Adverse events in humans associated with accidental exposure to the livestock brucellosis vaccine RB51
Adverse events in humans associated with accidental exposure to the livestock brucellosis vaccine RB51
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DOI：
10.1016/j.vaccine.2004.02.041
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发表时间：
2004-09-03
期刊：
影响因子：
5.5
通讯作者：
Perkins, BA
中科院分区：
文献类型：
--
作者：
Ashford, DA;di Pietra, J;Perkins, BA
流产布鲁氏菌RB51株疫苗是一种减毒活菌疫苗，于1996年2月23日获得美国农业部兽医服务、动植物卫生检疫局兽医生物制品中心有条件的许可，用于美国牛的疫苗接种。在牛的疫苗接种过程中可能发生意外的人接种，并且已知以前为牛设计的布鲁氏菌活疫苗会导致人感染布鲁氏菌病。疾病控制和预防中心（CDC）在美国建立了意外接种RB51疫苗的被动监测，以确定这种兽医疫苗是否与人类疾病有关，描述意外接种的情况，评估暴露后化学预防的潜在功效，并制定暴露后RB51暴露后管理建议。收到了26个人的报告。21人（81%）因针刺伤意外接触RB51, 4人（15%）因结膜喷雾剂接触RB51, 1人（4%）因喷雾剂接触开放性伤口。19人（73%）报告了至少一种全身性症状，其中3人（12%）报告了持续的局部反应并累及全身。一例需要手术，并从该个体的伤口中分离出流产杆菌RB51菌株。7例报告没有与意外暴露相关的不良事件。9例报告曾接触过布鲁氏菌疫苗，其中1例还报告在接触s19疫苗后曾诊断为布鲁氏菌病。在美国，接种RB51疫苗的人意外针头刺伤和结膜或开放性伤口暴露与与布鲁氏菌病一致的局部和全身不良事件有关；然而，RB51菌株疫苗是否能引起人类全身性布鲁氏菌病仍不确定。需要对接触者进行早期培养，并在将来发展为疾病，需要对抗rb -51抗体进行血清学诊断，以确定这些不良事件是否由RB51引起，并确定适当的预防方案。Elsevier Ltd.出版。
Brucella abortits strain RB51 vaccine, is an attenuated live bacteria] 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 S 19 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. Published by Elsevier Ltd.