Recommendations for surveillance and postexposure prophylaxis (PEP) after laboratory exposure to Brucella isolates

Recommendations for surveillance and postexposure prophylaxis (PEP) after laboratory exposure to Brucella isolates

Evaluate all workers exposed to Brucella isolates* and classify exposures as either high risk or low risk^¶.

Recommend PEP for workers with high-risk exposures to Brucella isolates. PEP should be offered as soon as Brucella exposure has been identified and be administered for up to six months following exposure.

Administer doxycycline (100 mg twice daily) and rifampin (600 mg once daily) for three weeks.

For individuals with exposure to Brucella abortus RB51 strain (which is resistant to rifampin), administer doxycycline (100 mg twice daily) and trimethoprim-sulfamethoxazole (160 mg/800 mg twice daily) for three weeks.

For patients with contraindications to doxycycline or rifampin, trimethoprim-sulfamethoxazole may be used.

Pregnant women with high-risk exposures should be considered for PEP in consultation with their obstetricians.

Discuss potential PEP with workers who have low-risk exposures to Brucella isolates; PEP may be warranted for patients who are immunocompromised or pregnant.

Obtain baseline serum samples from all workers exposed to Brucella, unless exposed to B. abortus RB51 strain or B. canis (these strains do not elicit a measurable serologic response using available assays).

Arrange for periodic serologic testing on all workers exposed to Brucella (6, 12, 18, and 24 weeks post exposure) using agglutination testing (eg, tube or Brucella microagglutination testing) at the state public health laboratory or CDC; serologic testing is not recommended for workers exposed to B. abortus RB51 strain or B. canis.

Among workers with Brucella exposure, arrange for weekly symptom monitoring and daily temperature monitoring for six months following exposure.

PEP: postexposure prophylaxis; CDC: United States Centers for Disease Control and Prevention.
* A Brucella-exposed worker is defined as any worker present in the microbiology laboratory during workup and identification of a Brucella isolate, from the time the culture is first manipulated until all culture isolates are destroyed or removed from the laboratory.
¶ A high-risk exposure is defined as (1) having direct personal exposure to Brucella (eg, sniffing bacteriologic cultures, direct skin contact, pipetting by mouth, inoculation, or spraying into the eyes, nose, or mouth), (2) performing work on an open bench (ie, outside of biosafety level 3 containment equipment) with an open culture plate containing a Brucella isolate or being in close proximity to such work (eg, across an open bench top or within 5 feet), or (3) presence in the laboratory during any procedure conducted on a Brucella isolate that might result in generation of aerosolized organisms and inhalational exposure (eg, vortexing or catalase testing). A low-risk exposure is defined as being present in the laboratory during an exposure but not meeting the definition for a high-risk exposure.

Data from:

Yoder J, Roberts V, Craun GF, et al. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking--United States, 2005-2006. MMWR Surveill Summ 2008; 57:39.
Traxler RM, Guerra MA, Morrow MG, et al. Review of brucellosis cases from laboratory exposures in the United States in 2008 to 2011 and improved strategies for disease prevention. J Clin Microbiol 2013; 51:3132.

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Recommendations for surveillance and postexposure prophylaxis (PEP) after laboratory exposure to Brucella isolates