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][77][78]

Pasteurisation of milk is also highly effective in preventing human transmission.[1][49][50][77]​ In endemic areas, the population should be educated to pasteurise 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.

Owing to the infectious nature of this pathogen, post-exposure prophylaxis is usually recommended after laboratory accidents or major aerosol exposure, as outbreaks of this disease can be economically devastating. The evidence for post-exposure prophylaxis is at present limited.

  • The US Centers for Disease Control and Prevention (CDC) recommend symptom monitoring (at least weekly for 24 weeks after exposure), serological monitoring (at 0, 6, 12, 18, and 24 weeks after exposure), and post-exposure antimicrobial prophylaxis for people with high-risk exposures.[63]

  • A 21-day course of doxycycline plus trimethoprim/sulfamethoxazole is recommended for the RB51 strain, provided there are no contraindications. Antibiotic prophylaxis for species other than the RB51 strain is usually a combination of doxycycline and rifampin.[63]

  • Post-exposure prophylaxis should be started as soon as possible, but can be initiated up to 24 weeks after exposure. Post-exposure prophylaxis is not typically recommended for low-risk exposures.[63]

International guidelines may recommend different antimicrobial regimens for post-exposure prophylaxis, and some guidelines may recommend monotherapy due to the adverse effects associated with combination antimicrobial therapy.

  • For example, the UK Health Security Agency (UKHSA) recommends monotherapy with doxycycline or trimethoprim/sulfamethoxazole for 21 days in adults at high risk after a possible laboratory exposure, within 72 hours of exposure. Alternatives for pregnant women include rifampicin (with or without trimethoprim/sulfamethoxazole) or ciprofloxacin, or observation only.[79]

All microbiology personnel should be aware of the risk of brucellosis, even in non-endemic 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][80] 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.[63]​​

Secondary prevention

Brucellosis is a reportable condition in some countries. In a non-endemic 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 serological tests in low-endemicity settings.[142]

Public Health England: Brucella: laboratory and clinical services Opens in new window

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