Do You Know Your 
BT Agent?

This tiny gram-negative coccobacillus is oxidase, catalase, and nitrate positive, 
but is most noted for its strong urease reaction which can occur in minutes.

History of CAP-LPX

     LPS-10
     Brucella abortus (RB51)

History of CAP-LPX

     LPS-10

History of CAP-LPX

     LPS-10
     Brucella abortus (RB51)


History of CAP-LPX

     LPS-07
     Brucella abortus (RB51)


2007 LPS-B: B. abortus RB51

     Oct. 15, 2007: sent to labs
     Distributed to 1,316 labs – U.S. & Canada
     Nov. 27, 2007: CDC notified by NYSDOH
     Potential RB51 exposure


2007 LPS-B: B. abortus RB51

     Instructions:
     Handle in a Class II BSC
     Use BSL-3 primary barriers (gloves, etc.)
     RB51 sent to NYSDOH lab mislabeled as a routine patient 
     Worked with isolate on open bench
     24 laboratorians with potential exposure

2007 LPS-B: B. abortus RB51

NYSDOH surveyed participating NY sentinel labs:

     16 labs – improper handling
     CDC recommends all states assess their labs

2007 LPS-B: B. abortus RB51

CDC provides questions to assess exposure:

     Types of manipulations and aerosol generating procedures
     Defined levels of exposure (high, low, none) 
     Number recommended to receive PEP
     Any illness in exposed, consistent with Brucella

2007 LPS-B: B. abortus RB51

“High-risk” Exposure:

     Performed a high-exposure practice (e.g. sniffing plates)
     Were within 5 feet of any manipulation of RB51 on open bench
     Were present in lab during widespread aerosol-generating event 
     (e.g. vortexing) of RB51

2007 LPS-B: B. abortus RB51

Voluntary Reports - Exposures:

     36 states, 2 cities, 1 county, and DC
     254 labs
     916 lab workers
     679 (74%) High-risk
     237 (26%) Low-risk
     % persons who received PEP – not available
     As of Jan.14, 2008 – no illnesses

2007 LPS- Delaware Labs

     # labs reporting exposure  -  5
     # staff – High risk exposure-  11
     # staff- low risk exposure- 12
     No risk- Carrying a closed culture plate to an incubator, Observing a 
     fixed/stained slide under a microscope, Observation of a closed culture plate 

2007 LPS-B: B. abortus RB51

Questions Raised:

     Are labs reading instructions?
     Are labs disregarding safety?
     What about every day organisms – TB,  N. meningitidis?
     What if large-scale BT event?

Delaware Epi Data"

2007 LPS-B: B. abortus RB51

Lessons Learned:

     Clinical Labs may not be handling the CAP-LPS samples appropriately
     A need for more clear instructions
     A need for training and education of Sentinel Labs