{"id":10376,"date":"2025-03-01T14:07:49","date_gmt":"2025-03-01T19:07:49","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan399\/"},"modified":"2025-03-02T00:54:33","modified_gmt":"2025-03-02T05:54:33","slug":"dhan399","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan399\/","title":{"rendered":"php\/alerts\/dhan399 ~  Division of Public Health &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n\n    <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan399.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->399 <!--[END]--> <\/h1>\n\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->January 24, 2019 3:35 pm <!--[END]--> <\/h2>\n\n\n    <\/header>\n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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Symptoms of brucellosis can include fever, sweats, malaise, anorexia, headache, fatigue, muscle and joint pain, \n\n\n\n\n\nand potentially more serious complications (e.g., endocarditis, hepatomegaly, splenomegaly, and neurologic symptoms). In pregnant \n\n\n\n\n\npatients, <em>Brucella<\/em> infections can be associated with miscarriage. Symptom onset can occur anywhere from five days to six \n\n\n\n\n\nmonths following exposure. As of January 22, 2019, exposures have been identified in 19 states: Alabama, California, Connecticut, \n\n\n\n\n\nFlorida, Georgia, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, North Carolina, Ohio, \n\n\n\n\n\nPennsylvania, Rhode Island, South Carolina, and Virginia.<\/p>\n\n\n\n\n\n<h2>Background<\/h2>\n\n\n\n\n\n<p>This investigation is associated with the third known case of brucellosis from <em>Brucella<\/em> RB51 due to raw milk acquired \n\n\n\n\n\nin the U.S., since August 2017. A New York resident, who drank raw milk purchased from Miller\u2019s Biodiversity Farm in Quarryville, \n\n\n\n\n\nPennsylvania, was diagnosed with brucellosis in November 2018. Milk samples from the dairy tested positive for <em>Brucella<\/em> strain RB51. \n\n\n\n\n\nPeople who consumed raw milk or raw milk products from this dairy since January 2016 may have been exposed.<\/p>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>Patients who are still within six months of the date they last consumed the raw milk are at an increased risk for brucellosis \n\n\n\n\n\nand appropriate post-exposure prophylaxis (PEP) is recommended, along with six months of symptom monitoring. Please see diagram below.<\/li>\n\n\n\n\n\n<li>If patients are outside of the six-month window following their last consumption of the raw milk and have or develop an illness \n\n\n\n\n\nconsistent with brucellosis, a blood culture should be obtained prior to starting any treatment, preferably while the patient is symptomatic.<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n<p><em>Brucella<\/em> strain RB51 is a live-attenuated cattle vaccine strain, which can be shed in milk and can cause infections in humans. \n\n\n\n\n\nRB51 is resistant to rifampin and penicillin. There is no serological test available to detect RB51 infection. Blood culture is the recommended \n\n\n\n\n\ndiagnostic test for exposed individuals who are symptomatic.1<\/p>\n\n\n\n\n\n<h2>Recommendations<\/h2>\n\n\n\n\n\n<p>The Centers for Disease Control and Prevention (CDC) recommends the following:<\/p>\n\n\n\n\n\n<ol>\n\n\n\n\n\n<li>A 21-day course of both doxycycline and trimethoprim\/sulfamethoxazole for first-line PEP for RB51 exposure.<sup>2<\/sup> If brucellosis occurs despite \n\n\n\n\n\nprophylaxis, treatment should be pursued; alternative options should be considered for those with contraindications to the stated PEP and treatment regimens.<sup>2<\/sup> \n\n\n\n\n\nPlease note that RB51 is resistant to rifampin and penicillin.<\/li>\n\n\n\n\n\n<li>When ordering blood cultures to diagnose brucellosis, please advise the laboratory that blood culture may grow <em>Brucella<\/em> and that \n\n\n\n\n\nappropriate laboratory containment and precautions should be observed.<sup>3<\/sup> <\/li>\n\n\n\n\n\n<li>Advise patients to discard any leftover or stored, raw milk or raw milk products from this dairy farm.<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n<p>Please see the diagram found here at: <a href=\"https:\/\/emergency.cdc.gov\/han\/han00417.asp\">https:\/\/emergency.cdc.gov\/han\/han00417.asp<\/a> for information on developing an evaluation and treatment plan for patients who consumed raw milk or raw milk products from Miller\u2019s Biodiversity Farm since January 2016, and are still within the six-month window following their last known exposure.<\/p>\n\n\n\n\n\n<p>Treatment Decision Tree for Patients Who Consumed Raw Milk or Raw Milk Products from Miller&#8217;s Biodiversity Farm in Quarryville, Pennsylvania<\/p>\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n<p>Note: Testing for asymptomatic patients is not recommended.<\/p>\n\n\n\n\n\n<h2>References<\/h2>\n\n\n\n\n\n<p><sup>1<\/sup>Laboratory Diagnostics \u2013 RB51<\/p>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>Schurig GG, Roop RM, 2nd, Bagchi T, Boyle S, Buhrman D, Sriranganathan N. Biological properties of RB51; a stable rough strain of <em>Brucella abortus<\/em>. Vet Microbiol. 1991 Jul;28(2):171-88.<\/li>\n\n\n\n\n\n<li>Cossaboom CM, Kharod GA, Salzer JS, Tiller RV, Campbell LP, Wu K, et al. Notes from the Field: <em>Brucella abortus<\/em> vaccine strain RB51 infection and exposures associated with raw milk consumption &#8211; Wise County, Texas, 2017. MMWR Morb Mortal Wkly Rep. 2018 Mar 9;67(9):286.<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n<p><sup>2<\/sup>Treatment of Brucellosis<\/p>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>Ariza J et al. 2007. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med. 4(12): e317. <a href=\"http:\/\/www.plosmedicine.org\/article\/info:doi\/10.1371\/journal.pmed.0040317\">http:\/\/www.plosmedicine.org\/article\/info:doi\/10.1371\/journal.pmed.0040317<\/a><\/li>\n\n\n\n\n\n<li>Al-Tawfiq JA. 2008. Therapeutic options for human brucellosis. Expert Rev Anti Infect Ther. 6(1): 109-120. <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18251668\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18251668<\/a><\/li>\n\n\n\n\n\n<li>Solera J. 2010. Update on brucellosis: therapeutic challenges. Intl J Antimicrob Agent. 36S, S18\u2013S20. <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20692127\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20692127<\/a><\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n<p><sup>3<\/sup>Biosafety in Microbiological and Biomedical Laboratories <a href=\"https:\/\/www.cdc.gov\/biosafety\/publications\/bmbl5\/bmbl.pdf\">https:\/\/www.cdc.gov\/biosafety\/publications\/bmbl5\/bmbl.pdf<\/a><\/p>\n\n\n\n\n\n<h2>For More Information<\/h2>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>Risks from Unpasteurized Dairy Products<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/biosafety\/publications\/bmbl5\/bmbl.pdf\">https:\/\/www.cdc.gov\/brucellosis\/exposure\/unpasteurized-dairy-products.html<\/a><\/li>\n\n\n\n\n\n<li>Exposure to RB51 through Raw Milk or Milk Products: How to Reduce Risk of Infection<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/brucellosis\/clinicians\/rb51-raw-milk.html\">https:\/\/www.cdc.gov\/brucellosis\/clinicians\/rb51-raw-milk.html<\/a><\/li>\n\n\n\n\n\n<li>Symptoms of Brucellosis<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/brucellosis\/symptoms\/index.html\">https:\/\/www.cdc.gov\/brucellosis\/symptoms\/index.html<\/a><\/li>\n\n\n\n\n\n<li>Brucellosis and Expecting Mothers<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/brucellosis\/exposure\/expecting-mothers.html\">https:\/\/www.cdc.gov\/brucellosis\/exposure\/expecting-mothers.html<\/a><\/li>\n\n\n\n\n\n<li>Raw Milk Questions and Answers<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/foodsafety\/rawmilk\/raw-milk-questions-and-answers.html\">https:\/\/www.cdc.gov\/foodsafety\/rawmilk\/raw-milk-questions-and-answers.html<\/a><\/li>\n\n\n\n\n\n<li>Brucellosis Reference Guide<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/brucellosis\/pdf\/brucellosi-reference-guide.pdf\">https:\/\/www.cdc.gov\/brucellosis\/pdf\/brucellosi-reference-guide.pdf<\/a><\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n<p>For general, non-urgent inquiries during business hours (8:00 AM to 8:00 PM EST):<\/p>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>CDC-INFO<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/cdc-info\/index.html\">https:\/\/www.cdc.gov\/cdc-info\/index.html<\/a> or 1-800-232-4636<\/li>\n\n\n\n\n\n<li>For emergencies, 24\/7:<br>\n\n\n\n\n\nCDC Emergency Operations Center (EOC)<br>\n\n\n\n\n\n770-488-7100<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n<p>For clinicians and health departments during business hours (8:30 AM to 4:30 PM EST):<\/p>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>Bacterial Special Pathogens Branch<br>\n\n\n\n\n\n<a href=\"mailto:bspb@cdc.gov\">bspb@cdc.gov<\/a> or 404-639-1711<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n<p>The Centers for Disease Control and Prevention (CDC) protects people&#8217;s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.<\/p>\n\n\n\n\n\n<p>************************************<\/p>\n\n\n\n\n\n<p>You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n\n\n\nIf you are not a member and would like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a><\/p>\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n<hr>\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n<p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  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