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

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

Citations to this article as recorded by

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

Original Article

Major enteropathogens in humans, domestic animals, and environmental soil samples from the same locality: prevalence and transmission considerations in coastal Odisha, India: Arpit Kumar Shrivastava, Nirmal Kumar Mohakud, Swagatika Panda, Saumya Darshana Patra, Subrat Kumar, Priyadarshi Soumyaranjan Sahu; Epidemiol Health. 2020;42:e2020034. Published online May 26, 2020; DOI: https://doi.org/10.4178/epih.e2020034

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Abstract PDF Supplementary Material

Abstract

Objectives
Regions with limited sanitation facilities have higher rates of infections with various enteric pathogens. It is therefore important to identify different hosts and their relative contribution to pathogen shedding into the environment, and to assess the subsequent health risks to humans.

Methods

In this study, human faecal (n=310), animal faecal (n=150), and environmental (soil) samples (n=40) were collected from the same locality and screened for selected enteric pathogens by immunochromatography and/or polymerase chain reaction.

Results

At least 1 microbial agent was detected in 49.0%, 44.7%, and 40.0% of the samples from human, animals, and soil, respectively. Among humans, rotavirus was predominantly detected (17.4%) followed by enteropathogenic Escherichia coli (EPEC) (15.4%), Shigella (13.8), and Shiga toxin-producing E. coli (STEC) (9.7%). Among animals, STEC was detected most frequently (28.0%), and EPEC was the major enteric pathogen detected in soil (30.0%). The detection rate of rotavirus was higher among younger children (≤2 years) than among older children. Single infections were more commonly detected than multiple infections in humans (p<0.01), unlike the observations in animal and soil samples. For diarrhoeagenic E. coli and Shigella, most of the human and animal isolates showed close relatedness, suggesting possible cross-infection between humans and domesticated animals in the area studied.

Conclusions

The present study provides an improved understanding of the distribution of major enteric pathogens coexisting in humans and animals in the region, thereby suggesting a high potential for possible transmission among livestock and communities residing in the studied locality.

Summary

Citations

Citations to this article as recorded by

In vitro antioxidant and antidiarrheal activities of aqueous and n-hexane extracts of Cucurbita maxima seed in castor oil-induced diarrheal rats
Habibu Tijjani, Adamu Matinja, Marwanatu Yahya, Emmanuel Aondofa, Akibu Sani
Natural Resources for Human Health.2022; 2(2): 246. CrossRef

Reviews

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

Anthrax: An Overview.: Hyun Sul Lim, Young Goo Song, Han Sang Yoo, Seong Won Keun, Jong Wan Kim; Korean J Epidemiol. 2005;27(1):12-25.

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Abstract PDF: Abstract
Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.; Summary

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