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©2013 UpToDate ® Print Email 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, up to the end of the 6-month incubation period. - Administer doxycycline 100 mg twice daily and rifampin 600 mg once daily for 3 weeks or doxycycline alone if exposed to Brucella abortus RB51 strain, which is resistant to rifampin. - Trimethoprim-sulfamethoxazole (160 mg/800 mg) should be considered for patients with contraindications to doxycycline. - Pregnant workers 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. Obtain baseline serum samples from all workers exposed to Brucella , unless exposed to B. abortus RB51 strain, which does not elicit a measurable serologic response using available assays. Arrange for serologic testing on all workers exposed to Brucella (eg, 2, 4, 6, and 24 weeks postexposure) 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. Arrange for regular (eg, weekly) active surveillance for febrile illness among all workers exposed to Brucella isolates for 6 months after last exposure.

Arrange for serologic testing on all workers exposed to Brucella (eg, 2, 4, 6, and 24 weeks postexposure) 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. Arrange for regular (eg, weekly) active surveillance for febrile illness among all workers exposed to Brucella isolates for 6 months after last exposure. * 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: MMWR Surveill Summ 2008; 57:39.