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This afternoon the CDC released a HAN Advisory regarding a rare case of Brucella RB51 infection in Texas related to the consumption of raw milk. The United States sees about 100 cases each year, although most are not this resistant strain.
HAN messages (Alert, Advisory, Update, or Info) are designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.An `Advisory’ is a second tier message that provides important information for a specific incident or situation, but may not require immediate action. As others may have been exposed, the CDC is issuing guidance for clinicians who might run across a suspected infection.
Rifampin/Penicillin-Resistant Strain of RB51 Brucella Contracted from Consumption of Raw Milk
This is an official CDC Health Advisory
Distributed via the CDC Health Alert Network
September 13, 2017, 1230 ET (12:30 PM ET)
CDCHAN-00407
Summary:
The Texas Department of State Health Services, with assistance from 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).
Background
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 laboratory1 precautions should be observed. If brucellosis occurs despite prophylaxis, treatment regimens2 should be selected based on antimicrobial susceptibility results. Please see the diagram below for information on developing an evaluation and treatment plan for exposed patients. Women who are pregnant or breastfeeding should consult with their health care provider.
Treatment Decision Tree for Patients Who Were Exposed to (Consumed) Raw Milk/Raw Milk Products
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It is particularly important that lab personnel are made aware that they might be culturing Brucella, as in recent years most U.S. infections have been lab-acquired (see CIDRAP's 2015 report Exposures in NYC labs prompt alert on brucellosis risk for workers).
The CDC maintains a Brucellosis web page where you'll find additional information, including more on the risks of consuming raw milk.
