exposed to Lyme disease should contact SOHU for more information.

(2) Relapsing Fever is caused by a bacterium (Borellia spp.) and transmitted by soft ticks (genus Ornithodoros).

(3) Rocky Mountain Spotted Fever is found widely distributed in the United States (in addition to the Rocky Mountain area). It is caused by a rickettsia (Rickettsia rickettsii) and is transmitted by hard-shelled ticks (primarily the wood tick, Dermacentor andersonii).

(4) Plague (sylvatic or rural plague is the term for the disease picked up from exposure to infected feral animals). The causative agent, the bacterium, Yersinia pestis, can be transmitted by many species of contaminated ticks (but primarily by fleas).

(b) Persons working in tick-infected outdoor areas and those purposely collecting minute ticks that might be infected with the Lyme disease spirochete are at risk for exposure to disease via tick bites. The degree of hazard is less during winter for those working in outdoor areas. However, persons handling tick-infected animals, or exposed to tick-infested animal dens, may be exposed at any time of the year.

(c) Generally, these tick-borne diseases cause sudden onset of severe flu-like symptoms in infected persons within one or two weeks after infection [but see Lyme disease exception in c.(1)]. However, it is important to inform persons at risk of the following specific aspects of the above diseases:

(1) Lyme disease may not manifest itself for up to five weeks and symptoms may start with a non-painful red welt at the extremities or trunk, and later may expand up to 20 inches in diameter, frequently with central clearing or ulceration. Severe and chronic arthritis and/or neurologic abnormalities may occur within weeks or months and may last for two or more years. Early diagnosis and treatment are essential to prevent chronic disease. Currently, there is no vaccine for Lyme disease.

(2) Rocky Mountain Spotted Fever mortality, in untreated cases, may be as high as 50%. Early diagnosis and treatment are essential.

Currently, there is no approved vaccine for Rocky Mountain Spotted Fever.

(d) Persons engaging in activities in tick-infested areas should be counseled on the potential dangers involved with tick bites and cautioned to examine themselves for ticks. In addition they should be advised to use insect repellent and wear appropriate clothing to minimize skin exposure to ticks.

(e) Persons potentially exposed to tick bites should be advised of proper first-aid for such cases, i.e.:

(1) Remove the tick with steady pressure and without squashing it (for most ticks, grabbing the head with a pair of tweezers and exerting steady traction or touching a hot match to its shell will be effective).

(2) Gently wash the bite with soap and water apply alcohol or an alcohol-based antiseptic.

(f) Persons developing any of the symptoms noted in the preceding paragraphs on tick-borne diseases should contact a physician immediately and inform her/him of the potential of tick exposure.

2. Flea-Borne Diseases

(a) Plague

(1) The only flea-borne disease of significance relative to working with wild animals is Plague caused by the bacterium Yersinia pestis and transmitted by numerous species of fleas. The disease may appear in either the bubonic form (sudden onset of swollen and painful lymph nodes called "buboes" and flu-like symptoms within 12 days of infection) or the pneumonic form (abrupt onset of severe pneumonic symptoms, including blood in the sputum within two to three days of infection).

(2) mortality in untreated cases may be as high as 60% within two to five days after onset of symptoms. Early diagnosis and treatment is very effective in reducing mortality to very low levels.

(3) Persons developing any Plague symptoms should contact a physician immediately and inform her/him of the potential wildlife-flea exposure.

3. Mosquito-Borne Diseases

(a) Several forms of Encephalitis can be transmitted form wild and domestic animals to human via mosquito vectors (genera Culex and Aedes).

(b) Persons working outside in endemic areas during mosquito season are considered to be at risk of exposure to these diseases. At this time, there is no reason to suspect that BL is an endemic area.

C. Envenomation by Poisonous Animals

1. Poisonous Insects and Arachnids

(a) Bees Wasps, Hornets, Ants, and Spiders

There is danger of severe anaphylactic shock and even death as a result of insect bites to hypersensitive individuals.

Persons known to be hypersensitive to insect venom should be counseled to avoid working in jobs with high probability of exposure or they should carry (and know how to self-administer) appropriate anti-reaction medications (e.g. antihistamines and epinephrine).

2. Snakes and Lizards

(a) Contact with poisonous copperhead snakes is a danger on BL. Persons working outdoors should wear leather or thick rubber overshoes with pants legs tucked in, to minimize the chance of painful, and possibly poisonous bites.

(b) Not all bites from poisonous snakes results in envenomation. When envenomation does occur, signs and symptoms vary from moderate local reactions to life-threatening symptoms.

First aid consists of the application of a snug constriction band close to and proximal to the bite (not a tourniquet--only tight enough to restrict lymph and peripheral venous flow); small incision over the fang marks (no larger than 1/4 inch long and 1/8 inch deep); suction of incisions if within an hour of envenomation; immobilization of the affected part and, if possible, keeping the patient warm; and, if available, administration of antivenin.

Note: if first aid cannot be administered by a competent individual, the best course of action is to apply the constriction band and get the patient immediately to the nearest medical facility.

In cases of envenomation, the patient must be transported to the nearest medical facility as soon as possible.

(c) Persons engaging in outdoor work activities in areas of potential poisonous snake contact should be counseled on the potential dangers involved with bites and advised to use caution when working in high risk areas.

D. Water Borne Diseases

1. There are at least four diseases that persons working in the field may contract from wading in or drinking contaminated water, i.e.:

(a) Giardiasis

Caused by the intestinal protozoan, Giardia lamblia, and transmitted by ingestion of untreated contaminated water. Symptoms are generally limited to chronic mild mucoid diarrhea, abdominal pain, and weight loss. Beaver are a significant wildlife reservoir for this parasite.

(b) Leptospirosis

Caused by bacteria, Leptospira spp., and transmitted by wading in, or ingestion of, untreated contaminated water. Symptoms usually are limited to sudden flu-like symptoms with fever spikes up to 102o F, recurring in cycles of about one to two weeks. More severe symptoms may occur (e.g. abortion, kidney failure and meningitis). Cattle and swine may be significant animal reservoirs for this organism, and rats (and other rodents) are the normal carrier host.

(c) Erysipeloid

Caused by a bacterium, Erysipelothrix rhusiopathiae, and transmitted by contaminated water. Symptoms are generally limited to localized wound infections. This disease is seen primarily in persons occupationally handling animals, meat, poultry, fish, and shellfish.

(d) Salmonellosis

Caused by a bacteria, Salmonella spp., and transmitted by ingestion of untreated contaminated water or hand-to-mouth contamination following handling of infected animals or contaminated water. Generally, symptoms are limited to mild diarrhea. However, the diarrhea may be severe and life-threatening in very young or elderly persons. This disease usually is associated with populations of freshwater turtles but poultry, swine, cattle, and rodents are important reservoirs.

(e) Persons at risk of ingesting food contaminated by feces of infected animals should be counseled on precautions. Persons engaging in outdoor activities that require them to work in bodies of water with unknown microbiological content, and/or consume such water, should be counseled on the potential hazards associated with aquatic environments and on the procedures for minimizing risks of infection and for decontaminating water for drinking purposes.

(f) Persons developing any of the symptoms discussed above should consult a physician as soon as possible and inform him/her of the exposure to potentially contaminated water.

VII. COMPONENTS OF THE EAESP SPECIFICALLY FOR PARTICIPANTS

WITH ONLY "CASUAL" ANIMAL CONTACT:

A. Counseling of Casual Animal Handlers

Prior to their initial animal contact persons with only casual animal contact will be counseled by the responsible supervisor as to any potential health hazards associated with their animal exposure.

Casual animal handlers may not have been required to participate during the initial screening, i.e., filling out forms addressed in Attachment 3.

Therefore, the supervisor must contact SOHU to obtain the appropriate forms described in Attachment 3. In addition, the supervisor will be responsible for informing persons with casual animals contact about, and providing instruction in the use of, appropriate safety procedures and equipment.

All casual animal handlers will provided with a written handout documenting the potential hazards and appropriate safety procedures involved with their animal exposure.

B. Health Status Survey

Prior to their initial animal contact, all casual animal handlers will be required to complete a health questionnaire [see Attachment 3] to determine:

1. that they do not have a medical condition that would preclude them from working with animals (e.g. undergoing immune suppression therapy or severe allergies) and

2. that they have a current tetanus vaccination (within the previous 10 years).

VIII. SURVEILLANCE RECALL

A. Employees enrolled in the EAESP are recalled for medical follow-up at a periodicity that depends upon the specific type of animal exposure.

1. Participants working with small laboratory animals (Code A1) are advised to return for tetanus booster every 10 years.

2. participants working with large animals and wildlife (Codes A2 & A3) are routinely recalled annually for serological monitoring of immunization for rabies.

If immunization for rabies is not indicated, these participants are advised to return for tetanus booster every 10 years.

B. Notices for surveillance recall [see Attachment 2] are sent to employee's supervisors, as necessary, every 6 or 12 months. Recall appointments are then arranged by the examining physician's office and the employee's supervisor.

C. Supervisors will be informed of an employee's non-compliance with the EAESP (e.g., employee did not participate in scheduled medical examination).

ATTACHMENT 1

ATTACHMENT 2

TABLE 1

Summary Activities in Employees Animal Exposure Surveillance Program

Code type Employee and Special Subgroups

Routine Procedures Al A2 A2 (Females 15-45 working with cats)

A3 A4

Full physical exam PA PA PA PA * History update Annual Annual Annual Annual * TB screen skin test PA PA PA PA *

TB reactors PA & qyr PA & qyr PA & qyr PA & qyr * Rabies vaccine ___

PA PA PA *

Rabies booster

___ Serum test/boost 2 yr

Serum test/boost 2 yr

Serum test/boost 2 yr

Tetanus 10 yr 10 yr 10 yr 10 yr 10 yr Serum storage PA & 5 yr PA & 5 yr PA & 5 yr PA * Toxoplasmosis Titer PA & annually Other See EAESP text for special requirements including actions as a result of injuries.

* An A4 employee may need any of the listed routine procedures depending on the specific protocol or type of contact.

Notes: PA=Preassignment

Preassignment physical exam includes medical history, examination of pertinent body systems, vision test, TB test, chest X-ray, hearing test health risk appraisal. Further tests may be performed if indicated.

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