筛查家庭接触者
在疫区,多达 30% 的家庭接触者可能有暴露于布鲁氏菌的血清学证据,伴有或不伴有症状。[18]Mendoza-Núñez M, Mulder M, Franco MP, et al. Brucellosis in household members of Brucella patients residing in a large urban setting in Peru. Am J Trop Med Hyg. 2008;78:595-598.http://www.ajtmh.org/content/78/4/595.fullhttp://www.ncbi.nlm.nih.gov/pubmed/18385354?tool=bestpractice.com[17]Almuneef MA, Memish ZA, Balkhy HH, et al. Importance of screening household members of acute brucellosis cases in endemic areas. Epidemiol Infect. 2004;132:533-540.http://www.ncbi.nlm.nih.gov/pubmed/15188722?tool=bestpractice.com如果资源允许,可以使用临床问卷、血清学和/或 PCR 对家庭接触者进行筛查,如果阳性,可以治疗。
暴露后筛查
应当使用常规的临床和血清学监测方法随访暴露于布鲁氏菌释放的实验室工作人员和其他人员,尤其是不能立刻给予暴露后预防时。[26]Centers for Disease Control and Prevention (CDC). Laboratory-acquired brucellosis - Indiana and Minnesota, 2006. MMWR Morb Mortal Wkly Rep. 2008;57:39-42.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5702a3.htmhttp://www.ncbi.nlm.nih.gov/pubmed/18199967?tool=bestpractice.com[27]Reddy S, Manuel R, Sheridan E, et al. Brucellosis in the United Kingdom - a risk to laboratory workers? Recommendations for prevention and management of laboratory exposure. J Clin Pathol. 2010;63:90-92.http://www.ncbi.nlm.nih.gov/pubmed/18495792?tool=bestpractice.com[100]Health Protection Agency. Brucellosis: guidelines for action in the event of a deliberate release. September 2009. http://www.hpa.org.uk/ (last accessed 26 August 2016).https://www.gov.uk/guidance/brucellosis--2[101]Rusnak JM, Kortepeter MG, Aldis J, et al. Experience in the medical management of potential laboratory exposures to agents of bioterrorism on the basis of risk assessment at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID). J Occup Environ Med. 2004;46:801-811.http://www.ncbi.nlm.nih.gov/pubmed/15300132?tool=bestpractice.com[102]Corbel MJ. Brucellosis: an overview. Emerg Infect Dis. 1997;3:213-221.http://wwwnc.cdc.gov/eid/article/3/2/97-0219_article.htmhttp://www.ncbi.nlm.nih.gov/pubmed/9204307?tool=bestpractice.com除了不要求 6 个月之后的随访外,还未就最佳随访频率和持续时间达成一致。对频繁观察的依从性差。对于暴露于某些疫苗菌株,例如 RB51 或犬布鲁氏菌,血清学监测不合适,因为这些菌株不会引起人类的血清学应答。