Brucella Exposure Risk Events in Ten Clinical Laboratories, New York City, 2015 - 2017.

Ackelsberg, Joel; Liddicoat, Anna; Burke, Taryn; Szymczak, Wendy A; Levi, Michael H; Ostrowsky, Belinda; Hamula, Camille; Patel, Gopi; Kopetz, Virginia; Saverimuttu, Jessie; Sordillo, Emilia Mia; D'Souza, David; Mitchell, Elizabeth A; Lowe, William; Khare, Reeti; Tang, Yi-Wei; Bianchi, Anabella Lucca; Egan, Christina; Perry, Michael J; Hughes, Scott; Rakeman, Jennifer L; Adams, Eleanor; Kharod, Grishma A; Tiller, Rebekah; Saile, Elke; Lee, Stephen; Gonzalez, Edimarlyn; Hoppe, Brett; Leviton, Ira M; Hacker, Susan; Ni, Kuey Fen; Orsini, Reina L; Jhaveri, Sangam; Mazariegos, Irving; Dingle, Tanis; Koll, Brian; Stoddard, Robyn A; Galloway, Renee; Hoffmaster, Alex; Fine, Annie; Lee, Ellen; Dentinger, Catherine; Harrison, Emily; Layton, Marcelle

During 2015-2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events ("Brucella events") in 7 clinical laboratories (CLs). Most patients traveled to endemic countries and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as clinicians did not consider brucellosis until notified that bacteremia with Brucella was suspected.In 3 Brucella events, CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), with limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events that accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including procedures that could generate infectious aerosols. During 3 Brucella events, CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each, CLs had isolated Brucella previously.Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred.Laboratory assessments were conducted after Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF for identification until BTAs have been ruled out.