Introduction: Vaccination of cattle, sheep and goats with attenuated strains of Brucella is an effective measure for controlling brucellosis, although the vaccines pose risks to humans during the manufacturing process and throughout their distribution and administration to animals. Objective: The aim of this study was to review the risk posed to humans by occupational exposure to vaccine strains and the measures that should be implemented to minimize this risk. Materials and methods: This article reviewed the scientific literature indexed in PubMed up to January 31, 2023, following "the PRISMA guidelines"; special emphasis was placed on the vaccine strain used and the route of exposure. Results: Twelve primary reports were found: six included the Rev-1 strain, three the S19, and four the RB-51 strain. Rev-1 seemed to be the most virulent. The most frequent type of exposure was needle injury during administration, while exposure accidents during vaccine manufacturing were exceptional. Prolonged contact with the pathogen, lack of information and a low adherence to personal protective equipment (PPE) use in the work environment were determining factors for becoming infected. Despite strict protection measures, a percentage of vaccine manufacturing workers developed a positive serology to the vaccine strain, which may have conferred immunity. Conclusions: Brucella vaccines pose risk of contagion to humans from their production to their administration to cattle; therefore, protection measures should be extreme, and active surveillance of exposed workers should be implemented.
La enfermedad de Kimura se debe sospechar ante masas o nódulos linfoides en cabeza y cuello, con afectación del tejido celular subcutáneo y linfadenopatías regionales, con poca inflamación y pocos síntomas sistémicos, habitualmente acompañadas de eosinofilia periférica y elevación de IgE sérica. Presenta buen pronóstico incluso sin tratamiento, aunque con tendencia a la recidiva. Se presenta el caso de un varón caucásico de 66 años con una masa laterocervical de rápida aparición cuyo diagnóstico final se realizó con la biopsia, en la que se encontraron hallazgos mixtos con hiperplasia angiolinfoide con eosinofilia (HALE), que antes se pensaba que era la misma entidad.
BackgroundCattle vaccination remains an essential measure for the control of brucellosis. Strict preventive measures are applied to protect vaccine manufacturing workers (VMW) employed in processing these live attenuated vaccines. We analyzed the serological responses of VMW in contact with the Brucella melitensis Rev.1 strain.MethodsWe conducted an observational study of a cohort of VMW in a Spanish biopharmaceutical company, a leader in manufacturing veterinary products. The results of the Brucella serological tests carried out on these workers between 2012 and 2019 were reviewed, as well as demographic data, length of time in the company (seniority), and level of exposure. Multivariate analysis was performed with the logistic regression test.ResultsOf the 115 VMW studied, 47 (41%) showed positive Rose Bengal tests during company check-ups. Exposure levels were correlated with seropositivity, with an adjusted OR of 6.6 (95% CI: 2.1-20.3) for the high exposure and 2.0 (95% CI: 0.6-6.7) for the medium exposure groups. Sixteen (34%) seropositive VMW demonstrated an acute serologic pattern of IgG and IgM antibodies seropositivization, while 31 (66%) manifested a chronic serologic pattern of constant or intermittent positive IgG antibodies with persistently negative IgM antibodies. Seniority was inversely associated with the acute pattern: adjusted OR of 0.88 (95% CI: 0.79-0.97) for each year added. No seropositive VMW showed evidence of active brucellosis during follow up.ConclusionDespite strict safety measures, a percentage of VMW were exposed to the Rev.1 strain. Exposure levels were correlated with seropositivity. None of them developed symptomatic infection during follow-up. Two different serological patterns were observed: an acute IgM-positive pattern or a chronic IgM-negative pattern. Seniority was associated with the chronic pattern.
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