Assessing Laboratory Risk Level and PEP

Risk Level = High

Persons at Risk	Exposure Activities	PEP Recommendations	Follow up/Monitoring
Person performing activity and any person within a 5 ft. radius	Work with a Brucella isolate Sniffed or opened culture plate Mouth pipetted specimen material Worked in Class II biosafety cabinet or on open bench without using BSL-3 precautions	Doxycycline 100mg twice daily and rifampin 600mg once daily for 3 weeks TMP-SMZ should be considered for patients with contraindications to doxycycline Persons with contraindications to rifampin should consult with their HCP Pregnant women should consult with obstetrician	Sequential serologic testing at 0, 6, 12, 18 and 24 weeks post exposure Symptom watch (e.g. weekly) and daily self fever check for 24 weeks No serological monitoring available for RB51 and B. canis exposures
All persons present in laboratory room	Occurrence of widespread aerosol generating procedures*

 

Risk Level = Low

Persons at Risk	Exposure Activities	PEP Recommendations	Follow up/Monitoring
All persons present in laboratory room at distance greater than 5 ft. from activity	Present in the lab at the time of manipulation of Brucella isolate on an open bench, but who do not have high risk exposures as defined above	Discuss with HCP May consider if immunocompromised or pregnant	Sequential serologic testing at 0, 6, 12, 18 and 24 weeks post exposure Symptom watch (e.g. weekly) and daily self fever check for 24 weeks No serological monitoring available for RB51 and B. canis exposures

 

Risk Level = None

Persons at Risk	Exposure Activities	PEP Recommendations	Follow up/Monitoring
None	Handling and testing of Brucella isolate in a Class II biosafety cabinet using BSL-3 precautions	None	N/A

Recommendations for Lab Exposure Surveillance

1. Determine number of workers exposed to Brucella isolates and classify exposures into high- and low-risk (using above chart)
2. For high-risk exposures, recommend PEP:
   • doxycycline 100mg twice daily and rifampin 600mg once daily for 3 weeks
   • trimethoprim-sulfamethoxazole should be considered for those patients with contraindications to doxycycline
   • pregnant workers with high-risk exposures should consider PEP in consultation with their obstetricians
   • persons with contraindications to rifampin should consult with their health care provider for alternative PEP
3. For low-risk exposures, consider PEP and discuss with affected workers
4. Obtain baseline serum samples from all workers as soon as possible after a potential Brucella exposure is recognized. If available, obtain pre-exposure stored specimens.
5. Arrange for sequential serologic testing on all workers exposed to Brucella (e.g. 0, 6, 12, 18 and 24 weeks post exposure) using agglutination tests at state public health laboratory or CDC.
6. Arrange for regular (e.g. weekly) symptom watch and daily self fever checks for persons with high- and low-risk exposures for 6 months following last exposure.

*Widespread aerosol generating procedures include, but are not limited to:

• centrifuging without sealed carriers
• vortexing
• sonicating
• accidents resulting in spillage or splashes (i.e. breakage of tube containing specimen).

Other manipulations may require further investigation. These may include:

• automated pipetting of a suspension containing the organism
• grinding the specimen
• blending the specimen
• shaking the specimen
• other procedures for suspension in liquid to produce standard concentration for identification (i.e. inclusion of steps that could be considered major aerosol generating activities).