Adverse events in humans associated with accidental exposure to the livestock brucellosis vaccine RB51.

Brucella abortus strain RB51 vaccine, is an attenuated live bacterial vaccine that was licensed conditionally by the Center for Veterinary Biologics, Veterinary Services, Animal and Plant Health Inspection Service, USDA, on 23 February 1996, for vaccination of cattle in the United States. Accidental human inoculations can occur during vaccination of cattle, and previous live Brucella vaccines designed for cattle have been known to cause brucellosis in humans. The Centers for Disease Control and Prevention (CDC) established passive surveillance for accidental inoculation with the RB51 vaccine in the United States to determine if this veterinary vaccine is associated with human disease, to describe the circumstances of accidental inoculation, to evaluate the potential efficacy of post-exposure chemoprophylaxis, and to develop recommendations for post-exposure management following exposure to RB51. Reports were received from 26 individuals. Accidental exposure to RB51 occurred by needle stick injury in 21 people (81%), conjunctival spray exposure in four (15%), and spray exposure of an open wound in one (4%) individual. At least one systemic symptom was reported in 19 (73%) people, including three (12%) who reported persistent local reactions with systemic involvement. One case required surgery, and B. abortus strain RB51 was isolated from the wound of that individual. Seven cases reported no adverse event associated with accidental exposure. Nine cases reported previous exposure to Brucella vaccines, including one case who also reported a previous diagnosis of brucellosis following exposure to S19 vaccine. Accidental needle stick injuries and conjunctival or open wound exposures of humans with the RB51 vaccine are associated with both local and systemic adverse events in the United States that are consistent with brucellosis; however, it remains undetermined if strain RB51 vaccine can cause systemic brucellosis in humans. Early culture attempts on those exposed and developing disease in the future and serologic diagnostic assays for anti-RB-51 antibodies are needed to define if these adverse events are due to RB51 and to define appropriate prophylaxis regimens.

Rabies surveillance in the United States during 2001.

During 2001, 49 states and Puerto Rico reported 7,437 cases of rabies in nonhuman animals and 1 case in a human being to the Centers for Disease Control and Prevention, an increase of < 1% from 7,364 cases in nonhuman animals and 5 human cases reported in 2000. More than 93% (6,939 cases) were in wild animals, whereas 6.7% (497 cases) were in domestic species (compared with 93.0% in wild animals and 6.9% in domestic species in 2000). The number of cases reported in 2001 increased among bats, cats, skunks, rodents/lagomorphs, and swine and decreased among dogs, cattle, foxes, horses/mules, raccoons, and sheep/goats. The relative contributions of the major groups of animals were as follows: raccoons (37.2%; 2,767 cases), skunks (30.7%; 2,282), bats (17.2%; 1,281), foxes (5.9%; 437), cats (3.6%; 270), dogs (1.2%; 89), and cattle (1.1%; 82). Nine of the 19 states where the raccoon-associated variant of the rabies virus has been enzootic reported decreases in the numbers of rabid raccoons during 2001. Among states with extensive wildlife rabies control programs, Ohio reported (other than rabies in bats) 1 case of rabies in a raccoon that was associated with the epizootic of rabies in raccoons and 1 case in a bovid that was infected with a bat variant of the rabies virus, compared with no cases reported in any terrestrial animals during 2000. Texas reported 1 case associated with the dog/coyote variant of the rabies virus (compared with no cases in 2000) and 20 cases associated with the gray fox variant of the virus (a decrease of 50% from reported cases in 2000). Reports of rabid skunks in Massachusetts and Rhode Island, states with enzootic raccoon rabies, exceeded reports of rabid raccoons for the fifth consecutive year. A similar situation may soon exist in the state of Maine (32 rabid skunks and 34 rabid raccoons during 2001). Nationally, the number of rabies cases in skunks during 2001 increased by 2.7% over those reported in 2000. Texas reported the greatest number of rabid skunks ever documented during a single year by any state, as well as the greatest numerical increase in rabid skunks (778 cases in 2001, compared with 550 in 2000; an increase of 228 cases, or 41.5%) and the largest overall state total of rabies cases (1,043) during 2001. Arizona reported the greatest percentage increase in rabid skunks (247.1%), representing an increase from 17 rabid skunks in 2000 to 59 in 2001. Nineteen of these cases were infected with a bat variant of the rabies virus, documenting a spillover event followed by unprecedented detection of temporal enzootic transmission of a bat variant in a terrestrial species. The number of cases of rabies reported in bats during 2001 (1,281 cases) increased 3.3% and surpassed the previous year's record (1,240 cases) as the largest number of reported cases ever recorded for this group of mammals. Cases of rabies reported in dogs (89) and cattle (82) decreased by 21.9 and 1.2%, respectively; these are the lowest numbers reported for rabid cattle and dogs since the dawn of national rabies record keeping (ca 1938). Cases in cats (270) increased by 8.4% over those reported in 2000, whereas rabies among sheep and goats declined 70%, from 10 cases in 2000 to 3 cases (goats only) in 2001. Rabies among horses and mules declined 1.9% (52 cases in 2000 to 51 cases in 2001). Reported cases of rabies in mongooses in Puerto Rico increased 18.6%, compared with the previous year (70 cases in 2001 from 59 cases in 2000), whereas cases of rabies in dogs declined 15.3% (15 to 13). One case of rabies in a human being reported by California during 2001 was the result of infection with a canine variant of the rabies virus acquired outside the United States.