Update: Widespread Outbreaks of Hepatitis A among People Who Use Drugs and People Experiencing Homelessness across the United States

Multiple states across the country have reported outbreaks of hepatitis A, primarily among people who use drugs and people experiencing homelessness. Since the hepatitis A outbreaks were first identified in 2016, more than 15,000 cases, 8,500 (57%) hospitalizations, and 140 deaths as a result of hepatitis A virus (HAV) infection have been reported. This Health Alert Network (HAN) update recommends that public health departments, healthcare facilities, and partners and programs providing services to affected populations vaccinate at-risk groups against hepatitis A, applying the updated recommendations of the Advisory Committee on Immunization Practices (ACIP).

This is an update to the Health Alert Network (HAN) advisory released on June 11, 2018 titled Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness(https://emergency.cdc.gov/han/han00412.asp). Read the entire HAN.

Kingston Pharma, LLC RECALLS ” DG™/health NATURALS baby Cough Syrup + Mucus” Because of Possible Health Risk

March 20, 2019 – Kingston Pharma, LLC of Massena, NY is recalling Lot KL180157 of its 2-fluid ounce (59 mL) bottles of DG™/health NATURALS baby Cough Syrup + Mucus” because it has the potential to be contaminated with Bacillus cereus/ Bacillus circulansBacillus cereus in food products has the potential to produce two forms of gastrointestinal illness, one being a syndrome primarily of vomiting, and the other of diarrhea.  Most often, illnesses are mild and self-limiting, although more serious and even lethal cases have occurred.  Individuals at risk for more severe forms of illness include infants, young children, and others with weakened immune systems. No illnesses have been reported to date in connection with this problem with the use of DG™/health NATURALS baby Cough Syrup + Mucus. Read recall  in full at: https://www.fda.gov/Safety/Recalls/ucm634052.htm

The recalled DG™/health NATURALS baby Cough Syrup + Mucus” bottles were distributed nationwide in Dollar General retail stores.  The product comes in a carton labeled DG™/health baby Cough Syrup + Mucus in 2-fluid ounce bottles marked with Lot KL180157 Expiration date 11/20 on the bottom of the carton and back of the bottle label; UPC Code 8 54954 00250 0.

The potential for contamination was noted after audit testing revealed the presence of Bacillus cereus /Bacillus circulans in some bottles of this lot of the product. One in ten bottles showed low levels of Bacillus cereus and two in ten bottles showed low levels of Bacillus circulans.

Production of the product has been suspended while FDA and the company continue their investigation as to the source of the problem.

Consumers who have purchased Lot KL180157 of DG™/health NATURALS baby Cough Syrup + Mucus” may return them to the place of purchase for a full refund. Consumers with questions may contact the company at 1-844-724-7347 8:30 a.m. to 6:00 p.m. EST or e-mail at Christina.Condon@SciRegs.com.

FDA Commissioner Scott Gottlieb, M.D., on advancing new policies aimed at preventing youth access to, and appeal of, flavored tobacco products, including e-cigarettes and cigars

  • FDA is proposing to end current compliance policy as it applies to flavored electronic nicotine delivery system (ENDS) products such as electronic cigarettes (other than tobacco-, mint-, and menthol-flavored products), and prioritize enforcement of such products offered for sale in ways that pose a greater risk for minors to access these tobacco products.
  • In addition, FDA expects manufacturers of all flavored ENDS products (other than tobacco-, mint-, and menthol-flavored) that remain on the market under these new conditions to submit premarket applications to the agency by Aug. 8, 2021. This application date is one year earlier than the agency previously proposed. 

When we first announced our comprehensive plan for tobacco and nicotine regulation in July 2017, we outlined a framework to better protect kids and to significantly reduce tobacco-related disease and death. We are continuing to implement that framework today. It remains the blueprint for the agency’s tobacco-related policymaking. Read the full Release. 

Claire’s Stores, Inc., Announces Voluntary Recall of Three Make-Up Products

Out of an abundance of caution, Claire’s Stores, Inc., announced a voluntary recall of three cosmetic products: Claire’s Eye Shadows, Claire’s Compact Powder and Claire’s Contour Palette. We initiated this voluntary recall after testing by the U.S. Food and Drug Administration indicated the possible presence of asbestos fibers in product samples from one lot of each product. Inhalation of asbestos over time has been linked to serious adverse health consequences.

The products are no longer available in our stores, but may still be in the homes of consumers. The SKUs/Lots being recalled are:

  • Claire’s Eyeshadows, UPC #888711847165, SKU #84716, Lot No. 08/17
  • Claire’s Compact Powder, UPC #888711839153, SKU #83915, Lot No. 07/15
  • Claire’s Contour Palette, UPC #888711401947, SKU #40194, Lot No. 04/17

The SKUs and UPCs can be found on the price tickets affixed to the products, and all batch numbers are shown on the back panels below the ingredient lists.

All three products were offered for sale between October 2016 and March 2019 and have been removed from the marketplace. They were sold in Claire’s stores nationwide and on www.claires.com. Any consumers who have purchased these products should discontinue use and return them to a Claire’s store for a full refund.

Read complete recall at: https://www.fda.gov/Safety/Recalls/ucm633237.htm?utm_campaign=Claire%E2%80%99s%20Stores%2C%20Inc.%2C%20Announces%20Voluntary%20Recall%20of%20Three%20Make-Up%20Products&utm_medium=email&utm_source=Eloqua 

FDA has received reports of adverse reactions to some “decal,” henna, and “black henna” temporary tattoos

FDA has received reports of adverse reactions to some “decal,” henna, and “black henna” temporary tattoos. Here is information about the safety of these products and how they are regulated. Learn more: https://www.fda.gov/Cosmetics/ProductsIngredients/Products/ucm108569.htm

“Decal” Temporary Tattoos

Decal temporary tattoos are used to decorate any part of the body, including areas of the face and around the eyes, and may last for a day or up to a week or more. They are especially popular with children and at Halloween.

There are two kinds of decal tattoos:

  • Some are images attached to a removable backing. The decal image is removed from the backing by wetting, and the image is then applied directly to the skin.
  • Others have a backing that adheres to the skin, creating a partial or complete barrier between the skin and the dyes used in the image.

The difference is important, because not all dyes are known to be safe for use on the skin. While an adhesive backing may protect the skin from unapproved colors, there may be other ingredients on or in the decal to help the image adhere better either to the backing or to the skin that may cause problems for some people.

FDA has received reports of reactions to some decal-type temporary tattoos. Before using a temporary tattoo on your face, it may be a good idea to try it on a less conspicuous part of your body.

Henna, or Mehndi, and “Black Henna”

Henna, a coloring made from a plant, is approved only for use as a hair dye. It is not approved for direct application to the skin, as in the body-decorating process known as mehndi. This unapproved use of a color additive makes these products adulterated. It is unlawful, for example, to introduce an adulterated cosmetic into interstate commerce.

Because henna typically produces a brown, orange-brown, or reddish-brown tint, other ingredients must be added to produce other colors, such as those marketed as “black henna” and “blue henna.” Even brown shades of products marketed as henna may contain other ingredients intended to make them darker or make the stain last longer on the skin.

The extra ingredient used to blacken henna is often a coal-tar hair dye containing p-phenylenediamine (PPD), an ingredient that can cause dangerous skin reactions in some people. That’s the reason hair dyes have a caution statement and instructions to do a “patch test” on a small area of the skin before using them. Sometimes, the artist may use a PPD-containing hair dye alone. Either way, there’s no telling who will be affected. By law, PPD is not permitted in cosmetics intended to be applied to the skin.

FDA has received reports of injuries to the skin from products marketed as henna and products marketed as “black henna.” For more information on Henna, see the consumer update: Temporary Tattoos May Put You at Risk.

Statement from FDA Commissioner on New Data Demonstrating Rising Youth Use of Tobacco Products and the Agency’s Ongoing Actions to Confront the Epidemic of Youth E-cigarette Use

Feb. 11, 2019 – In his statement below that was released by U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, M.D., he discusses new data demonstrating rising youth use of tobacco products and the Agency’s ongoing actions to confront the epidemic of youth e-cigarette use.

“Today, the U.S. Centers for Disease Control and Prevention (CDC) released additional data from our joint FDA/CDC 2018 National Youth Tobacco Survey. These data are a sobering reminder of the initial results we shared last fall indicating a rampant rise of youth e-cigarette use, which has prompted the FDA to take a series of escalating regulatory actions as part of our Youth Tobacco Prevention Plan. We are advancing those actions, and committing to some new steps. The epidemic use of e-cigarettes among children is one of the biggest public health challenges currently facing the FDA.

According to the data released today, approximately 4.9 million middle and high school students were current users (used in the past 30 days) of some type of tobacco product in 2018, up from 3.6 million in 2017. This increase is driven by an alarming surge in e-cigarette use. More than 3.6 million middle and high school students were current (past 30 day) e-cigarette users in 2018, a dramatic increase of more than 1.5 million students in one year. The study authors suggest — as the FDA also noted at the time of the initial release of this data in the fall – that the rise in e-cigarette use in the last year is likely due to the recent popularity of certain types of e-cigarettes, such as JUUL. Further, youth who use e-cigarettes also are using them more frequently and using flavored products more often than last year. Many youth tobacco product users are also using multiple products. Among current tobacco users, about 2 in 5 (1.68 million) high school students and 1 in 3 (270,000) middle school students used two or more tobacco products in 2018. The most commonly used tobacco product combination was e-cigarettes and conventional cigarettes among both middle and high school students.

Similarly, data from the recent National Institutes of Health’s Monitoring the Future study found comparable trends: From 2017 to 2018, current (past 30-day) e-cigarette use reportedly increased from 6.6 percent to 10.4 percent among 8th grade students; 13.1 percent to 21.7 percent among 10th grade students; and 16.6 percent to 26.7 percent among 12th grade students. In other words, more than a quarter of 12th graders in the U.S. are using e-cigarettes—exposing them to harmful effects of nicotine and other chemicals and putting them at risk of transitioning to other tobacco products.

These risks were further reinforced in research recently published in JAMA Network Open, which showed that, compared with non-users, youth who use e-cigarettes are more likely to transition to conventional cigarettes ‒ risking a lifetime of addiction to smoking and resulting smoking-attributable disease and erasing the reductions in youth smoking rates that we’ve achieved in America. The bottom line is that kids using e-cigarettes aren’t kids who “would have smoked cigarettes.” Quite the opposite. As a society, we’ve made great strides in stigmatizing cigarette use among kids. The kids using e-cigarettes are children who rejected conventional cigarettes, but don’t see the same stigma associated with the use of e-cigarettes. But now, having become exposed to nicotine through e-cigs, they will be more likely to smoke. I will not allow a generation of children to become addicted to nicotine through e-cigarettes. We must stop the trends of youth e-cigarette use from continuing to build and will take whatever action is necessary to ensure these kids don’t become future smokers.

Based on a growing body of evidence, I fear the youth trends will continue in 2019, forcing us to make some tough decisions about the regulatory status of e-cigarettes. The signs that we’re seeing are not encouraging. They point to continued growth in youth use of these products. No child should be using any tobacco or nicotine-containing product. We’ll continue to take steps to try to investigate the root causes of this spike in youth e-cigarette use and arrest the momentum of these trends, in particular, by ensuring these products are sold in ways that make them less accessible and appealing to youth. But, if these youth use trends continue, we’ll be forced to consider regulatory steps that could constrain or even foreclose the opportunities for currently addicted adult smokers to have the same level of access to these products that they now enjoy. I recognize that such a move could come with significant impacts to adult smokers. The FDA has repeatedly affirmed our collective view that e-cigarettes may have promise as a tool for helping currently addicted adult smokers quit smoking. But, with the staggering data on youth trends, we’re struggling to preserve these opportunities for adults while addressing the youth epidemic. I simply won’t allow their sale to come at the expense of addicting a generation of kids to nicotine.

To help address this growing use among kids, over the past year, the FDA has taken a rigorous enforcement stance, including a number of actions to combat the illegal sales of e-cigarettes to youth through our enforcement efforts at brick-and-mortar and internet storefronts, as well as taken steps to target companies engaged in kid-friendly marketing that increases the appeal of these products to youth. I’ve also appealed to the companies responsible for many of these products, and met with senior executives from five of the largest manufacturers of e-cigarette products. In addition, last week, I sent letters to the chief executive officers of Altria Group Inc. and JUUL Labs Inc. asking to meet with them to discuss my concerns that they don’t seem fully committed to their written promises about the steps they’d take to stop youth use of their products.

Just last week, the FDA escalated enforcement action against certain local Walgreens and Circle K retail locations for repeatedly selling tobacco products to minors by filing a complaint seeking to bar the two specific retail locations from selling tobacco products for 30 days. As part of that effort we’re also writing the corporate management of a number of large, national retail chains to discuss whether there is a corporate-wide issue related to their stores’ non-compliance and put them on notice that the FDA is considering additional corporate-wide enforcement avenues to address violative tobacco sales to youth, which have also included illegal sales of e-cigarettes to kids. This past fall, we marked a historic milestone of conducting a total of one million tobacco retailer inspections since we began doing so in 2010. To commemorate this, we’re sending letters to governors and agencies across the country thanking them for their work to support our efforts to protect youth – and reminding them of the need for continued vigilance to make sure retailers aren’t selling tobacco products to minors.

Beyond enforcement and social responsibility, we’ve committed to meaningful policy changes. Notably, in November, I announced proposed new steps to protect youth by preventing access to flavored tobacco products, including e-cigarettes. This policy framework will both address the disturbing trend of youth e-cigarette use and advance the historic declines we’ve achieved in recent years in the rates of combustible cigarette use among kids. This framework reflects a re-doubling of the FDA’s efforts to protect kids from all nicotine-containing products. It also reflects a very careful public health balance between steps to enable the opportunities to transition to non-combustible products to be available for adults; and our solemn mandate to make nicotine products less accessible and less appealing to children. In other words – a balance between closing the on-ramp for kids to become addicted to nicotine through combustible and non-combustible products, while maintaining the off ramp for adults through access to potentially less harmful forms of nicotine delivery for adult smokers seeking to transition away from combustible tobacco products.

Evidence shows that minors are especially attracted to flavored e-cigarette products, and that youth access these products from both brick and mortar retailers as well as online. With that in mind, we’re revisiting our compliance policy that has resulted in certain e-cigarettes, including flavored e-cigarettes, remaining on the market until 2022 while their manufacturers submit applications for premarket authorization. In particular, as I announced on Nov. 15, 2018, the FDA is revisiting the compliance policy on premarket tobacco product application authorization for all flavored e-cigarette products other than tobacco, mint, and menthol, sold in physical locations where people under the age of 18 are permitted. For example, this would include e-cigarettes or electronic nicotine delivery system (ENDS) products, such as e-liquids, cartridge-based systems, and cigalikes, in fruit and candy flavors like cherry, vanilla, crème, tropical, melon and others. In addition, we will seek to curtail the sale of applicable flavored ENDS products that are sold online without heightened age verification processes.

We’ll be providing further information on these policies soon. If data continue to show upwards trends in youth use of tobacco products, we’ll continue to refine our policies as necessary, taking additional steps to strengthen our response.

More recently, we’ve undertaken efforts to further the discussion and understanding around how we can help aid those kids who are already addicted to the nicotine in e-cigarettes quit. This includes holding a public hearing to discuss efforts to eliminate youth e-cigarette use as well as other tobacco product use, with a focus on the potential role of drug therapies to support cessation and the issues impacting the development of such therapies for youth. Already, I’ve heard too many troubling stories from parents of teenagers, pediatricians, and young people themselves about the effects of this epidemic. The stories make clear that, for many young e-cigarette users, addiction has already taken hold.

We’ve also launched “The Real Cost” Youth E-Cigarette Prevention Campaign – a new, comprehensive effort targets nearly 10.7 million youth, aged 12-17, who have used e-cigarettes or are open to trying them. The new campaign features hard-hitting advertising on digital and social media sites popular among teens, as well as posters with e-cigarette prevention messages in high schools across the nation. The new e-cigarette prevention effort builds off the FDA’s first youth tobacco prevention campaign, “The Real Cost,” which launched in 2014 to reduce teen cigarette smoking. In its first two years, the youth smoking prevention campaign prevented nearly 350,000 teens from initiating cigarette smoking and resulted in savings of more than $31 billion for youth, their families and society at large by reducing smoking-related costs like early loss of life, costly medical care, lost wages, lower productivity and increased disability. The success of “The Real Cost” campaign suggests that our other tobacco prevention campaigns, including our campaign on youth use of e-cigarettes, can build on this success as we strive to reduce the number of kids who use tobacco products.

As part of the youth e-cigarette prevention campaign, we also joined forces with Scholastic to expand distribution of youth e-cigarette prevention posters to every public and private high school in the U.S. and released new resources for doctors, youth groups, churches, state and local public health agencies, and others on the dangers of youth e-cigarette use. Additionally, our work with Scholastic to provide educators with resources to help them engage with students about e-cigarette use has helped reach more than 2.7 million students so far. We’ve also received very positive teacher feedback on the helpfulness of these resources. Vaping remains a top issue at some schools, but teachers are reporting that vaping on campus has declined after using these resources on the dangers of youth e-cigarette use.

While these efforts are a good start, we recognize they’re not enough. This is an exploding epidemic. We’ll continue to put the full scope of our regulatory tools against this mounting public health crisis. We’re considering some new steps for 2019.

Moving forward, the FDA has a number of actions planned and we’ll have more to say on these and other actions very soon. We’re continuing our stepped-up enforcement actions with a sustained campaign to monitor, penalize and prevent e-cigarette sales to minors in retail locations, including manufacturers’ internet storefronts. The agency is also exploring action under both its civil and criminal enforcement tools to target potentially violative sales and marketing practices by manufacturers as well as retailers. We’re also investigating counterfeit e-cigarette products. In addition to our meeting with Altria and JUUL, we also plan to meet with state attorneys general to discuss how they can help combat youth e-cigarette use in their states. We’re also exploring how we can partner with others to look at opportunities to work together around these shared goals. These are just some of the additional steps that we’re taking.

The numbers are clear – we’re experiencing epidemic-level rises in youth e-cigarette use, which is threatening the progress we’ve made toward reducing youth tobacco use. These trends require forceful and sometimes unprecedented action among regulators, public health officials, manufacturers, retailers and others to address this troubling problem. Our commitment to stemming the epidemic of youth e-cigarette use has not waivered, but we know there’s more to be done by all parties.”

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.”

This message is broadcasted by the Division of Communications in FDA’s Office of Regulatory Affairs (ORA).

 

People in 19 states exposed to Brucella bacteria from drinking raw milk

Food Safety News
Feb. 11, 2019
By Coral Beach
QUARRYVILLE, Pa. — Although it’s illegal to sell unpasteurized milk across state lines, federal officials say people in 19 states have been exposed to drug-resistant Brucella after consuming raw milk from Miller’s Biodiversity Farm in Pennsylvania. In a nationwide food safety alert, the Centers for Disease Control and Prevention warned that anyone who has consumed raw dairy products from the farm in the past three years should check in with their doctors. The outbreak strain of Brucella — RB51 — is resistant to rifampin, one of the antibiotics that is typically be used to prevent or treat brucellosis. The CDC and state officials are urging consumers to throw away any raw dairy products from Miller’s Biodiversity Farm that they have in their homes.  … Investigators have discovered people in 19 states bought or consumed raw milk from the Pennsylvania farm. The CDC alert did not report how the unpasteurized, raw milk had been illegally transported or sold across state lines. The 19 states are Alabama, California, Connecticut, Florida, Georgia, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, and Virginia.

Learn more: https://www.cdc.gov/media/releases/2019/s0211-brucellosis-raw-milk.html

Tris Pharma, Inc Expands Its Voluntary Nationwide Retail Recall of Ibuprofen Oral Suspension Drops, USP, 50 mg per 1.25 mL, Due to Higher Concentration of Ibuprofen

January 29, 2019 – Monmouth Junction, NJ, Tris Pharma, Inc. is expanding the scope of its November 2018 recall by adding three (3) additional lots of Ibuprofen Oral Suspension Drops, USP, 50 mg per 1.25 mL, to the retail (pharmacy) level. Some units from these batches have been found to have higher levels of Ibuprofen concentration.

Infants already susceptible to the adverse effects of ibuprofen may be at a slightly higher risk if they receive medication from an impacted bottle. There is a remote probability that infants, who may be more susceptible to a higher potency level of drug, may be more vulnerable to permanent NSAID-associated renal injury. Some units from these six (6) lots have been found to contain Ibuprofen as high as 10% above the specified limit. Studies have shown that safety issues or toxicity is generally accepted to be a concern in infants at doses in excess of 700% of the recommended dose.1 To date, no serious adverse events have been reported related to this recall.

Learn more about this expanded recall: https://www.fda.gov/Safety/Recalls/ucm630112.htm

Jac. Vandenberg, Inc. Recalls Fresh Peaches, Fresh Nectarines and Fresh Plums Because They May Be Contaminted with Listeria Monocytogenes

Jac. Vandenberg, Inc. of Yonkers, New York is recalling 1,727 cartons of Fresh Peaches, 1,207 cartons of Fresh Nectarines and 365 cartons of Fresh Plums because they have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

The Fresh Peaches, Fresh Nectarines and Fresh Plums were distributed in Alabama, California, Georgia, Illinois, Kentucky, Maine, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, West Virginia and Virginia through small retail establishments and the following select retail stores, read more:  https://www.fda.gov/Safety/Recalls/ucm629797.htm

Third Case of Rifampin/Penicillin-Resistant Strain of RB51 Brucella from Consuming Raw Milk

CDC HEALTH ADVISORY

Third Case of Rifampin/Penicillin-Resistant Strain of RB51 Brucella from Consuming Raw Milk 

Summary

The New York State Department of Health and Pennsylvania Department of Health are investigating Brucella RB51 exposures that may be connected to consuming raw (unpasteurized) milk from Miller’s Biodiversity Farm in Quarryville, Pennsylvania. Symptoms of brucellosis can include fever, sweats, malaise, anorexia, headache, fatigue, muscle and joint pain, and potentially more serious complications (e.g., endocarditis, hepatomegaly, splenomegaly, and neurologic symptoms). In pregnant patients, Brucella infections can be associated with miscarriage. Symptom onset can occur anywhere from five days to six months following exposure. As of January 22, 2019, exposures have been identified in 19 states: Alabama, California, Connecticut, Florida, Georgia, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, and Virginia.

Background

This investigation is associated with the third known case of brucellosis from Brucella RB51 due to raw milk acquired in the U.S., since August 2017. A New York resident, who drank raw milk purchased from Miller’s Biodiversity Farm in Quarryville, Pennsylvania, was diagnosed with brucellosis in November 2018. Milk samples from the dairy tested positive for Brucella strain RB51. People who consumed raw milk or raw milk products from this dairy since January 2016 may have been exposed.
– Patients who are still within six months of the date they last consumed the raw milk are at an increased risk for brucellosis and appropriate post-exposure prophylaxis (PEP) is recommended, along with six months of symptom monitoring. Please see diagram below.
– If patients are outside of the six-month window following their last consumption of the raw milk and have or develop an illness consistent with brucellosis, a blood culture should be obtained prior to starting any treatment, preferably while the patient is symptomatic.

Brucella strain RB51 is a live-attenuated cattle vaccine strain, which can be shed in milk and can cause infections in humans. RB51 is resistant to rifampin and penicillin. There is no serological test available to detect RB51 infection. Blood culture is the recommended diagnostic test for exposed individuals who are symptomatic.1

Recommendations

The Centers for Disease Control and Prevention (CDC) recommends the following:

  1. A 21-day course of both doxycycline and trimethoprim/sulfamethoxazole for first-line PEP for RB51 exposure.If brucellosis occurs despite prophylaxis, treatment should be pursued; alternative options should be considered for those with contraindications to the stated PEP and treatment regimens.Please note that RB51 is resistant to rifampin and penicillin.
  2. When ordering blood cultures to diagnose brucellosis, please advise the laboratory that blood culture may grow Brucella and that appropriate laboratory containment and precautions should be observed.3
  3. Advise patients to discard any leftover or stored, raw milk or raw milk products from this dairy farm.

Please see the diagram below for information on developing an evaluation and treatment plan for patients who consumed raw milk or raw milk products from Miller’s Biodiversity Farm since January 2016, and are still within the six-month window following their last known exposure.

Treatment Decision Tree for Patients Who Consumed Raw Milk or Raw Milk Products
from Miller’s Biodiversity Farm in Quarryville, Pennsylvania

Note: Testing for asymptomatic patients is not recommended.

Read this CDC Advisory in full at: CDC HAN 417 Third Case of Rifampin Penicillin-Resistant RB51 Brucella from Consuming Raw Milk 01.23.19