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On 28 December 2012, the New York State Department of Health (NYSDOH) and the Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), were notified of Coccidioides species contamination in commercially distributed tubes of rhesus monkey kidney (RhMK) cells from company A; Coccidioides posadasii was later identified through gene-specific PCR in two lots (A491216-B and A491206-T) (1). On 31 December 2012, company A issued a recall of the affected lots. By 3 January 2013, company A reported that all customers receiving the affected lots were notified of the recall. The NYSDOH (1) and CDC sent electronic communications to health care providers, state epidemiologists, public health officers, and laboratorians recommending steps for handling and disposing of the recalled product and reporting suspected Coccidioides exposures.
Coccidioides spp. are dimorphic fungi that cause infection following inhalation of infectious arthroconidia. Conditions that promote arthroconidium formation include room temperature incubation on solid media for ≥3 days (2–4). The risk of C. posadasii infection following manipulation of contaminated tissue culture cells in this event was low because the RhMK cells were maintained in liquid media. Adherence to biosafety level 2 containment procedures minimizes exposure-associated infection risk resulting from fungal sporulation.
One hundred ninety-nine laboratories in 38 states received 12,456 recalled RhMK shell vials and tubes. Six employees from three clinical laboratories in Washington, Pennsylvania, and Colorado reported potential inhalation exposure when transport medium from the RhMK cells was exchanged for liquid growth medium on the benchtop. All exposures were considered low risk. Prophylaxis was not indicated, but exposed individuals were counseled and advised to watch for symptoms. No clinical illness has been reported.
Both RhMK cell lots were sourced from the kidney of a 10-year-old rhesus monkey used for breeding and housed outdoors at a California academic facility. The monkey was sacrificed in January 2012 due to unexplained weight loss. Fresh kidney tissue was shipped in transport media to an intermediary distributor before shipment to company A. Transport media and monkey tissue were cultured for bacterial, but not fungal, growth at both company A and the intermediary; cultures were negative. Archived sera from the animal tested negative by immunodiffusion for Coccidioides species antibodies during January 2013. No signs of fulminant infection were observed during necropsy, which included gross examination and histopathology of kidney tissue. The monkey's brain, lung, and reproductive organs were also used for research purposes at the facility housing the monkey; however, the risk of infectious exposures was considered low because tissue manipulation was performed in a biosafety cabinet. There were no reports of contaminated tissue or suspected Coccidioides species exposure to these organs.
We highlight the importance of rapid dissemination of information, efficient coordination and communication between public health agencies and the private sector, and detailed, accessible histories of research animals. By use of electronic communication systems, alerts and recommendations were quickly disseminated; however, current public health communication systems do not permit rapid communication with research/academic laboratories. Culture to identify fungal contaminants and manipulation of animal tissues should be performed with extreme caution and in accordance with appropriate biosafety procedures.
We acknowledge the following persons for contributions to this investigation: Ronald Lollar, Steve Schulstrom, George Thompson, and Rachel Reader. We also acknowledge the Bureaus of Communicable Disease Control and Healthcare Associated Infections at the New York State Department of Health, Wadsworth Laboratories, and the North Shore-Long Island Jewish Health System Laboratories.
Published ahead of print 20 March 2013