Forwarded by the Delaware Division of Public Health.
This is an official
CDC HEALTH ADVISORY
Distributed via the CDC Health Alert Network
January 23, 2019 1430 ET (2:30 PM ET)
The New York State Department of Health and Pennsylvania Department of Health are investigating Brucella RB51 exposures that may be connected to consuming raw (unpasteurized) milk from Miller's Biodiversity Farm in Quarryville, Pennsylvania. Symptoms of brucellosis can include fever, sweats, malaise, anorexia, headache, fatigue, muscle and joint pain, and potentially more serious complications (e.g., endocarditis, hepatomegaly, splenomegaly, and neurologic symptoms). In pregnant patients, Brucella infections can be associated with miscarriage. Symptom onset can occur anywhere from five days to six months following exposure. As of January 22, 2019, exposures have been identified in 19 states: Alabama, California, Connecticut, Florida, Georgia, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, and Virginia.
This investigation is associated with the third known case of brucellosis from Brucella RB51 due to raw milk acquired in the U.S., since August 2017. A New York resident, who drank raw milk purchased from Miller’s Biodiversity Farm in Quarryville, Pennsylvania, was diagnosed with brucellosis in November 2018. Milk samples from the dairy tested positive for Brucella strain RB51. People who consumed raw milk or raw milk products from this dairy since January 2016 may have been exposed.
Brucella strain RB51 is a live-attenuated cattle vaccine strain, which can be shed in milk and can cause infections in humans. RB51 is resistant to rifampin and penicillin. There is no serological test available to detect RB51 infection. Blood culture is the recommended diagnostic test for exposed individuals who are symptomatic.1
The Centers for Disease Control and Prevention (CDC) recommends the following:
Please see the diagram found here at: https://emergency.cdc.gov/han/han00417.asp for information on developing an evaluation and treatment plan for patients who consumed raw milk or raw milk products from Miller’s Biodiversity Farm since January 2016, and are still within the six-month window following their last known exposure.
Treatment Decision Tree for Patients Who Consumed Raw Milk or Raw Milk Products from Miller's Biodiversity Farm in Quarryville, Pennsylvania
Note: Testing for asymptomatic patients is not recommended.
1Laboratory Diagnostics – RB51
2Treatment of Brucellosis
3Biosafety in Microbiological and Biomedical Laboratories https://www.cdc.gov/biosafety/publications/bmbl5/bmbl.pdf
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