Primary prevention

Currently, there are no vaccines available for either melioidosis or glanders, although several groups are working on developing them.[55] Preventive strategies thus rely on minimising exposure to the causative organisms, although evidence is lacking that this approach is effective in preventing infection.

Since human glanders has invariably followed close contact with infected animals or laboratory work with Burkholderia mallei, prevention in humans involves standard contact precautions (mask, gloves, and gown) when dealing with infected animals. In the long term, control of human glanders has been achieved through elimination of the infection in the animal population.

Based on the activities found to be associated with an increased risk of acquiring melioidosis, the following recommendations for prevention have been made:[45]

  • Avoid direct contact with soil or environmental water

  • If contact with soil or environmental water is necessary, wear protective gear including rubber gloves, boots, or waders, and wash with soap and clean water immediately after exposure

  • In the event of an injury involving contamination with soil or environmental water, immediately clean the wound with soap and clean water

  • Keep open wounds covered and avoid contact with soil or water until completely healed. Do not apply any herbal remedies or other substances to the wound. In the event that the wound comes into contact with soil or environmental water, clean the wound thoroughly with soap and clean water

  • Always wear shoes. Do not walk barefoot

  • Only drink bottled or boiled water. Do not drink any untreated water

  • Do not eat food contaminated with soil or dust. If food is to be eaten without cooking, wash thoroughly using clean water. Use clean eating utensils, and wash these in clean water

  • When outside, avoid heavy rain or dust clouds. If caught in a dust cloud, cover mouth and nose. Use an umbrella to protect yourself from the rain

  • Do not smoke, and avoid binge drinking and drinking alcohol in excess

  • Be aware that you are at greater risk of melioidosis if you have certain conditions, including diabetes, chronic kidney disease, and diseases that require corticosteroid therapy or medications that suppress the immune system.

Such measures are of particular importance for those who are at increased risk through having underlying conditions known to predispose to melioidosis, such as diabetes, chronic renal or liver disease, thalassaemia, or corticosteroid use.[1]

Cancer patients on chemotherapy and those on high-dose immunosuppression (especially corticosteroids) are advised to avoid being outside during periods of heavy rainfall with strong winds.

Both B mallei and Burkholderia pseudomallei should be handled with biosafety level 3 containment precautions, although laboratory-acquired melioidosis is rare (laboratory-acquired glanders has been reported more frequently). Comprehensive guidance on managing accidental laboratory exposure to both B mallei and B pseudomallei, including whether to start post-exposure prophylaxis, has been published. Oral trimethoprim/sulfamethoxazole for 21 days is the first-line choice for prophylaxis: amoxicillin/clavulanate is a suitable alternative.[56][57]

Secondary prevention

There are only a few anecdotal reports of melioidosis (or glanders) spreading from person to person, and the risks to casual or domestic contacts are very low so no specific precautions are recommended. Healthcare workers caring for infected patients should use standard contact precautions. In some endemic areas, melioidosis and glanders are statutorily notifiable diseases that must be reported to local health authorities. In non-endemic areas this is now also a common requirement in the light of their potential use as biothreat agents; in the US both Burkholderia mallei and Burkholderia pseudomallei are categorised as Tier 1 select agents.[5] However, this risk should be kept in perspective, and in most cases of melioidosis a clear exposure risk (travel, laboratory work) will be revealed by a careful history.

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