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The monkey population in urban areas of India is substantially high and is growing steadily. Although measures are taken by animal control authorities to curb the monkey population, they continue to be a public menace. A study conducted in New Delhi found that monkey bites and cat bites share the second place for most common animal bites, after dog bites. The most common monkeys in India are the macaque, or old world, monkeys, which are reservoirs of the simian Herpes B virus in the wild. While monkeys are known to cause damage to public property, they seldom attack humans. When aggravated, teased or provoked in any manner, the agile monkey may attack. A monkey bite can be a very distressing situation and may be associated with other injuries as well. First-aid measures should be taken to prevent complications and the patient should be taken to a healthcare facility immediately. Certain injections will also be needed at the healthcare centre to prevent infections transmitted by monkey bites.

  1. Recognising a monkey bite
  2. What to do in case of a monkey bite
  3. Medical treatment of a monkey bite
  4. Complications of a monkey bite

Monkey bites can present as follows:

  • Pain and tenderness
  • Puncture wound
  • Bleeding may or may not be present depending on the depth of the bite
  • Surrounding skin may be bruised and appear blue
  • Shallow wounds after a monkey bite may only show a break in the skin surface without bleeding
  • Deeper wounds after a monkey bite may be associated with tears in soft tissue and bleeding
  • The bone may be exposed in very deep wounds caused by monkey bites 
  • Inability to move the joint or limbs due to muscle, tendon or joint injury in the affected area 
  • Agitation, sweating, crying or screaming 
  • Excessive pain that causes the patient to faint

As monkey bites can lead to various complications and transmission of certain viruses and bacteria, immediate first aid within 5 minutes of the incident is needed.

Steps to take when giving first aid to a person who has experienced a monkey bite are:

  • Try to keep the patient calm.
  • Wash your hands thoroughly with soap and water if possible.
  • Wear gloves and safety goggles wherever possible while assisting the monkey bite patient, especially if the patient has a deep wound and is bleeding.
  • The wound needs to be cleaned and scrubbed (even if the patient is bleeding) immediately after or and within 5 minutes of the bite for at least 15 minutes. This is the most important step as it can prevent the transmission of certain monkey-borne viruses. Steps to clean the monkey bite wound:
  • Cleanse the exposed wound area by thoroughly washing and scrubbing with soap, a concentrated solution of detergent, povidone-iodine (betadine) or chlorhexidine and water. This should be done within 5 minutes of the monkey bite. 
  • Irrigate the washed area with running water for 15-20 minutes.
  • Dry the wound gently with sterile gauze pads.
  • Apply a fresh pad and wrap it in place with gauze and tape.
  • If possible, try to identify the monkey or take a photograph. This can help identify the monkey type and guide hospital care.
  • Immediately take the patient to the emergency department of a healthcare facility.

(Read more: Monkey fever)

Steps to take if the eyes, nose or mouth of a person comes in contact with the saliva, urine, feces, blood or any other secretion of a monkey:

  • The eyes, nose and/or mouth should immediately be cleaned with filtered water or sterile irrigation fluid (if available).
  • Normal saline should be used to flush the eyes if available.
  • Never use detergent, soap, povidone-iodine (betadine) or chlorhexidine (Dettol or Savlon) on the eyes.
  • Try to identify the monkey or take a photograph if possible. This may help guide hospital care.
  • Take the patient to the emergency department of a healthcare facility immediately.

Once at the medical emergency department, the doctors will irrigate the wound or exposed skin and mucous membrane with sterile irrigation fluid for another 15 minutes. The patient will then promptly receive antibiotics and post-exposure prophylaxis treatment. Post-exposure prophylaxis refers to the medicines or immunoglobulins that are given to a person after coming in contact with a possible source of disease to prevent infection. If the wound is cleaned and scrubbed in time after a monkey bite (within 5 minutes), virus transmission could be prevented.

Treatment at the healthcare facility would involve:

  • Tetanus post-exposure prophylaxis: Depending on the nature of the wound, tetanus post-exposure prophylaxis may be required.
    • Unvaccinated persons should start and complete a primary series with an age-appropriate tetanus toxoid-containing vaccine (i.e., DTaP, TdaP, Td).
    • If the patient has received all three tetanus vaccinations in the past and received the last dose less than 5 years back, no further jabs for tetanus are needed.
    • If the patient has received all three tetanus vaccinations in the past but received the last dose more than 5 years ago, a vaccine booster is given. 
    • 250 IU intramuscular dose of tetanus immunoglobulin (TIG) is administered to unvaccinated patients with contaminated dirty wounds or immunocompromised people with HIV.
  • Rabies post-exposure prophylaxis: A dose of human rabies immune globulin (HRIG) or rabies vaccine is given on the day of the monkey bite and then a dose of the vaccine may be given again on days 3, 7 and 14. People who have been previously vaccinated for rabies may receive only a vaccine.
  • B virus post-exposure prophylaxis: If the skin has not been broken through or there has been no contact with the secretions of the monkey, B virus prophylaxis may be skipped. Otherwise, the recommended protocol is:
    • Administration of B virus-specific immunoglobulin, if available
    • Valacyclovir 1g by mouth every 8 hours for 14 days or Acyclovir 800 mg by mouth 5 times daily for 14 days
  • Antibiotic prophylaxis: Large wounds that are at risk of becoming infected may need an antibiotic course.

Untreated monkey bites can lead to serious complications including:

  • Wound infections
  • Herpes B virus
  • Rabies
  • Tetanus

(Read more: Viral infection)

References

  1. Vodopija R, Vojvodić D, Sokol K, Racz A, Gregurić Beljak Ž, Baranj N, et al. MONKEY BITES AND INJURIES IN THE ZAGREB ANTIRABIES CLINIC IN 2014. Acta Clin Croat. 2018 Sep;57(3):593-601. PMID: 31168195.
  2. Newton F. Monkey bite exposure treatment protocol. United States Armed Forces., J Spec Oper Med. 2010 Winter;10(1):48-9. PMID: 20306415.
  3. Rasania SK, Bhalla S, Khandekar J, Pathi S, Matta S, Singh S. Post exposure management of animal bite cases attending a primary health center of Delhi. J Commun Dis. 2004 Sep;36(3):195-8. PMID: 16509257.
  4. Riesland NJ, Wilde H. Expert Review of Evidence Bases for Managing Monkey Bites in Travelers. J Travel Med. 2015 Jul-Aug;22(4):259-62. PMID: 26031198.
  5. Barkati S, Taher HB, Beauchamp E, Yansouni CP, Ward BJ, Libman MD. Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers. Emerg Infect Dis. 2019 Sep;25(9):e190045. PMID: 31441751.
  6. Rothe K, Tsokos M, Handrick W. Animal and Human Bite Wounds. Dtsch Arztebl Int. 2015 Jun 19;112(25):433-42; quiz 443. PMID: 26179017.
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