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Dear Colleague:
The American Society for Microbiology (ASM) Sentinel Laboratory Guideline Working Group together with the Public and Scientific Affairs Board Committees on Professional Affairs and Laboratory Practices have been actively monitoring all communications regarding the potential exposures to Brucella abortus RB51 submitted as part of the College of American Pathologists (CAP) Laboratory Preparedness Survey (LPS) Set B in October 2007.
A number of communications have been circulated that we encourage microbiologists in Advanced Sentinel Laboratories to be familiar with:
1. In March 2007, the CAP provided notification to Medical Directors of laboratories subscribing to LPS that changes were being made to the survey. In particular, laboratories were to follow the ASM Sentinel Laboratory Guidelines posted on the ASM website and were required to have a certified Class II Biological Safety Cabinet in place to safely follow these protocols. A certificate of acceptance of these conditions was to be returned by April 9, 2007. In addition, it was noted that individual states might also elect to challenge Sentinel Laboratory reporting and shipping of isolates characterized as possible bioterrorism agents.
2. The first survey, LPS SetA was distributed in May and the resutls were returned in late July without indicent. The second survey, LPS Set B, was distributed on October 15, 2007 and results are pending. However, included in this survey was a strain of Brucella abortus RB51, an attenuated veterinary vaccine strain that has rarely caused infections in humans (MMWR 47(09); 172-175; March 13, 1998). One state LRN Reference Laboratory reported “inappropriate” shipping of the Brucella isolate by a Sentinel Laboratory resulting in several laboratory personnel exposures. Subsequently, a survey of participating laboratories in this state identified ~85% of Sentinel Laboratories as performing procedures with “high exposure risk.” All LRN Reference Laboratories and public health officials were notified of this situation and advised on actions to take beginning December 3, 2007. On December 10, 2007, laboratories received a CAP notification advising participants to review laboratory handling of the sample to determine if high risk exposures may have occurred.
3. To assist in risk assessment, CDC posted an extensive “FAQ” document on December 7, 2007. In addition, a number of state laboratories and public health departments have provided additional information on handling of potential exposures. ASM strongly encourages Sentinel Laboratories to comply with all state recommendations for review of practices for exposure risk assessment and to follow recommendations provided by these same entities regarding Post-Exposure Prophylaxis. In addition, an MMWR Notice to Readers emphasizing biosafety practices for biothreat agents including Brucella will be published in the near future.
4. The ASM also encourages all Sentinel Laboratories to review the ASM Sentinel Laboratory Guideline for Brucella, as well as the protocols for all other agents, to ensure that all testing is performed as currently recommended. All Sentinel Laboratory Guidelines are available on the ASM website. Also included is a Sentinel Laboratory Guideline for safe and compliant Packing and Shipping of Infectious Substances, and a definition of requirements for designation as an Advanced Sentinel Laboratory.
5. Finally, the ASM strongly encourages participating laboratories to be familiar with biosafety guidance available in the Biosafety in Biomedical and Microbiological Laboratories (BMBL), 5th edition. Requirements for BSL2 and BSL3 laboratories, and for safe handling of BSL2 and BSL3 organisms have been recently updated in this document.
As the lead organization for the development and updating of the ASM Sentinel Laboratory Guidelines, the ASM is committed to ensuring that all information included in these protocols is accurate, complete, practical, and in compliance with all accepted standards of care and current regulations. The Sentinel Laboratory Protocol Working Group together with the Brucella Subject Matter Experts will be reviewing the Brucella protocol for improvements following this incident. Notification will be given as soon as a revised version is available. In addition, the ASM has been asked to become a member of the LPS Working Group together with CAP, APHL, and CDC. Through cooperation and coordination with these entities, the ASM will strive to ensure that Sentinel Laboratories are well-prepared to meet both proficiency survey and real-life emerging infection challenges in the future.
James Snyder, Ph.D., DABMM
ASM Representative to the Laboratory Response Network
Coordinating Editor, ASM Sentinel Laboratory Guidelines
Vickie Baselski, Ph.D., DABMM
Chair, Professional Affairs Committee, PSAB
Susan Sharp, Ph.D., DABMM
Chair, Laboratory Practices Committee, PSAB |
