Forty (40) cases of laboratory-associated anthrax, occurring primarily at facilities conducting anthrax research, have been reported (66, 151). No laboratory-associated cases of anthrax have been reported in the United States since the late 1950's when human anthrax vaccine was introduced.
Naturally and experimentally infected animals pose a potential risk to laboratory and animal care personnel.
LABORATORY HAZARDS: The agent may be present in blood, skin lesion exudates, cerebrospinal fluid, pleural fluid, sputum, and rarely, in urine and feces. Direct and indirect contact of the intact and broken skin with cultures and contaminated laboratory surfaces, accidental parenteral inoculation, and rarely, exposure to infectious aerosols are the primary hazards to laboratory personnel.
RECOMMENDED PRECAUTIONS: Biosafety Level 2 practices, containment equipment and facilities are recommended for activities using clinical materials and diagnostic quantities of infectious cultures. Animal Biosafety Level 2 practices, containment equipment and facilities are recommended for studies utilizing experimentally infected laboratory rodents. A licensed vaccine is available through the Centers for Disease Control and Prevention; however, immunization of laboratory personnel is not recommended unless frequent work with clinical specimens or diagnostic cultures is anticipated (e.g., animal disease diagnostic laboratory). Biosafety Level 3 practices, containment equipment and facilities are recommended for work involving production volumes or concentrations of cultures, and for activities which have a high potential for aerosol production. In these facilities immunization is recommended for all persons working with the agent, all persons working in the same laboratory room where the cultures are handled, and persons working with infected animals.
Bordetella pertussis, a human respiratory pathogen of worldwide distribution, is the causative agent of whooping cough. The disease is typically a childhood illness; however, the agent has been associated, with increased frequency, in adult illness (106, 112, 130). Several outbreaks in health-care workers have been reported in the literature (106, 112). Adolescents and adults with atypical or undiagnosed disease can serve as reservoirs of infection and transmit the organism to infants and children (135). Eight cases of infection with B. pertussis in adults have been documented at a large research institution. The individuals involved did not work directly with the organism, but had access to common laboratory spaces where the organism was manipulated. One case of secondary transmission to a family member was documented (122). A similar incident occurred at a large midwestern university resulting in two documented cases of laboratory-acquired infection and one documented case of secondary transmission (146). Other laboratory-acquired infections with B. pertussis have been reported, as well as adult-to-adult transmission in the workplace (19, 35). Laboratory-acquired infections resulting from the manipulation of clinical specimens or isolates have not been reported. The attack rate of this airborne infection is influenced by intimacy and frequency of exposure of susceptible individuals.
LABORATORY HAZARDS: The agent may be present in respiratory secretions, but is not found in blood or tissues. Since the natural mode of transmission is by the respiratory route, the greatest potential hazard is aerosol generation during the manipulation of cultures or concentrated suspensions of the organism.
RECOMMENDED PRECAUTIONS: Biosafety Level 2 practices, containment equipment, and facilities are recommended for all activities involving the use or manipulation of known or potentially infectious clinical materials or cultures. Animal Biosafety Level 2 should be used for the housing of infected animals. Primary containment devices and equipment (e.g., biological safety cabinets, centrifuge safety cups, or specially designed safety centrifuges) should be used for activities likely to generate potentially infectious aerosols. Biosafety Level 3 practices, procedures, and facilities are appropriate when engaged in large scale production operations. The current pertussis vaccine may not provide complete and permanent immunity; however, a booster dose of pertussis vaccine is not recommended for use in persons who have passed their seventh birthday (50).
B. abortus, B. canis, B. melitensis, and B. suis have all caused illness in laboratory personnel (129, 151, 176). Brucellosis is the most commonly reported laboratory-associated bacterial infection (127, 143, 151). Hypersensitivity to Brucella antigens is also a hazard to laboratory personnel. Occasional cases have been attributed to exposure to experimentally and naturally infected animals or their tissues.
LABORATORY HAZARDS: The agent may be present in blood, cerebrospinal fluid, semen, and occasionally urine. Most laboratory-associated cases have occurred in research facilities and have involved exposure to Brucella organisms being grown in large quantities. Cases have also occurred in a clinical laboratory setting: direct skin contact with cultures or with infectious clinical specimens from animals (e.g., blood, uterine discharges) are commonly implicated in these cases. Aerosols generated during laboratory procedures have caused large outbreaks (95). Mouth pipetting, accidental parenteral inoculations, and sprays into eyes, nose and mouth have also resulted in infection.
RECOMMENDED PRECAUTIONS: Biosafety Level 2 practices are recommended for activities with clinical specimens of human or animal origin containing or potentially containing pathogenic Brucella spp. Biosafety Level 3 and Animal Biosafety Level 3 practices, containment equipment and facilities are recommended, respectively, for all manipulations of cultures of the pathogenic Brucella spp. listed in this summary, and for experimental animal studies. Vaccines are not available for use in humans.
C. jejuni/C. coli gastroenteritis is rarely a cause of laboratory associated illness. Three laboratory-acquired cases have been documented (138, 149, 155). Numerous domestic and wild animals, including poultry, pets, farm animals, laboratory animals, and wild birds are known reservoirs and are a potential source of infection for laboratory and animal care personnel. Experimentally infected animals are also a potential source of infection (155).
LABORATORY HAZARDS: Pathogenic campylobacters may occur in fecal specimens in large numbers. C. fetus subsp. fetus may also be present in blood, exudates from abscesses, tissues, and sputa. Ingestion or parenteral inoculation of C. jejuni constitute the primary laboratory hazards. The oral ingestion of 500 organisms caused infection in one individual (163). The importance of aerosol exposure is not known.
RECOMMENDED PRECAUTIONS: Biosafety level 2 practices, containment equipment and facilities are recommended for activities with cultures or potentially infectious clinical materials. Animal Biosafety Level 2 practices, containment equipment and facilities are recommended for activities with naturally or experimentally infected animals. Vaccines are not available for use in humans.