Important Notice for Omaha/Lincoln Clinical Laboratories: Category A Specimen Shipments

Attention clinical laboratories in the Omaha/Lincoln area:

Shipping Category A packages require special handling and thus needs to be transported to the NPHL via an exclusive courier and cannot be transported via a standard courier. To schedule an exclusive courier for Category A transport, please call NPHL Client Services at (800) 334-0459 and request an exclusive courier.

Routine Category A packages (e.g., contains isolates of Mycobacterium tuberculosis, Shiga toxin-positive E. coli, etc.) are not required to be transported via STAT couriers. The use of STAT couriers must be approved in advance by NPHL testing personnel in response to high consequence pathogens.

As always, laboratories outside the Omaha/Lincoln area should use FedEx for shipping Category A packages.

Following this procedure helps maintain compliance with shipping regulations and ensures the safe and timely transport of isolates. Thank you for your cooperation!

Measles

Submitted by Alison Keyser-Metobo, MPH from the Nebraska Department of Health and Humans Services

Texas and New Mexico are currently experiencing a measles outbreak with over 250 cases (as of 3/14/2025). Most measles cases reported in 2025 have been among children aged 12 months and older who had not received the measles-mumps-rubella (MMR) vaccine. Nebraska currently does not have any cases. Healthcare providers should ensure children are current on routine immunizations including MMR.

Measles is a highly contagious viral illness that can cause severe health complications, including pneumonia, encephalitis, and death, especially in unvaccinated persons. Providers should consider measles as a diagnosis in anyone with a fever (≥101°F or 38.3°C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently been to countries or US states currently experiencing measles outbreaks or has had contact with a known measles case. If a provider decides to test a patient for measles, they should immediately notify their local health department, so they are aware that measles testing is happening in their jurisdiction.

Measles collection requirements: Providers should collect a nasopharyngeal swab, throat swab or urine for reverse transcription polymerase chain reacting (RT-PCR) testing or a blood specimen for serology.

If a patient is insured and does not have concerning exposures like travel to Gains County Texas, the RT-PCR and serology laboratory testing should be performed by a commercial laboratory or local laboratory. RT-PCR and serology testing (IgM and IgG) are available at Mayo, Quest, and LabCorp. If a patient is uninsured or has concerning exposures the Nebraska Department of Health and Human Services (NE DHHS) can pay for the test. Providers must get prior approval from NE DHHS before sending specimens to the Nebraska Public Health Laboratory. 

Brucella and Safety from Laboratory-Acquired Infections



Laboratory personnel working with bacterial cultures face various risks, but one pathogen stands out: Brucella species. Due to its highly infectious nature and potential for aerosol transmission, Brucella poses a serious occupational hazard, necessitating stringent biosafety practices.

The Risks of Brucella Exposure

Brucella is a gram-negative, facultatively intracellular bacterium that causes brucellosis, also known as undulant fever. Humans typically acquire the infection through direct contact with infected animals, ingestion of contaminated dairy products, or, in laboratory settings, accidental exposure to aerosols.

In the lab, exposures often occur due to:

• Aerosolization during culture handling, subculturing, or improper centrifugation.
• Unintentional exposure from open plates or spills.
• Direct contact with cultures or contaminated surfaces.

Even small numbers of Brucella organisms can cause infection, making biosafety precautions critical.

Biosafety Measures to Prevent LAIs

To minimize the risk of exposure, laboratories should implement strict biosafety practices when handling suspected Brucella specimens.

Key Safety Guidelines:

• Work in a Biosafety Cabinet (BSC): All procedures involving Brucella cultures should be performed inside a Class II BSC to prevent aerosol release.
• Minimize Aerosol-Generating Activities: Avoid vertexing, open flaming loops, or pipetting by mouth. Centrifugation should be performed in sealed safety cups.
• Use proper personal protective equipment (PPE).
• Decontaminate Workspaces and Equipment: Use freshly prepared 10% bleach or another effective disinfectant to clean surfaces and dispose of contaminated materials properly.
• Report Exposures Immediately: If a suspected exposure occurs, notify biosafety personnel and occupational health services for post-exposure monitoring and possible prophylaxis.

Recognizing Laboratory-Acquired Brucellosis

Symptoms of brucellosis can appear anywhere from a few days to several months after exposure and often include:

• Fever and chills
• Sweating (particularly at night)
• Joint and muscle pain
• Fatigue
• Hepatosplenomegaly (in severe cases)

Early detection and treatment prevents complications.