Primary prevention
There are no human vaccines against Brucella species. Therefore, the mainstay of disease prevention is to avoid or control animal infection, thereby reducing the risk of human infection. Animal vaccination is considered the most effective method to achieve this goal.[15][16] The vaccines currently available are highly immunogenic and can protect the animal for many years. In addition, the testing and slaughtering of infected animals removes them and their contaminated products from the food chain, thereby reducing the risk of human infection.[1][75][76]
Pasteurization of milk is also highly effective in preventing human transmission.[1][49][50][75] In endemic areas, the population should be educated to pasteurize all milk products and not to eat potentially infected raw meat products or animal viscera.[15] People who consume raw milk (or raw milk products) that are potentially contaminated with the RB51 strain (the B abortus strain used in animal vaccines) are at high risk for infection. The Centers for Disease Control and Prevention (CDC) recommend symptom monitoring and post-exposure prophylaxis (e.g., a 21-day course of doxycycline plus trimethoprim/sulfamethoxazole provided there are no contraindications) in these patients. Antibiotic prophylaxis for species other than the RB51 strain is usually a combination of doxycycline and rifampin.[77]
All microbiology personnel should be aware of the risk of brucellosis, even in nonendemic regions, and should be discouraged from risky procedures such as sniffing culture plates and handling or vortexing known or possible Brucella cultures in the open laboratory.[33][78] Isolates of unidentified gram-negative or gram-variable coccobacilli and bacilli should be handled in appropriate biosafety cabinets in the laboratory.[33][35][36][37][38]
Hunters of feral animals, such as wild pigs, should take precautions to avoid contaminating themselves with infected material while butchering or handling the dead animals.[79]
Secondary prevention
Brucellosis is a reportable condition in the US.
In a nonendemic area, all cases of brucellosis should be notified and investigated, particularly if a food source is implicated or if infection may have been introduced into local animals. The possibility of deliberate release should be considered, although inappropriate panic can be caused by false-positive serologic tests in low-endemicity settings.[145]
Owing to the infectious nature of this pathogen, postexposure prophylaxis (PEP) is usually recommended after laboratory accidents or major aerosol exposure, as outbreaks of this disease can be economically devastating. The evidence for PEP is at present limited. Current empiric recommendations for adults are 3 weeks of doxycycline plus rifampin.[35][124] However, this regimen has significant adverse effects leading to early discontinuation, and monotherapy is probably adequate.[78][125] Monotherapy with doxycycline or trimethoprim/sulfamethoxazole is now the recommended option in the UK.[146] Children are unlikely to need PEP, but women who are pregnant or might be pregnant may be offered rifampin alone for 3 weeks or together with trimethoprim/sulfamethoxazole, by analogy with full treatment regimens.[122][35][58] UK guidelines also recommend ciprofloxacin for 3 weeks as an alternative treatment option for pregnant women or women who might be pregnant.[146]
CDC: assessing laboratory risk level and PEP Opens in new window
Use of this content is subject to our disclaimer