A review of laboratory-acquired Brucella infections and exposures amongst clinical laboratory staff in the UK

RPD Cooke , K Mohandas , L Perrett , NJ Beeching

1 1 2
1

Brucella Reference Unit, Aintree Hospitals NHS Foundation Trust, Liverpool , FAO/WHO/OIE Collaborating Centre for Reference and Research on Brucellosis, Veterinary Laboratories 2, 3 Agency, Surrey and Liverpool School of Tropical Medicine, Liverpool, UK

Introduction
Brucellosis is one of the most commonly reported laboratory-acquired bacterial infections, accounting for 8% of all such infections in a recent British/US review from 1979-1999.1,2 However, there is concern that these infections are often under-reported and that information on laboratory-acquired brucellosis (LAB) is scare and mainly anecdotal. Brucellosis is not a notifiable infection in the UK. A review of LAB and laboratory exposures in the UK is presented.

Methods
Zoonoses reports on human brucellosis, published by the Department of Environment, Food and Rural Affairs (DEFRA) 2001-2006, were analysed to identify LAB and exposures. As LAB is reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR 1995), the statistical branch of the Health and Safety Executive (HSE) was contacted to obtain UK data on LAB and exposures. The OIE Brucella Reference Laboratory, part of the Veterinary Laboratories Agency (VLA), provides a national reference service for the identification of Brucella isolates from human sources. Using their database of referring clinical laboratories between 2000-2007, a telephone questionnaire survey was undertaken to determine the action taken by the laboratory management following the isolation of Brucella from a clinical specimen.
Table: A summary of the management by UK clinical laboratories of Brucella laboratory exposures, 2000 2007 Total number of Total number Number of Number of Brucella Brucella isolates of referring UK Brucella isolates processed in referred to clinical isolates unable Containment Level 3 Veterinary laboratories to be followed facility by referring Laboratory Agency up laboratory (%) 69 43 8 37 (61)

Results
Only the DEFRA Zoonoses Report 2004 identified a single laboratory incident involving staff exposure to Brucella culture plates. Through the HSEs The Health and Occupational Reporting network (THORN) 1998-2006, only two cases of LAB were identified, both occurred in 1999. 43 UK clinical laboratories, who had referred suspected Brucella isolates to the VLA, were contacted. Out of 61 Brucella isolates referred to VLA, 24 (39%) were not initially processed in a Containment Level 3 facility. Only 5 laboratories had subsequently developed protocols for dealing with future such incidents. A full summary of the findings is presented in the Table.

Total number of laboratory management meetings following Brucella exposures (%)

Number of Number of Brucella Brucella exposures reported exposures through RIDDOR 1995 resulting in laboratory staff follow-up 25 8

27 (44)

Discussion
The results of this study strongly suggest that the current UK surveillance systems for LAB and laboratory Brucella exposures are likely to result in under-reporting. The fact that very few clinical laboratories had protocols for the notification and follow-up of staff who worked with isolates, subsequently identified as Brucella, may reflect the absence of UK national guidance on this subject. The appropriateness of the management of exposed staff is probably best achieved by a prospective national surveillance programme. Such a collaborative project, involving the Brucella sero-diagnosis Reference Unit and the VLA, is about to be established.

References
1. Harding AL, Byers KB, Epidemiology of Laboratory-Associated Infection.In: Fleming DO, Hunt DLeds. Biological Safety: principles and practices. 3rd ed. Washington DC:ASM Press, 2000:35-56. 2. Centers for Disease Control. Laboratory-acquired brucellosis Indiana and Minnesota, 2006. MMWR Jan 2008; 57(2);39-42.