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Epidemiol Health > Accepted Articles
Epidemiology and Health 2022;e2022048.
DOI: https://doi.org/10.4178/epih.e2022048    [Accepted] Published online May 18, 2022.
Human brucellosis outbreak investigation - Douz, Tunisia, 2018
Nejib Charaa1  , Rabaa Ghrab2  , Aicha Ben Othman2  , Mohamed Makhlouf3  , Hejer Ltaief4  , Nissaf Ben Alaya4,5  , Mohamed Chahed5 
1Regional Directorate of Health, Kebili, Tunisia
2Douz health district, Douz, Tunisia
3Regional Directorate of Health, Sfax, Tunisia
4National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
5Departement of Preventive Medicine and Epidemiology, Faculty of Medicine, Tunis, Tunisia
Correspondence  Nejib Charaa ,Email: n.charaa@gmail.com
Received: Oct 9, 2021  Accepted after revision: May 18, 2022
Abstract
OBJECTIVES:
The incidence of Human brucellosis in Tunisia in 2017 was 9.8 per 100,000 population. In Douz district two cases were reported in March, 2018. The last indigenous cases were notified in 2015. The aim of this study was to identify the source of contamination and set up control interventions.
METHODS:
A case-control study was conducted. A case was a resident of Douz who presented clinical brucellosis with a Wright test ≥ 160. A control was a neighbor of the case who had a negative Rose Bengal test. Univariate and Multivariate analysis were performed to estimate odds ratios of risk factors. Active screening was carried out in goats.
RESULTS:
A total of 25 cases and 52 controls were enrolled in the study. All cases consumed goat’s milk; out of which 92% had bought it from the same breeder. Consumption of goat’s milk from this breeder (aOR=30.78, 95% CI [6.47-235.91]) and consumption of raw goat’s milk (aOR=14.84, 95% CI [2.04-310.44]) were independent risk factors for the occurrence of brucellosis in cases. The breeder had 18 goats, five of which were smuggled from a neighboring country. Three of them were diagnosed with brucellosis.
CONCLUSION:
Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered. An education campaign was conducted. Vaccination, control of animal movements across borders and control of goat’s milk sales must be strengthened in order to prevent a possible spread of the disease in the south-western region of Tunisia.
Keywords: Brucellosis; Outbreaks; Case-Control Studies; One health; Zoonoses; Foodborne disease
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