Table 3.

Comparison of Brucella postexposure follow-up recommendations

Procedure	CDC recommendations, 2008 (23)	Modifications to recommendationsa
Antimicrobial PEP	High risk: doxycycline (100 mg) twice daily and rifampin (600 mg) once daily for 3 weeks; TMP-SMZ should be considered for patients with contraindications for doxycycline	Doxycycline (100 mg) twice daily and rifampin (600 mg) once daily for 3 weeks; TMP-SMZ or another antimicrobial agent effective against Brucella should be selected for persons with contraindications to doxycycline or rifampin; regimen and dosing should be chosen in consultation with the person's HCP; pregnant women should consult an obstetrician
	Low risk: discuss with HCP; consider if patient is immunocompromised or pregnant	No change
Serologic monitoringb	Baseline, 2, 4, 6, 24 weeks after last known exposure	Sequential serologic testing at baseline, 6, 12, 18 and 24 weeks post exposure (after last known exposure)
Symptom surveillance	Regular (e.g., weekly) symptom watch for febrile illness through 24 weeks after last known exposure	Regular (e.g., weekly) symptom watch and daily self temp checks through 24 weeks post-exposure (after last known exposure)

^aThese modifications are based on the above case reports and a review of the literature (24).

^bObtain baseline and periodic serum samples from all workers exposed to Brucella, unless they have been exposed to B. abortus strain RB51 or B. canis, which do not elicit a measurable serologic response in available B. abortus antigen-based assays.