Epidemiology and Health

Original Article

Risk factors for Q fever incidence in Korea: a comparative analysis using frequentist and Bayesian methods: Ji-Hyun Son, Sung-Dae Park; Epidemiol Health. 2025;47:e2025046. Published online August 20, 2025; DOI: https://doi.org/10.4178/epih.e2025046

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated the principal determinants of human Q fever incidence and explored regional variation between metropolitan cities and provinces in Korea.
METHODS
Panel data on human Q fever incidence, livestock populations, and facility metrics were collected across 17 metropolitan cities and provinces from 2017 to 2024. Analytical approaches included frequentist models (ordinary least squares [OLS], random effects [RE], fixed effects [FE]) and Bayesian models.
RESULTS
Frequentist panel analysis indicated that slaughterhouse count was positively associated with Q fever incidence in both pooled OLS (β=1.20, p<0.001) and RE models (β=1.03, p<0.001), but not in the FE model (β=0.14, p=0.65). After correcting for serial correlation using Driscoll-Kraay standard errors, livestock population (β=0.55, p<0.01), livestock market count (β=-2.01, p<0.05), and livestock Q fever cases (β=-0.11, p<0.01) were significantly associated with human incidence. A Bayesian FE model confirmed a significant relationship between slaughterhouses and human Q fever incidence (posterior mean: 0.87; 95% credible interval [CrI], 0.21 to 1.42), providing more stable inference with limited samples and allowing probabilistic uncertainty estimation. A Bayesian hierarchical model revealed a stronger association in metropolitan cities (posterior mean, 1.46; 95% CrI, 0.34 to 2.57) than in provinces (1.22), while livestock population remained significant in provinces (0.94; 95% CrI, 0.15 to 1.74).
CONCLUSIONS
In Korea, slaughterhouse density was the main determinant of Q fever in metropolitan cities and livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies and reinforce the value of a One Health approach.; Summary

Korean summary
본 연구는 대한민국 내 큐열(Q fever) 발생의 주요 위험 요인이 지역별로 다르다는 것을 규명하였다. 광역시(metropolitan cities)에서는 도축장 밀도가, 도(provinces)에서는 가축 사육 밀도가 사람에서 큐열 발생의 주된 위험 요인으로 확인되었다. 이러한 결과는 사람, 동물, 환경의 건강을 통합적으로 고려하는 원헬스(One Health) 접근법에 기반하여 각 지역 특성에 맞는 예방 전략이 필요함을 강조한다.

Key Message
This study identified that the primary risk factors for Q fever in Korea vary by region. Slaughterhouse density was the main determinant of human Q fever incidence in metropolitan cities, whereas livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies based on a One Health approach, which integrally considers human, animal, and environmental health.

Systematic Review

Guts of healthy humans, livestock, and pets harbor critical-priority and high-risk Escherichia coli clones: Idris Nasir Abdullahi, Islem Trabelsi; Epidemiol Health. 2025;47:e2025013. Published online March 22, 2025; DOI: https://doi.org/10.4178/epih.e2025013

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
In May 2024, the World Health Organization classified carbapenem (CARB)- and third-generation cephalosporin (3GC) resistance (R) in <italic>Escherichia coli</italic> as a critical priority, whereas colistin (COL) is a “last resort” antibiotic for their treatment. This meta-analysis evaluated the pooled prevalence, high-risk lineages, genetic relatedness, and mechanisms of CARBR, COLR, and 3GCR in <italic>E. coli</italic> from healthy humans and animals.
METHODS
We conducted a systematic review and meta-analyses following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria on all eligible studies that reported the analysis of <italic>E. coli</italic>, and antimicrobial susceptibility to CARB, COL and 3GC in <italic>E. coli</italic> from gut samples of clinically healthy humans, livestock, and pets from June 2014 to June 2024. Random-effect models and conserved signature indels phylogeny 1.4 were used to determine pooled prevalence rates (PPs) and the relatedness of publicly available <italic>E. coli</italic> genomes, respectively.
RESULTS
Of the 5,034 identified articles, 64 studies were deemed eligible. The overall PPs of 3GCR, CARBR, and COLR <italic>E. coli</italic> were 22.5% (95% confidence interval [CI], 17.5 to 28.3), 2.2% (95% CI, 1.0 to 4.7), and 15.5% (95% CI, 10.8 to 21.8), respectively. The PPs of 3GCR-, COLR- and CARBR <italic>E. coli</italic> significantly varied by hosts, continent, and year of studies (p<0.05). Diverse <italic>E. coli</italic> lineages were found, including 13 high-risk <italic>E. coli</italic> sequence types (STs), within which ST10 predominated. Phylogenomic analyses produced 4 clusters of related CARBR- and COLR <italic>E. coli</italic> strains (<25 single nucleotide polymorphism): ST940-<italic>bla</italic>OXA-181 from humans in Lebanon, ST617-<italic>mcr</italic>-1 from pigs in China, ST46-<italic>mcr</italic>-1 from poultry in Tanzania, and ST1720-<italic>mcr</italic>-1 from goats in France.
CONCLUSIONS
COLR and 3GCR are more frequent than CARBR in gut <italic>E. coli</italic>. These 10-year epidemiological data highlight the persistence and transmission of critical priority and high-risk <italic>E. coli</italic> strains in healthy humans and animals, raising significant One Health concerns.; Summary

Special Article

Limiting the spillover of zoonotic pathogens from traditional food markets in developing countries and a new market design for risk-proofing: Sandeep Ghatak, Kandhan Srinivas, Arockiasamy Arun Prince Milton, Govindarajan Bhuvana Priya, Samir Das, Johanna F. Lindahl; Epidemiol Health. 2023;45:e2023097. Published online October 30, 2023; DOI: https://doi.org/10.4178/epih.e2023097

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Abstract Summary PDF

Abstract

Traditional food markets are age-old systems that primarily serve the food supply needs of society’s less affluent sectors, often operating with minimal infrastructure. These markets are prevalent in low and middle-income countries. However, their hygienic conditions are frequently suboptimal, potentially fostering the emergence and spread of presumptive zoonotic diseases. The recent emergence of zoonotic or potentially zoonotic diseases and their possible links to traditional food markets underscore the need for focused attention on this overlooked issue. The socioeconomic characteristics of traditional food markets reveal that despite the risk of zoonotic pathogen spread, these markets play a crucial role for large segments of the population. These individuals rely on such markets for their livelihood, food, and nutrition. Therefore, a comprehensive set of measures addressing various aspects of traditional food markets is necessary to manage and mitigate the risks of potential zoonotic disease emergence. In this article, we explore various facets of traditional food markets, paying special attention to the risks of zoonotic diseases that urgently require stakeholder attention. We also propose a new market design to prevent the risk of zoonotic spillover and advocate for the development of a Market Hygiene Index for these markets.

Summary

Key Message
Embracing Tradition, Ensuring Safety! Traditional food markets are vital for many communities, supplying food and livelihoods. Yet, their suboptimal hygiene poses potential risks for zoonotic diseases. Our article sheds light on the importance of addressing this issue and offers a new market design for risk-proofing in developing countries. Join the conversation on safeguarding these markets and support the vulnerable for a safer, healthier future!

Citations

Citations to this article as recorded by

Prevalence of bacterial contamination on seafoods products collected from traditional fish market in Bali Province during 2023
Putu Eka Sudaryatma, Putu Angga Wiradana, Imanuddin Razaq, Ni Luh Sunarsih, Aris Jatmiko, Anak Agung Ayu Putri Permatasari, Ni Kadek Yunita Sari, I Gede Widhiantara, I Made Gde Sudyadnyana Sandhika, I Wayan Rosiana
Jurnal Pengolahan Hasil Perikanan Indonesia.2025; 28(3): 297. CrossRef
Genomic Profiling Reveals Clinically Relevant Antimicrobial Resistance and Virulence Genes in Klebsiella pneumoniae from Hong Kong Wet Markets
Wing Yui Ngan, Subramanya Rao, Aster Hei Yiu Fung, Olivier Habimana
Antibiotics.2025; 14(9): 922. CrossRef
Impact of open markets on zoonotic threats and antimicrobial resistance: A One Health concern
Md. Abdullah Evna Hasan, Md Saiful Islam, Naeem Ahammed Ibrahim Fahim, Md. Tabeer Hossain Antor, Samia Salam, Rownak Jahan, Rony Ibne Masud, Zuhayr Bakhtiyar, Dilruba Akter Jany, Md. Liton Rana, Sadia Afrin Punom, Al Muksit Mohammad Taufiquer Rahman, Md.
One Health.2025; 21: 101228. CrossRef
Food Safety Practices and Behavior Drivers in Traditional Food Markets in Ethiopia: Assessing the Potential for Consumer-Driven Interventions
Ariel V. Garsow, Smret Hagos, Eric Djimeu, Carrel Fokou, Haley Swartz, Genet Gebremedhin, Bisaku Chacha, Elisabetta Lambertini
International Journal of Environmental Research and Public Health.2025; 22(11): 1645. CrossRef

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 Summary PDF

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

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Geospatial analysis of open-source intelligence data to early detect laboratory-acquired infections, using the 2019 brucellosis laboratory leak in China as a case study
Atalay Goshu Muluneh, Samsung Lim, Aye Moa, Chandini Raina Maclntyre
Infection.2026; 54(1): 331. CrossRef
Utilization of AI – reshaping the future of food safety, agriculture and food security – a critical review
Jerina Rugji, Zeki Erol, Fulya Taşçı, Laura Musa, Ambreen Hamadani, Migena Gjoni Gündemir, Esa Karalliu, Shahida Anusha Siddiqui
Critical Reviews in Food Science and Nutrition.2025; 65(26): 5136. CrossRef
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

Systematic Review

Distribution pattern and prevalence of West Nile virus infection in Nigeria from 1950 to 2020: a systematic review: Idris Nasir Abdullahi, Anthony Uchenna Emeribe, Peter Elisha Ghamba, Pius Omoruyi Omosigho, Zakariyya Muhammad Bello, Bamidele Soji Oderinde, Samuel Ayobami Fasogbon, Lawal Olayemi, Isa Muhammad Daneji, Muhammad Hamis Musa, Justin Onyebuchi Nwofe, Nkechi Blessing Onukegbe, Chukwudi Crescent Okume, Sanusi Musa, Abubakar Muhammad Gwarzo, Odunayo Oyetola Rahmat Ajagbe; Epidemiol Health. 2020;42:e2020071. Published online November 26, 2020; DOI: https://doi.org/10.4178/epih.e2020071

24,993 View
276 Download
12 Web of Science
9 Crossref

Abstract PDF

Abstract

OBJECTIVES
West Nile virus (WNV) is a re-emerging mosquito-borne viral infection. This study investigated the pooled prevalence pattern and risk factors of WNV infection among humans and animals in Nigeria.

METHODS

A systematic review was conducted of eligible studies published in PubMed, Scopus, Google Scholar, and Web of Science from January 1, 1950 to August 30, 2020. Peer-reviewed cross-sectional studies describing WNV infections in humans and animals were systematically reviewed. Heterogeneity was assessed using the Cochrane Q statistic.

RESULTS

Eighteen out of 432 available search output were eligible and included for this study. Of which 13 and 5 were WNV studies on humans and animals, respectively. Although 61.5% of the human studies had a low risk of bias, they all had high heterogeneity. The South West geopolitical zone of Nigeria had the highest pooled prevalence of anti-WNV immunoglobulin M (IgM; 7.8% in humans). The pooled seroprevalence of anti-WNV IgM and immunoglobulin G (IgG) was 7.1% (95% confidence interval [CI], 5.9 to 8.3) and 76.5% (95% CI, 74.0 to 78.8), respectively. The WNV RNA prevalence was 1.9% (95% CI, 1.4 to 2.9), while 14.3% (95% CI, 12.9 to 15.8) had WNV-neutralizing antibodies. In animals, the pooled seroprevalence of anti-WNV IgM and IgG was 90.3% (95% CI, 84.3 to 94.6) and 3.5% (95% CI, 1.9 to 5.8), respectively, while 20.0% (95% CI, 12.9 to 21.4) had WNV-neutralizing antibodies. Age (odds ratio [OR], 3.73; 95% CI, 1.87 to 7.45; p<0.001) and level of education (no formal education: OR, 4.31; 95% CI, 1.08 to 17.2; p<0.05; primary: OR, 7.29; 95% CI, 1.80 to 29.6; p<0.01) were significant risk factors for WNV IgM seropositivity in humans.

CONCLUSIONS

The findings of this study highlight the endemicity of WNV in animals and humans in Nigeria and underscore the need for the One Health prevention and control approach.

Summary

Citations

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Seroprevalence of West Nile Fever and Associated Risk Factors in Livestock of Afar Region, Northeast Ethiopia
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Mutiat Busayo Odebisi-Omokanye, Muhammed Mustapha Suleiman, Mariam Kehinde Sulaiman, Sidiq Abubakar Atolagbe
Problems of Virology.2024; 69(4): 320. CrossRef
Toward evidence-informed policymaking in Nigeria? A systematic review of agricultural evidence syntheses
Toyib Aremu
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Comparison of West Nile Virus Disease in Humans and Horses: Exploiting Similarities for Enhancing Syndromic Surveillance
Erika R. Schwarz, Maureen T. Long
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A Scoping Review of West Nile Virus Seroprevalence Studies among African Equids
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Pathogens.2021; 10(7): 899. CrossRef

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