Laboratory associated
infections and other hazards
1976 – Bacterial infections were most
frequently reported as occupationally
associated infections of laboratory workers
Viral and rickettsial infections were reported
in the later half
Commonly recorded infections:
Brucellosis
Q Fever
Viral Hepatitis
Typhoid Fever
Tuberculosis
• The complications of laboratory associated
infections cited above provides a historical
perspective of hazards of occupational
infection which necessarily are not
indicative of the present day risk of
infection
• Brucellosis – 6000 cases of humans in
USA (1947) verses 407 in 1963
Typhoid
• Typhoid fever
– 6000 in 1942
– 2341 in 1952
– 390 in 1984 Of these 70% were aquired during foreign travel
Tuberculosis
1,21000 in1950
22,500 in1984
• As the incidence of .top five diseases has
decreased in the general population, there
has been a corresponding decrease in the
number of laboratory specimens received
and examined that contained these agents
This has certainly reduced the probability
of occupational exposure
• On the other hand newly emerging
diseases and newly recognized organisms
may increase the risk of infection for
laboratory personnel
• WEST NILE VIRUS (WNV), A MOSQUITO
borne flavivirus introduced recently to
North America, is a human, equine, and
avian neuropathogen.1 The majority of
human infections with WNV are mosquito-
borne; however, laboratory acquired
infections with WNVand other arboviruses
also occur
• This report summarizes two recent cases
of WNV infection in laboratory workers
without other known risk factors who
acquired infection through percutaneous
inoculation.
• The microbiologist worked in a Class II laminar flow
biosafety cabinet under biosafety level 2 (BSL-2)
conditions and lacerated a thumb while using a scalpel to
remove the bird’s brain.
• The wound, a superficial cut over the dorsal surface of
the interphalangeal joint, was cleansed and bandaged.
• Four days after injury, the microbiologist had acute
symptoms of headache, myalgias, and malaise followed
by chills, sweats, dysesthesias, recurring hot flashes,
swelling of the postauricular lymph nodes, and anorexia
• The microbiologist continued to work during illness and
had intermittent chills, sweats, dysesthesias, and hot
flashes for approximately 1 week before recovering fully.
• On the third day of illness (7 days postinjury), the
microbiologist sought medical care from a physician and
reported no history of recent mosquito bites, prolonged
outdoor activities, or recent blood transfusion.
• On physical examination, the patient was afebrile with
erythema on the cheeks, but the examination was otherwise
normal.
• Serial serum samples taken from the patient and submitted to
CDC for WNV serologic testing revealed evidence of an
acute WNV infection.
• The initial specimen (collected 3 days after illness onset) was
negative for WNV-specific IgM or neutralizing antibodies.
• Specimens collected 13 and 21days after illness onset both
were positive for WNV-specific IgM antibody; the latter
specimen was positive for WNV specific neutralizing antibody
• In October 2002, a microbiologist working in a U.S.
laboratory who was harvesting WNV-infected mouse
brains in a Class II laminar flow biosafety cabinet under
BSL-3 conditions5 punctured a finger with a
contaminated needle.
• The wound was cleansed and bandaged. The
microbiologist’s body temperature was measured several
times each day, and 3 days after injury, the
microbiologist had upper respiratory infection (URI)
symptoms without fever or chills. The next day, URI
symptoms continued with malaise, fatigue, chills, and a
low-grade fever (100.9°F [38.3°C]).
• That evening, the patient took an over the-counter cold
medication.
• The next morning, the patient awoke without fever or chills but with
continued URI symptoms and a dry cough and hoarseness that persisted for
1 week, although the patient missed only 1 day of work.
• At no time did the patient notice a skin rash, an increase in the usual degree
of joint pain, or a stiff neck.
• The patient reported no history of recent mosquito bites, prolonged outdoor
activities, or recent blood transfusion.
• The patient had a history of exposure to multiple flaviviruses or flavivirus
antigens (i.e., had had dengue fever and had received yellow fever and
Japanese encephalitis vaccines).
• Serial serum samples taken and submitted to CDC for WNV serologic
testing revealed evidence of an acute WNV infection.
• WNV-specific IgM antibody was absent from both the initial specimens (1
day after injury and 3 days before fever onset) and a specimen collected 2
days after fever onset.
• Antiflaviviral IgG antibody was detected in both of these specimens by
enzyme linked immunosorbent assay (ELISA), but no change in the
intensity of IgG activity was observed.
• A serum specimen collected 10 days after illness onset was positive for
WNV-specific IgM antibody and showed a sharp increase in the intensity of
anti-flaviviral IgG antibody by ELISA
