Evaluation and Outcomes of Obstetric and Surgical Healthcare-associated Brucella Exposures

Exposure to Brucella spp. in healthcare settings is rarely reported, and optimal exposure assessment and management remain poorly defined. We describe Brucella melitensis exposure in obstetric/surgical and laboratory settings and our exposure management approach.

Seventy-four potentially exposed employees were identified; exposure risk was assessed using four categories adapted from the CDC Brucellosis Reference Guide for laboratory exposures.

Twenty (27%) were minimal risk requiring no intervention, 17 (23%) minimal risk requiring 24-week symptom monitoring, 2 (3%) low risk also requiring 24-week serologic monitoring, and 20 (27%) high risk also offered postexposure prophylaxis; 16 (80%) initiated it. Fifteen (20%) were lost to follow-up. Among those ultimately recommended monitoring, 11/22 (50%) underwent serologic testing (one completed 24-week serologic testing) and 29/39 (74%) accepted symptom monitoring (completion was 65% for daily and 83% for weekly). No secondary cases were identified.

A tiered approach incorporating contact type, aerosol-generating events, and personal protective equipment can guide Brucella clinical exposure assessment and management. Early recognition, appropriate precautions, and public health consultation are important. Infection prevention programs and occupational health services should have coordinated processes for timely exposure identification, risk stratification, and postexposure follow-up. We also propose a broader risk assessment framework for future clinical exposures. Further research is needed to refine the management of Brucella clinical exposures.