Health Advisory
DIVISION OF PUBLIC HEALTH INVESTIGATING TWO BRUCELLOSIS CASES LIKELY DUE TO CONSUMPTION OF DAIRY PRODUCTS MADE WITH UNPASTEURIZED MILK

The Delaware Division of Public Health (DPH) is issuing this health advisory to increase awareness among health care providers on the risk of brucellosis associated with unpasteurized food sources. Two cases have been identified (one confirmed and one suspected) in Delaware from late May to early June 2019.

Summary

From late May 2019 to early June 2019, two cases of brucellosis (one confirmed and one suspected) have been identified in Delaware. These cases involve individuals from two separate households (familiar to each other), who consumed homemade unpasteurized dairy products from Mexico. The products were gifts, not purchased locally. The first case was identified as B. melitensis by the Centers for Disease Control and Prevention (CDC). Species identification of the second case is currently pending by the CDC. The principal hosts for B. melitensis are goats and sheep. This strain is also most pathogenic in humans and is most commonly related to consumption of unpasteurized dairy products from countries where the disease is present. Brucellosis is not common in the United States. Prior to these cases, in Delaware, DPH confirmed three cases since 2010 – one each in 2010, 2017, and 2018. The case in 2010 was associated with consumption of unpasteurized milk while the nature of exposure in the 2017 and 2018 cases is unknown.

Background

Brucellosis is a bacterial infection caused by contact with infected animals or contaminated animal products. Infection is most commonly transmitted by eating or drinking unpasteurized/raw dairy products. Person-to-person spread of brucellosis is extremely rare. Infected mothers who are breast-feeding may transmit the infection to their infants. Sexual transmission has been rarely reported. While uncommon, transmission may also occur via tissue transplantation or blood transfusions.

Symptoms of brucellosis include fever, sweats, malaise, anorexia, headache, fatigue, and muscle and joint pain. More serious presentations can include endocarditis, hepatomegaly, splenomegaly, and neurologic symptoms. In pregnant women, Brucella infections can be associated with miscarriage.

Symptom onset can occur anywhere from five days to six months following exposure.

Recommendations for Patients with Suspected Infection

Health care providers caring for febrile patients who live in, or have recently traveled to, a country where brucellosis is endemic should consider brucellosis among their differential diagnoses. It is also important to inquire about activities related to risk factors to more precisely assess the risk of exposure. Questions about risk factors may include:

•  Travel history – a list of countries where there is an increased risk of brucellosis can be found here: https://www.cdc.gov/brucellosis/exposure/areas.html
•  Consumption of unpasteurized dairy products or undercooked meat
•  Occupational or recreational exposures such as working in a laboratory, work in a slaughterhouse or meatpacking industry, hunting and assisting animals with the birthing process.

Diagnosis

Isolation and identification of Brucella can confirm a diagnosis of brucellosis. Brucella is most commonly isolated from blood cultures.

When sending specimens to a laboratory for culture and isolation, be sure the laboratory is aware of your suspected diagnosis. Breathing in the bacteria that causes brucellosis may also lead to infection. This risk is generally greater for people in laboratories that work with the bacteria.

Treatment

Generally, doxycycline and rifampin are recommended in combination for a minimum of six to eight weeks for confirmed cases of brucellosis.

Reporting

Brucellosis is a reportable disease in Delaware. All Delaware health care providers and laboratories are required by regulation to report patients with known or suspected brucellosis.

How to Report

Immediately contact the DPH Office of Infectious Disease Epidemiology (888-295-5156, 24/7) of any known or suspected brucellosis case.

Additional Information

CDC: https://www.cdc.gov/brucellosis/index.html

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