CDC Health Advisory - Brucella RB51 Exposures and Illnesses in Texas

PUBLISHED: Sep 14, 2017
Relevant to: Ambulatory Care, Critical Access Hospitals, Hospitals, Medical Office/Clinic

The Texas Department of State Health Services, with assistance from the US Centers for Disease Control and Prevention (CDC), is investigating Brucella RB51 exposures and illnesses that may be connected to the purchase and consumption of raw (unpasteurized) milk from K-Bar Dairy in Paradise, Texas. Symptoms of brucellosis can include: fever, sweats, malaise, anorexia, headache, fatigue, muscle & joint pain, and potentially more serious complications (e.g., swelling of heart, liver, or spleen, neurologic symptoms).

According to the CDC, a person who drank raw milk from K-Bar Dairy in Paradise, Texas, has been hospitalized with brucellosis. Milk samples from the dairy have tested positive for a Brucella strain called RB51. People who consumed milk or milk products from this dairy from June 1, 2017, to August 7, 2017 are at an increased risk for brucellosis and should receive appropriate post-exposure prophylaxis (PEP). They are advised to consult with their health care providers regarding PEP care and possible diagnostic testing. Please note: the incubation period for brucellosis can range from five days to six months.

Recommendations:

  • Brucella strain RB51 is resistant to rifampin and penicillin. A combination of doxycycline and trimethoprim/sulfamethoxazole for 21 days is the recommended first-line PEP regimen for RB51 exposure.
  • There is no serological test available to detect RB51 infection. Blood culture is the recommended diagnostic test for exposed symptomatic individuals.
  • When ordering blood cultures to diagnose brucellosis, please advise the laboratory that blood culture may grow Brucella and that appropriate laboratory precautions should be observed.
  • If brucellosis occurs despite prophylaxis, treatment regimens should be selected based on antimicrobial susceptibility results.

The Health Advisory includes a diagram that outlines the steps involved in developing an evaluation and treatment plan for exposed patients. Women who are pregnant or breastfeeding should be advised to consult with their health care provider.

Health care providers are reminded that Brucella is a national notifiable condition. The Nationally Notifiable Disease List provides comprehensive reporting of diseases that occur in the United States. The list is compiled through collaborative efforts among state health departments and the CDC. Reporting of diseases is mandated by state legislation and regulations, please verify reporting requirements for your state.

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