Epidemiology and Health

Epidemiologic Investigation

Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018: Nejib Charaa, Rabaa Ghrab, Aicha Ben Othman, Mohamed Makhlouf, Hejer Ltaief, Nissaf Ben Alaya, Mohamed Chahed; Epidemiol Health. 2022;44:e2022048. Published online May 18, 2022; DOI: https://doi.org/10.4178/epih.e2022048

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Abstract

OBJECTIVES
In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions.

METHODS

This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened.

RESULTS

Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis.

CONCLUSIONS

Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.

Summary

Key Message
Human brucellosis, despite being a major economic and health problem and the availability of proven control methods, is still endemic in North African countries. The scarcity of epidemiological data, under-reporting, certain weaknesses in surveillance systems and the lack of well-conducted outbreak investigations, contribute to this endemic state. This field epidemiological investigation of a human brucellosis outbreak highlighted the importance of serological surveillance, the slaughter of infected animals, vaccination, control of animal movements across borders and pasteurization of milk in the fight against this disease.

Citations

Citations to this article as recorded by

Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis
Zhiguo Liu, Liping Gao, Miao Wang, Min Yuan, Zhenjun Li
Emerging Microbes & Infections.2024;[Epub] CrossRef
Native circulating Brucella melitensis lineages causing a brucellosis epidemic in Qinghai, China
Hongmei Xue, Zhijun Zhao, Jianling Wang, Li Ma, Jiquan Li, Xuxin Yang, Lingling Ren, Liqing Xu, Zhiguo Liu, Zhenjun Li
Frontiers in Microbiology.2023;[Epub] CrossRef

Perspective

Neglected paths of transmission of milkborne brucellosis and tuberculosis in developing countries: novel control opportunities: Arockiasamy Arun Prince Milton, Samir Das, Sandeep Ghatak; Epidemiol Health. 2020;42:e2020073. Published online December 4, 2020; DOI: https://doi.org/10.4178/epih.e2020073

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Abstract PDF

Abstract

Brucellosis and tuberculosis are lingering zoonotic infections that are endemic in many developing parts of the world, with considerable economic and health costs. Although guidelines for the control of these diseases exist, we highlight neglected transmission routes of these diseases. We show that informal, door-to-door marketing of unpasteurized milk provides an important route for disease transmission through kitchen cross-contamination. Furthermore, the practice of discarding the first strippings of milk at farms needs adjustment to avoid floor and environmental contamination. Herein, we propose handling guidelines and a design for a milk stripping collection vessel. We believe that taking action to block these hitherto unrecognized transmission routes will complement existing efforts and guidelines.

Summary

Citations

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A review of three decades of use of the cattle brucellosis rough vaccine Brucella abortus RB51: myths and facts
J. M. Blasco, E. Moreno, P. M. Muñoz, R. Conde-Álvarez, I. Moriyón
BMC Veterinary Research.2023;[Epub] CrossRef
Editorial: Taking a Fresh Look at Old Zoonoses, What Have We Been Missing in One Health Research and Education?
Alessandra Scagliarini, Olli Peltoniemi, Anita Luise Michel
Frontiers in Public Health.2022;[Epub] CrossRef

Epidemiologic Investigation

How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time: Meysam Olfatifar, Seyed Mehdi Hosseini, Payam Shokri, Soheila Khodakarim, Naghmeh Khadembashi, Sajjad Rahimi Pordanjani; Epidemiol Health. 2020;42:e2020058. Published online August 10, 2020; DOI: https://doi.org/10.4178/epih.e2020058

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Abstract

OBJECTIVES
Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis.

METHODS

An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas.

RESULTS

The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables.

CONCLUSIONS

The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.

Summary

Citations

Citations to this article as recorded by

Asymmetric Effects of Weather-Integrated Human Brucellosis Forecasting System Using a New Nonlinear Autoregressive Distributed Lag Model
Yongbin Wang, Chenlu Xue, Bingjie Zhang, Yuchun Li, Chunjie Xu, Daniel Diaz
Transboundary and Emerging Diseases.2024; 2024: 1. CrossRef
Spatio-temporal Analysis of COVID-19: A Global Study
Sajjad Rahimi Pordanjani, Maryam Mohammadian, Somayeh Derakhshan, Fatemeh Hadavandsiri, Seyed Saeed Hashemi Nazari, Mohammad Hossein Panahi
Middle East Journal of Rehabilitation and Health Studies.2023;[Epub] CrossRef
Factors Associated With Diagnostic Delays in Human Brucellosis in Tongliao City, Inner Mongolia Autonomous Region, China
Jingbo Zhai, Ruihao Peng, Ying Wang, Yuying Lu, Huaimin Yi, Jinling Liu, Jiahai Lu, Zeliang Chen
Frontiers in Public Health.2021;[Epub] CrossRef
Clinical Effect of Doxycycline Combined with Compound Sulfamethoxazole and Rifampicin in the Treatment of Brucellosis Spondylitis
Xin-Ming Yang, Yong-Li Jia, Ying Zhang, Pei-Nan Zhang, Yao Yao, Yan-Lin Yin, Ye Tian
Drug Design, Development and Therapy.2021; Volume 15: 4733. CrossRef

REVIEW

Review of Brucellosis in Nepal: Krishna Prasad Acharya, Nirajan Niroula, Krishna Kaphle; Epidemiol Health. 2016;38:e2016042. Published online October 1, 2016; DOI: https://doi.org/10.4178/epih.e2016042; Retraction in: Epidemiol Health 2017;39(0):e2017018

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Review

Brucellosis: An Overview.: Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Mi Yeoun Park, Jong Wan Kim; Korean J Epidemiol. 2005;27(1):26-36.

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Abstract PDF: Abstract
Brucellosis is zoonotic disease of worldwide distribution and still remains endemic in some developing countries. The main pathogenic species worldwide are B. abortus, responsible for bovine brucellosis, B. melitensis. The B. abortus is most common in Korea. Each Brucella spp. has a preferred natural host that serves as a reservoir of infection. The incubation period varies between 5 and 60 days, and Brucella infection may be asymptomatic or symptomatic. The majority of patients complained of fever (undulating fever), sweats, malaise, anorexia, and arthralgia. The diagnosis of brucellosis requires the isolation of Brucella from blood or body tissues, or the combination of suggestive clinical presentation and positive serology. There were first patients in 2002, thereafter 16 patients in 2003, and 47 patients in 2004, the human brucellosis are increasing more gradually in Korea. Brucellosis is an occupational risk for farmers, veterinarians, and abattoir workers. The main sources of Brucella are infected animals or their products, such as milk, blood, carcasses, and abortion products. Routes of transmission of the infection to humans include direct contact with infected animals and their secretions through cuts and abrasions in the skin, by way of infected aerosols inhaled or via the ingestion of unpasteurized dairy products. A combination of doxycycline and streptomycin has been used widely in brucellosis. Prevention of brucellosis in human still depends on the eradication or control of the disease in animal hosts, the exercise of hygienic precautions to limit exposure to infection through occupational activities and the effective heating of dairy products, and other potentially contaminated foods. Also, physicians and veterinarians must be concerned about specific environments and clinical patterns of brucellosis.; Summary

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