Zoonotic tuberculosis and brucellosis in Africa: neglected zoonoses or minor public-health issues? The outcomes of a multi-disciplinary workshop

Assessment of knowledge, attitude and practices (KAP) of farmers about transmission of zoonotic diseases in Ada'a district, Oromia, Ethiopia

In developing countries like Ethiopia, zoonotic diseases pose a significant health and economic burden, with high exposure of farmers to zoonotic infection given the prevailing traditional husbandry practices. A cross-sectional survey involving 388 farmers in the Ada'a district central Ethiopia was conducted to investigate their knowledge, attitudes, and practices (KAP) regarding the transmission of zoonotic diseases. The respondents' mean age was 41.0 ± 10.0 SD years. The majority of respondents (39.4%) were between the ages of 41 and 50, and 90.0% were married. Farmers claimed that conversations with family, colleagues, and friends were the primary sources of zoonoses information. Farmers stated that the primary sources of information on zoonotic diseases as community. They had a relatively low level (66.8%) of knowledge on zoonotic diseases and half of them (54.9%) did not have good information on zoonoses. Three-quarters (75.2%) of the farmers reported that they neither consume meat and milk nor use offal and hide/skin from sick or dead animals. Similarly, 71.1% of them stated that they do not eat meat from regularly aborting sheep/goats, and never consume raw meat and milk. Most of the respondents correctly answered that raw meat (82.7%) and raw milk (79.9%) are means of disease transmission from animals to humans. However, considerable proportions of them were unaware of zoonotic transmission of bovine tuberculosis (61.3%) and brucellosis (74.7%) transmission through raw milk intakes, and risk of taeniasis (71%) due to raw meat consumption. But, considerable proportions had never dewormed (48.7%), or tested their animals for brucellosis (82.7%) and bovine tuberculosis (83.3%), and more than three quarters (77.3%) did not used personal protective equipment when handling sick animals. Farmers who had a secondary education or above (OR = 6.8, CI = 2.4-18.0, p = 0.004), aged between 41 and 50 years (OR = 3.0, 95% CI: 1.2-7.2, p = 0.015), and those having good knowledge (OR = 2.1, CI = 1.3-3.5, p = 0.002), and positive attitude related to zoonotic diseases (OR = 7.8, CI = 4.7-12.9, p < 0.001) had better practices that reduce the risk of exposure to zoonotic infections than their counterparts. This study revealed a knowledge gaps, a low level of the desired attitude, and high-risk behavioral practices which call for awareness creation about zoonotic disease transmission.

Farmers' perceptions of bovine brucellosis in Benin

Background and Aim

Cattle are the main source of meat in Benin. To improve the attitudes and practices of cattle breeders in relation to bovine brucellosis, a study has been carried out in Benin according to different agroecological zones. This study aimed to assess farmers' knowledge and practices concerning bovine brucellosis to generate essential information for control programs and public health interventions.

Materials and Methods

The study was conducted from February to May 2022, during which 608 farmers were interviewed using a structured questionnaire that provided information on socioeconomic characteristics, knowledge, and practices related to bovine brucellosis. Analysis of variance, Poisson regression, and the proportion comparison test were used to compare these characteristics in the different agroecological zones. At the end of the surveys, three distinct and homogeneous groups of perceptions (hierarchical classification of Multiple Correspondence Analysis components of R software) of bovine brucellosis were identified (these groups only consider farmers who declared knowledge of the disease). Groups were formed by applying the multiple correspondence analysis function of the FactoMineR library in R software, followed by a hierarchical ascending classification using the hierarchical clustering on principal component function of the same software (Agrocampus Rennes, France).

Results

Only 38% of respondents were aware of brucellosis. Knowledge of brucellosis was not related to sex or education level but was higher among farmers in agroecological Zones 1 and 4. Ethnic Dendi herders (62.16%) had better knowledge of the disease than those from other sociolinguistic groups (Somba: 50%, Fulani: 40.91%, Baribas: 26.97%, and others: 8.82%). Reduced milk production (98.29%), presence of hygroma (87.18%), and abortion (56.84%) are the main signs reported by herders familiar with the disease. All three groups had good knowledge of the disease and its zoonotic nature. Groups 1 (96% of breeders) and 2 (2.14%) were aware of the risk factors (contact with affected animals, the consumption of raw milk, the handling of runts, and reproductive rejection). In the case of Brucella, they prefer to treat animals rather than sell them and use both traditional and modern medicines. Group 3 (1.71%) did not know the risk factors and preferred to sell animals in the event of illness.

Conclusion

Pastoralists need to be made aware of the mode of transmission of bovine brucellosis, its clinical manifestations, its impact on animal health, and the zoonotic nature of the disease (impact on public health) so that bovine brucellosis can be rapidly detected in herds.

Systematic review and meta-analysis of tuberculosis in animals in Nigeria

Animal tuberculosis (TB) is a contagious and chronic disease caused by mycobacteria belonging to theMycobacterium tuberculosis complex (MTBC) in domestic and wild animals. MTBC strains infection has been confirmed in many animal species in Nigeria, including captive wildlife, cattle, dromedary camels, goats, and pigs. Despite widespread infection and the potential impact of the disease on public health, active surveillance and control strategies are absent in Nigeria. This study aimed to conduct the first comprehensive meta-analysis to assess the distribution of tuberculosis and analyze the potential moderators of infection in animals in Nigeria. Eligible studies (sixty-one (Cadmus et al., 2014) [61] prevalence and seven (Menzies and Neill, 2000) [7] case reports) were retrieved and included in the analysis. The analyses showed an overall pooled TB prevalence of 7.0% (95% CI: 6.0-8.0) comprising of infection distributed in cattle (8.0%, 95% CI: 7.0-8.0), goats (0.47%, 95% CI: 0-1.2), sheep (0.27%, 95% CI: 0.14-0.46), camels (13.0%, 95% CI: 0-47), and wildlife (13.0%, 95% CI: 9-16) respectively. The occurrence of infection was significantly moderated by the publication periods, geographical location, sample size, and detection methods. TB prevalence was heterogeneous across several predictors, with the year of publication exhibiting a higher rate (46%) of the detected heterogeneity. These findings should provide policy-relevant information to guide the design and establishment of prevention and control measures amenable to the local situations in Nigeria.

Risk Practices for Occupational Zoonotic Exposure to Tuberculosis in a High-Risk Population in Portugal

Concerning large game in Portugal, there is an epidemiological risk area for tuberculosis where the pressure of tuberculosis infection in wild animals is high. Hunters and other people involved in managing carcasses (evisceration and/or initial examination) of these animals should be considered as a high-risk population for sporadic occupational zoonotic infection. This study aims to evaluate and indicate these stakeholders’ main risk practices. The survey was carried out in two phases: a first phase with an anonymous survey to hunters about self-consumption of game meat and carcass handling practices, and a second phase of evaluation in loco of the practices carried out at collection points after driven hunts. As the main results suggested in this study, bad practices and improper handling of hunted carcasses potentially infected with tuberculosis were marked in both phases of the survey, mostly related to the lack of recognition of tuberculosis-like lesions and the non-use of individual protection material, such as gloves and masks. It is evident that stakeholders are interested in learning more about how to perform initial examination properly and what kind of biosecurity measures can be adopted to minimize zoonotic infection risk.

Wild animal densities as predictors of cattle disease risks and breed types in southwestern Uganda

BACKGROUND

This study investigated the spatial distribution of wild ungulates that pastoralist communities perceive as culprits in the transmission of cattle diseases outside protected areas in southwestern Uganda. Diseases are hypothesized as having influence on pastoralists' choice of cattle breed types. Until now, there have been no studies conducted on spatial patterns of wild animal species association with cattle breeds reared in Lake Mburo Conservation Area (LMCA), and how diseases transmitted therein potentially influence cattle breed herd sizes.

METHODS

Animal population survey was carried out on cattle and wild ungulate species along transect lines laid perpendicular to the northern boundary of Lake Mburo National Park (LMNP). Data on the costs of cattle mortality and disease control were gathered using face-to-face interviews. We used SPSS version 17 for descriptive statistics to summarize unit cost of disease control at herd level, whereas chi-square (χ2) tests of goodness-of-fit were used to analyze observations on frequency of wild animal sightings, whose association with spatial distribution patterns of cattle breeds was examined using Pearson correlation test.

RESULTS

Our results show inverse association of distance away from LMNP with wild animal populations and the cost of cattle disease control. The mean population of exotic cattle significantly increased as that of indigenous cattle decreased with increasing distance from LMNP. In a similar way, the cost of disease control and cattle abortion incidences were much lower in rangelands far away from LMNP (R² = 0.965, p < 0.001).

CONCLUSION

Spatial distribution of wild ungulates was significantly associated with reported cattle mortality, disease, and cost of disease control. Diseases and their costs of control potentially influenced spatial patterns of cattle breeds and breed herd sizes in LMCA, which in turn could affect range resource use for conserving different species of wild animals outside protected area.

Prevalence of bovine tuberculosis and characterization of the members of the Mycobacterium tuberculosis complex from slaughtered cattle in Rwanda

Background

Bovine tuberculosis (bTB) is an endemic disease in Rwanda, but little is known about its prevalence and causative mycobacterial species. The disease causes tremendous losses in livestock and wildlife and remains a significant threat to public health.

Materials and methods

A cross-sectional study employing a systematic random sampling of cattle (n = 300) with the collection of retropharyngeal lymph nodes and tonsils (n = 300) irrespective of granulomatous lesions was carried out in six abattoirs to investigate the prevalence and identify mycobacterial species using culture, acid-fast bacteria staining, polymerase chain reaction, and GeneXpert assay. Individual risk factors and the origin of samples were analysed for association with the prevalence.

Findings

Of the 300 sample pools, six were collected with visible TB-like lesions. Our findings demonstrated the presence of Mycobacterium tuberculosis complex (MTBC) in 1.7% (5/300) of sampled slaughtered cattle. Mycobacterium bovis was isolated from 1.3% (4/300) animals while one case was caused by a rifampicin-resistant (RR) M. tuberculosis. Non-tuberculous mycobacteria were identified in 12.0% (36/300) of the sampled cattle. There were no significant associations between the prevalence and abattoir category, age, sex, and breeds of slaughtered cattle.

Conclusions

This study is the first in Rwanda to isolate both M. bovis and RR M. tuberculosis in slaughtered cattle indicating that bTB is present in Rwanda with a low prevalence. The isolation of RR M. tuberculosis from cattle indicates possible zooanthroponotic transmission of M. tuberculosis and close human-cattle contact. To protect humans against occupational zoonotic diseases, it is essential to control bTB in cattle and raise the awareness among all occupational groups as well as reinforce biosafety at the farm level and in the abattoirs.

Tuberculosis in cattle (bTB) causes financial losses to livestock owners and is a disease transmissible to humans especially those with an occupational risk through exposure to infected animals and animal products. This study aimed to identify the prevalence of bTB and characterize the mycobacterial species from cattle slaughtered in the six abattoirs in Rwanda. Four M. bovis, as well as one rifampicin-resistant (RR) M. tuberculosis, were identified from slaughtered cattle and, thus, the apparent bTB prevalence was 1.7% (5/300). Likely, the RR M. tuberculosis isolate was mostly likely of human origin and transmitted to cattle during close human-cattle contact. It is therefore essential to control bTB in cattle and reinforce the protection of farmworkers and abattoir workers who are always exposed to infected animals.

Access to Veterinary Drugs in Sub-Saharan Africa: Roadblocks and Current Solutions

Background

Access to veterinary drugs for livestock has become a major issue over the last decade. Analysis has tended to focus on the demand for these products, while studies looking at the drivers behind their use generally focus on farmer behavior and interactions between veterinarians and farmers. However, the use of drugs also depends on structural factors that determine the functioning of the drug supply chain and farmers' access to the drugs. This article presents an overview of the factors that limit access to veterinary drugs in sub-Saharan Africa (SSA) as well as the international policy tools and arrangements that claim to improve it.

Methods

We have conducted a scoping review of the scientific and grey literature as well as the publicly-available data from both the animal health industry and international organizations. We aimed to gather information on the veterinary drugs market in SSA as well as on the international norms, recommendations, guidelines, and initiatives that impact SSA farmers' access to these drugs.

Findings

We highlight numerous barriers to veterinary drug access in SSA. The SSA market is highly dependent on imports, yet the region attracts little attention from the international companies capable of exporting to it. It suffers from a high level of fragmentation and weak distribution infrastructures and services, and is driven by the multiplication of private non-professional actors playing a growing role in the veterinary drug supply chain. The distribution system is increasingly dualized, with on the one hand the public sector (supported by development organizations) supplying small scale farmers in rural areas, but with limited and irregular means; and on the other side a private sector largely unregulated which supplies commercial and industrial farming systems. Different innovations have been developed at the international and regional levels to try to reduce barriers, such as homogenizing national legislations, donations, and vaccine banks. Alongside decades-old inter-state cooperation, many new forms of public-private partnerships and other hybrid forums continue to emerge, signaling the private sector's increasing influence in global governance.

Conclusions

Policies on animal health would be bolstered by a better understanding of the drivers behind and the components of access to veterinary drugs in different regional and national contexts. Inequalities in drug access need to be addressed and a market-driven approach adopted in order to strengthen our understanding of what determines veterinary drug use at the farm level. Policies should balance the interests of the various stakeholders, being careful not to reinforce bias toward certain diseases deemed "interesting" and neglect others that could prove to be highly important for veterinary public health.

Knowledge, Attitudes, and Practices Regarding Brucellosis among Parents in Aseer Region, Southwestern Saudi Arabia

This study aimed to investigate the knowledge, attitudes, and practices regarding brucellosis among parents in the Aseer region of southwestern Saudi Arabia in order to estimate the population sectors that are at high risk for accidental exposure to brucellosis. This was a cross-sectional survey conducted in 2018, including 311 participants representing various genders, ages, and levels of education. Bivariate analysis showed a significant association of good awareness of the disease with the male gender and higher education levels. Of the 311 participants, 90.0% had good knowledge, whereas 10.0% showed inadequate knowledge about brucellosis. Practices and attitudes regarding brucellosis were satisfactory as participants did not eat meat from their own animals (52.7%), did not practice slaughtering (71.4%), did not participate in the birth of animals (91.3%), were not exposed to abortion in animals (93.2%), and practiced burial of aborted animal fetuses (59.2%). The practice regarding brucellosis was unsatisfactory as 66.6% never wore gloves when dealing with animals. The study concluded that the majority of parents showed fair and positive knowledge, attitudes, and practices regarding brucellosis and found that gender and education were determinants of satisfactory awareness.

Control of Brucella melitensis in endemic settings: A simulation study in the Nile Delta, Egypt

Small ruminant brucellosis remains endemic in many low- and middle-income countries (LMICs), where it poses a major economic and public health burden. Lack of resources to support long-term vaccination, inherent characteristics of small ruminant production systems such as mixing of different flocks for grazing and limitations of the vaccines currently available, which can induce abortion in pregnant animals, have all hindered the effectiveness of control programmes. In the current study, the likely effect of different control scenarios on the seroprevalence of brucellosis among the small ruminant population in a hypothetical area of an endemic region was simulated using compartmental models. The model accounts for variability in transmission rates between villages and also simulates control scenarios that target villages with high seroprevalence. Our results show that vaccination of young replacement animals only can effectively reduce the prevalence of small ruminant brucellosis in endemic settings if a high vaccination coverage is achieved. On the other hand, test-and-slaughter alone is not a promising strategy for control of small ruminant brucellosis under husbandry practices typical of endemic low-resource settings. Furthermore, results show the potential success of some strategies requiring a relatively low overall vaccination coverage such as the vaccination of 50% of young replacements and 25% of adult animals each year. Control strategies selectively targeting high initial seroprevalence villages (p > 10%) did not decrease the overall seroprevalence to acceptable levels in most of the examined scenarios. Scenario analysis showed that the efficacy of the simulated control strategies can be improved mostly by decreasing the proportion of between-village trade and also by improving the performance of the used serological tests and increasing vaccine efficacy.

Development of a Genus-Specific Brucella Real-Time PCR Assay Targeting the 16S-23S rDNA Internal Transcribed Spacer from Different Specimen Types

The aim of this study was to develop a 16S-23S ribosomal deoxyribonucleic acid internal transcribed spacer (ITS) quantitative polymerase chain reaction (qPCR) assay for the early diagnosis and rapid screening of brucellosis. Blood, milk, and tissue samples were spiked with B. abortus biovar 1 (B01988-18 strain) to determine the analytical sensitivity and specificity of the assay. The 95% limit of detection of the ITS qPCR assay was highest in tissue, followed by blood, then milk, i.e., 0.48, 4.43, and 15.18 bacteria/PCR reaction, respectively. The diagnostic performance of the assay was compared to the Brucella cell surface protein (BCSP) 31 qPCR assay and bacterial culture. Out of 56 aborted foetal tissue samples from bovine, ovine, and caprine, 33% (19/56) were positive for Brucella spp. The sensitivity and specificity of the ITS qPCR assay was 87% and 95% respectively, compared to 92% and 89% for the BCSP31 qPCR assay and 47% and 55% for bacterial culture, respectively. The assay was efficient, sensitive, and specific, making it a valuable tool in the early detection of the Brucella pathogen.

Sero-prevalence of bovine brucellosis in the Bojanala Region, North West Province, South Africa 2009-2013

Bovine brucellosis affects food safety, food security and human health in rural communities in the North West Province, South Africa. The World Organisation for Animal Health suggests routine sero-surveillance and vaccination of cattle for control and to prevent zoonotic transmission. Although sero-surveillance and subsidised vaccination have been in place for decades, data from Bojanala have not previously been analysed. The aim of this study was to retrospectively analyse historical data on routine sero-surveillance of bovine brucellosis and state subsidised vaccination, in communal, commercial and dairy cattle in the study area. This was a descriptive, cross-sectional retrospective analysis of records from all adult cows bled by the state veterinary services during routine sero-surveillance for bovine brucellosis, in the Bojanala Region, North West Province, between 2009 and 2013. Fewer communal (N = 11 815) and dairy (N = 6696), than commercial beef (N = 28 251) cows, were tested. Overall herd prevalence (33.33%), differed significantly from individual prevalence (3.18%) in all groups. Communal herds had both the highest herd prevalence (38.8%) and the highest individual prevalence (5.2%). Both herd and individual sero-prevalence were lowest in dairy cattle, possibly because registered dairy herds are routinely tested. Over the 5-year study period, only 24 086 (7.15%) of the 342 500 cows eligible for free vaccination, were vaccinated. The annual number of cattle tested was highly variable. Dairy cattle that were regularly tested had a significantly lower herd and individual prevalence. Herd prevalence would be useful for spatial mapping, whilst individual prevalence could better reflect the risk of zoonotic transmission.

MLVA fingerprinting of Brucella melitensis circulating among livestock and cases of sporadic human illness in Egypt

Brucella melitensis is a serious public health threat, with human infection exhibiting acute febrile illness and chronic health problems. The present study investigated the genetic diversity and epidemiological links of the important zoonotic bacterium B. melitensis in Egypt using multilocus variable-number tandem repeat analysis (MLVA-16) including eight minisatellite (panel 1) and eight microsatellite (panel 2, subdivided into 2A and 2B) markers. A total of 118 isolates were identified as B. melitensis biovar 3 by classical biotyping and Bruce-ladder assay. Although B. melitensis is primarily associated with infection in sheep and goats, most of B. melitensis isolates in this study were obtained from secondary hosts (cattle, buffaloes, humans and a camel) suggesting cross-species adaptation of B. melitensis to large ruminants in Egypt. The MLVA-16 scheme competently discriminated 70 genotypes, with 51 genotypes represented by single isolates, and the remaining 19 genotypes were shared among 67 isolates, suggesting both sporadic and epidemiologically related characteristics of B. melitensis infection. Matching of local genotypes with representatives of global genotypes revealed that the majority of Egyptian isolates analysed had a West Mediterranean descendance. As this study represents the first comprehensive genotyping and genetic analysis of B. melitensis from different sources in Egypt, the information generated from this study will augment knowledge about the main epidemiological links associated with this bacterium and will allow a better understanding of the current epidemiological situation of brucellosis in Egypt. Ultimately, this will help to adopt effective brucellosis intervention strategies in Egypt and other developing nations.

Rethinking "One Health" through Brucellosis: ethics, boundaries and politics

One Health, as an international movement and as a research methodology, aspires to cross boundaries between disciplines. However, One Health has also been viewed as "reductionist" due to its overemphasize on physicians-veterinarians cooperation and surveillance capacity enhancement, while limiting the involvement with socio-political preconditioning factors that shape the impact of diseases, and the ethical questions that eventually structure interventions. The current article draws on a qualitative study of Brucellosis control in Israel, to address the benefits of broadening the One Health perspective to include ethical considerations and the socio-political aspects of health. Using in-depth-interviews, observations and document review, the article analyzes stakeholders' knowledge (policy makers, practitioners and livestock owners) to understand Brucellosis control interventions in the Negev region of Israel. The analysis highlights four different types of boundaries: geographical, professional, disciplinary and participatory. The variety of boundaries going beyond disciplinary ones, are often neglected by traditional One Health discourses, however they provide clearer understanding regarding the role of the Israel and Palestine relations; enforcement activities and trust creation; and mechanisms of decision-making and public participation, in Brucellosis interventions. A broad One Health analysis that addresses ethical concerns and socio-political environments, as well as human and veterinary medicine, encourages re-framing of causes and solutions when dealing particularly with Brucellosis in the Negev, but more generally with zoonotic diseases, low-trust settings and inequitable distribution of power. The inclusion of historical, political and bioethical considerations of Public Health in One Health creates opportunities to increase the relevance of One Health and expand its scope as a novel scientific paradigm.

A multifaceted risk model of brucellosis at the human-animal interface in Egypt

Brucellosis is a highly contagious zoonosis affecting humans and a wide range of domesticated and wild animal species. An important element for effective disease containment is to improve knowledge, attitudes and practices (KAP) of afflicted communities. This study aimed to assess the KAP related to brucellosis at the human-animal interface in an endemic area of Egypt and to identify the risk factors for human infection. A matched case-control study was conducted at the central fever hospitals located in six governorates in northern Egypt. Face-to-face interviews with cases and controls were conducted using a structured questionnaire. In total, 40.7% of the participants owned farm animals in their households. The overall mean practice score regarding animal husbandry, processing and consumption of milk and dairy products were significantly lower among cases compared with controls (-12.7 ± 18.1 vs. 0.68 ± 14.2, respectively; p < .001). Perceived barriers for notification of animal infection/abortion were predominate among cases and positively correlated with participants' education. The predictors of having brucellosis infection were consumption of unpasteurized milk or raw dairy products and practicing animal husbandry. Applying protective measures against infection significantly reduced its risk. A model predicting risk factors for brucellosis among those who own animal showed that frequent abortions per animal increased the chance for brucellosis infection among human cases by 50-fold (95% CI: 8.8-276.9), whereas the use of protective measures in animal care reduced the odds (OR = 0.11 [95% CI: 0.03-0.45]). In conclusion, consumption of unprocessed dairy products was equally important as contact with infected/aborted animals as major risk factors for Brucella spp. infection among humans in Egypt. There is poor knowledge, negative attitudes and risky behaviours among villagers which can perpetuate the risk of brucellosis transmission at the human-animal interface. This supports the need for integrating health education into the national brucellosis control programme.

Brucellosis awareness and knowledge in communities worldwide: A systematic review and meta-analysis of 79 observational studies

BACKGROUND

Brucellosis is regarded as a major zoonotic infection worldwide. Awareness and knowledge of brucellosis among occupational workers is considered an important aspect of brucellosis control in both humans and animals. The aim of this study was to explore the distributions of the pooled awareness level and the knowledge level of the disease worldwide.

METHODS

A meta-analysis was carried out to obtain pooled brucellosis awareness levels and knowledge levels of respondents regarding the zoonotic nature of brucellosis, mode of brucellosis transmission, and brucellosis symptoms in animals and humans. The analysis was conducted and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

RESULTS

A total of seventy-nine original articles reporting the brucellosis awareness levels of in populations from 22 countries were assessed. The total pooled awareness level of brucellosis was 55.5%, and the pooled awareness levels regarding the zoonotic nature of brucellosis, mode of brucellosis transmission, signs of human brucellosis and signs of animal brucellosis were 37.6%, 35.9%, 41.6%, and 28.4% respectively. The pooled awareness level was higher than the brucellosis-related knowledge level. Subgroup analyses showed that no obvious differences in brucellosis awareness levels between high-risk populations in Asia and Africa. Health workers (including human health workers and veterinarians) had the greatest overall awareness and knowledge of human brucellosis. The overall awareness levels and knowledge levels of livestock owners (farmers) and herders were higher than those of dairy farmers and abattoir workers. In addition, awareness and knowledge levels were higher among people who were involved in bovine, caprine and ovine animal production or in caprine and ovine animal production than among people who were involved in only bovine animal production.

CONCLUSIONS

Insufficient awareness and knowledge of brucellosis were observed in the original studies conducted mainly in Asia and Africa. Interventions to improve public knowledge about brucellosis are urgently needed.

Knowledge, attitudes and practices (KAPs) and risk factors of brucellosis at the human-animal interface in the Nile Delta, Egypt.. [DOI: 10.1101/607655]

Background

Brucellosis is a highly contagious zoonosis affecting human and almost all domestic species. It is a multi-burdens disease leading to severe economic losses due to disability in humans in addition to abortion, infertility and reduced milk production in animals. An Important element for effective prevention and control of brucellosis is to improve knowledge, attitude and practices of the community.

Objective(s)

This study aimed to assess the knowledge, attitudes and practices (KAP) related to brucellosis at human-animal interface and to determine the risk factors for human infection in the Nile Delta, Egypt.

Methods

A matched case-control study was conducted at the main fever hospitals located in 6 governorates in the Nile Delta, Egypt between June 2014 and June 2016. Face-to-face interviews with cases and controls was done using a structured questionnaire. Differences in proportions of KAP variables among the cases and controls were evaluated by Pearson’s Chi square test and apvalue <0.05 was set as a level of significance. A multivariate conditional logistic regression analysis was built to determine the risk factors for Brucella spp. infection among study participants.

Results

A total of 217 cases and 434 controls matched for age, gender and sociodemographic characteristics were enrolled and interviewed. In total, 40.7% of the participants owned animals in their households and lived in shared accommodation with animals [48.8% of cases vs 36.9% of controls; (p= 0.003)]. The majority (78.1%) used to accommodate cows and buffaloes with sheep and goats. Human brucellosis cases experienced more animal abortions comparing to the controls [(23.5% vs 9.7%, respectively), (p= 0.0003)]. The majority of the participants (82.4%) did not notify authorities in case that abortion occurs in their owned animals. Apparently, 67.4% of the participants [(70.0% of the cases vs 66.1% of the controls) (p= 0.315)] had not ever heard about brucellosis. The overall mean practice score regarding animal husbandry, processing and consumption of milk and dairy products was significantly lower among cases comparing to controls (−12.7±18.1 vs 0.68±14.2 respectively;p<0.0001). Perceived barrier for notification of animal infection and/or abortion was significantly higher among cases (p= 0.034) and positively correlated with participants’ education. Results of univariate analysis showed that participants who have animals’ especially small ruminates were at a higher risk of gettingBrucellaspp. infection than others. In the proposed multivariate conditional logistic regression model, the predictors of having brucellosis infection were consumption of unpasteurized milk, having consumed dairy products in the last 3 months before the study, consumption of yoghurt or home-made cheeses and involvement in contact with animals [OR (95% CI) = 4.12 (1.62 - 10.75); 2.71 (1.06 – 6.93); 2.51 (1.21 – 5.24); 1.96 (1.17- 3.30),p<0.05; and 4.97 (2.84 - 8.72)], respectively. Participants who take more protective measures against infection were at a significant lower risk of being diseased with brucellosis; [OR (95% CI) = 0.23 (0.10 - 0.58);p<0.001], respectively. A model predicting risk factors for brucellosis among those who own animal showed that frequent abortions per animal increased the chance for brucellosis infection among human cases by 49.33 fold [(95% CI)= (8.79 – 276.91);p= 0.001] whereas the practice protective measures with animals was protective for humans as well [OR (95% CI)= 0.11 (0.03-0.45);p= 0.002].

Conclusion

Consumption of dairy products stands side by side with the contact with infected animals particularly aborted ones as the major risk factors forBrucellaspp. infection among humans in Egypt. On the other hand, there is a poor knowledge, negative attitudes and risky behaviors among villagers which increase the magnitude of the risk of brucellosis transmission at the human-animal interface. This supports the need for integrating health education in the national brucellosis control programs in Egypt with a special emphasis on hygienic animal husbandry, disease notification and benefits of animal vaccination.

Author summary

Zoonotic brucellosis has a vast global burden and remains neglected in many areas of the world despite notable advances in disease containment strategies. Despite the implementation of a national brucellosis control program in Egypt, the challenges for the disease eradication are intractable and multifaceted. We modeled in the present study the multivariate factors for brucellosis persistence in Egypt which apparently pointed to lack of basic understanding of the nature of brucellosis, traditional practices, beliefs and risky behaviors being undertaken on farms and at households across a wide region of the country. Predominantly, consumption of dairy products from unregulated sources; underreporting animal infection and abortion; underutilization of animal vaccination service; unsanitary disposal of abortus; use of milk of infected/aborted ruminants and lack of protective measure when practicing animal husbandry. Together, these conflict with disease intervention strategies and contribute to disease spread and re-emergence. The proposed model can provide a framework for future containment strategies that should be adopted to support and enhance the adherence to the current national brucellosis control program.

Brucellosis knowledge, attitudes and practices of a South African communal cattle keeper group

Brucellosis remains an animal and public health concern in South Africa, given the intensity and widespread distribution of outbreaks in cattle. We conducted a cross-sectional survey among cattle keepers in the Whittlesea community of the Eastern Cape Province of South Africa, which utilises communal grazing. Individual cattle keepers (N = 227) who attended prearranged meetings in selected villages were interviewed using a structured questionnaire to assess their knowledge, attitude and practices (KAP) regarding bovine brucellosis. We compared KAP scores between previous brucellosis-affected villages and unaffected villages. We compared attitude and practices scores between those who had heard of brucellosis and those who had not and between those above the 75th percentile knowledge score and those below. The KAP for the study population were described using frequency tables. Scores of different groups were compared using the Welch t-test or the Wilcoxon rank-sum test. Knowledge scores of those who had heard of brucellosis (60%) showed a bimodal distribution with a 0/18 primary peak and 5-6/18 secondary peak. Attitude scores showed a median of 7/14 (interquartile range [IQR] 6-9), with 98% requesting more information on brucellosis. Practices scores showed a median of 6/18 (IQR 3-8), with high-risk practices identified that could facilitate brucellosis transmission. There were significant differences in attitude and practices scores between the groups above and below the 75th percentile knowledge score. The community showed poor knowledge, poor to average practices and average to good attitude. Identified high-risk practices highlight the risk of potential introduction and transmission of brucellosis between cattle and zoonotic transmission to humans.

Seroprevalence and risk factors of brucellosis among slaughtered indigenous cattle, abattoir personnel and pregnant women in Ngaoundéré, Cameroon

BACKGROUND

Brucellosis is a neglected debilitating zoonosis with a high prevalence in many developing countries. Bovine brucellosis is widespread in Cameroon but the epidemiological situation of human brucellosis is not known. A cross sectional study was carried to determine the seroprevalence and factors associated with bovine and human Brucellosis among abattoir personnel and pregnant women in Ngaoundéré, Cameroon.

METHODS

Serum sample from 590 abattoir cattle and 816 plausible occupational risk and vulnerable humans to brucellosis (107 abattoir personnel and 709 pregnant women) were collected and screened for anti-brucella antibodies using Rose Bengal Plate Test (RBPT) and ELISA tests. Structured questionnaires were used to collect data on socio-demographics and risk-factors. The differences in proportions between seropositive and seronegative reactors were tested using odds-ratio and χ2tests.

RESULTS

Bovine brucellosis seroprevalence was at 3.40% (n = 590; 3.4% for RBPT, 5.93% for i-ELISA). Human Brucella seroprevalence was at 5.6% among abattoir personnel (n = 107; 5.6% for RBPT, 12.15% for Brucella IgG ELISA) and 0.28% in pregnant women (n = 709; both tests). Breed (P < 0.00001) was associated with increased risk of brucellosis in cattle and the seroprevalence was highest among the Djafoun (OR = 16.67, 95%CI: 4.49-28.85) and Akou (OR = 16.96, 95% CI: 0.10-23.91) cattle compared to the other breeds. There was a moderate positive correlation (R2 = 0.5025) of Brucella IgG concentrations (> 200 U/ml) and clinical data for Brucella IgG ELISA seropositive humans. Several potential factors were associated (P > 0.05) with increased risk of human brucellosis seroprevalence among the abattoir personnel. The abattoir personnel were essentially males; the seropositive respondents were male and did not use protective equipment at work. Handling of foetus and uterine contents (OR = 13.00, 95%CI: 1.51-111.88) was associated with increased risk of human brucellosis.

CONCLUSIONS

Antibrucella antibodies are prevalent in cattle (3.40%), among abattoir personnel (5.60%) and in pregnant women (0.28%) in Ngaoundéré, Cameroon. The study reports the first evidence of human brucellosis in Cameroon and therefore, an indication of a real public health problem. Public awareness campaigns and health education especially among livestock professional and in agropastoral communities should be highlighted to disseminate knowledge, associated risk factors and control measures of brucellosis.

Herd-level risk factors associated with Brucella sero-positivity in cattle, and perception and behaviours on the disease control among agro-pastoralists in Tanzania

Brucellosis is endemic in Tanzania, particularly in agro-pastoral areas. This study investigated the herd-level sero-prevalence and risk factors for Brucella sero-positivity in cattle, and perception and behaviours associated with brucellosis control among agro-pastoralists in Morogoro Region, Tanzania. A cross-sectional study involving herd milk diagnosis by indirect enzyme-linked immunosorbent assay and questionnaire survey was conducted in 124 farms. Questions included potential risk factors, knowledge of brucellosis, willingness-to-pay for cattle vaccination, and item count technique (ICT) for selling behaviour of cows that experienced abortion. Risk factor analysis for Brucella sero-positivity in cattle and analysis of factors associated with willingness-to-pay were conducted using classical tests and generalised linear models. Most farmers had little knowledge about brucellosis (disease name: 13.7%, symptoms: 3.2%, transmission from cattle to human: 2.4%, and Brucella vaccine: 2.4%). The proportion of Brucella sero-positive herd was 44.4% (55/124, 95%CI: 35.5-53.5). No risk factors for Brucella sero-positivity were identified; however, using a veterinary service was identified as a preventive factor (OR = 0.39, 95%CI: 0.18-0.84, p =  0.02). For scenarios of vaccinating all cattle and only calves, 59.7% and 89.5% of farmers were willing to pay for vaccination, respectively. Being a Maasai tribe member was a hesitating factor for vaccinating all cattle (OR = 0.39, 95%CI: 0.19-0.83, p =  0.01) and using a veterinary service was an encouraging factor for vaccinating calves (OR = 4.0, 95%CI: 1.2-13.0, p =  0.02). The ICT found that 45.1% of farmers sold cows that experienced abortion. This estimate was not statistically different from that obtained by direct questioning (34.1%, SE = 7.5%, binomial p value = 0.27, factor score = 1.32), suggesting that farmers did not hesitate to sell such cows. The Maasai conducted more risky behaviours for human infection such as drinking raw milk (p = 0.06) or blood (p <  0.01) and helping delivery with bare hands (p = 0.03) than other tribes. Community-based brucellosis control programmes with calf vaccination may be feasible in the study areas. A One Health approach including the promotion of health education and expansion of veterinary services is crucial for disease control.

Prevalence and risk factors of brucellosis among febrile patients attending a community hospital in south western Uganda

Human brucellosis, a chronic disease contracted through contact with animals and consuption of unpasteurized dairy products is underreported in limited-resource countries. This cross-sectional study aimed to determine the prevalence and risk factors of brucellosis among febrile patients attending a community hospital in South western Uganda. A questionnaire that captured socio-demographic, occupational and clinical data was administered. Blood samples were tested for Brucella antibodies using Rose Bengal Plate Test (RBPT) and blood culture with standard aerobic BACTEC bottle was done. Of 235 patients enrolled, prevalence of brucellosis (RBPT or culture confirmed) was 14.9% (95% CI 10.6-20.1) with a culture confrmation in 4.3% of the participants. The factors independently associated with brucellosis were consumption of raw milk (aOR 406.15, 95% CI 47.67-3461.69); history of brucellosis in the family (aOR 9.19, 95% CI 1.98-42.54); and selling hides and skins (aOR 162.56, 95% CI 2.86-9256.31). Hepatomegaly (p < 0.001), splenomegaly (p = 0.018) and low body mass index (p = 0.032) were more common in patients with brucellosis compared to others. Our findings reveal a high prevalence of brucellosis among febrile patients and highlight a need for implementing appropiate tests, public awareness activities and vaccination of animals to control and eliminate the disease.

Animal brucellosis control or eradication programs worldwide: A systematic review of experiences and lessons learned

Brucellosis is one of the most common zoonoses worldwide, causing huge economic losses in the animal industry and posing a serious threat to human health. Although the World Health Organization (WHO) and World Organization for Animal Health (OIE) has recommended strategies or measures to control or eradicate brucellosis, only some developed countries have achieved freedom from animal brucellosis. In developing countries, brucellosis remains a serious problem, and the importance of its control has attracted little attention. The strategies and measures are difficult to implement effectively in countries with limited resources because the eradication of brucellosis is an expensive, time-consuming and labor-intensive project. Therefore, more effort is needed to explore the appropriate strategies and measures in developing countries. In this study, we collected the available publications regarding brucellosis control or eradication programs in different countries and areas, and summarized the main strategies and measures, supplementary measures, effects, and lessons learned during their implementation. Results showed that the freedom from animal brucellosis was only achieved in three countries among the 23 included countries and areas after the implementation of the programs, which had lasted several decades. Either alone or together, vaccination and test-and-slaughter programs can effectively reduce brucellosis prevalence. Supplementary measures involve a number of aspects, and their effective implementation is crucial to the success of disease control and cannot be ignored. While disease control or eradication requires extensive resources, some studies have shown that a well-designed and well-implemented disease control or eradication program is economically effective. Experience has revealed that even if significant results have been achieved, the project could not be terminated without careful consideration due to the potential for recurrence.

Seroprevalence and Associated Risk Factors of Brucellosis among Indigenous Cattle in the Adamawa and North Regions of Cameroon

A cross-sectional seroprevalence study was conducted on cattle in the North and Adamawa Regions of Cameroon to investigate the status of bovine brucellosis and identify potential risk factors. The diagnosis was carried out using the Rose Bengal Plate test (RBPT) and indirect ELISA (i-ELISA), while questionnaires were used to evaluate risk factors for bovine brucellosis in cattle. The Bayesian approach was used to evaluate the diagnostic tests' sensitivity and specificity. The overall individual level (n = 1031) and herd level (n = 82) seroprevalence were 5.4% (0.4-10.5) and 25.6% (16.2-35.0), respectively. Bayesian analysis revealed sensitivity of 58.3% (26.4-92.7) and 89.6% (80.4-99.4) and specificity of 92.1% (88.7-95.2) and 95.7% (91.1-99.7) for RBPT and i-ELISA, respectively. Management related factors such as region, locality, herd size, and knowledge of brucellosis and animal related factors such as sex and age were significantly associated with seropositivity of brucellosis. Zoonotic brucellosis is a neglected disease in Cameroon. The study highlights the need for control measures and the need to raise public awareness of the zoonotic occurrence and transmission of bovine brucellosis in the country. An integrated disease control strategy mimicking the one health approach involving medical personnel, veterinarians, related stakeholders, and affected communities cannot be overemphasized.

Brucellosis in cattle and micro-scale spatial variability of pastoral household income from dairy production in south western Uganda

Brucellosis in cattle and humans has received world-wide research attention as a neglected and re-emerging zoonotic disease with many routes of transmission. Studies of brucellosis in Uganda have emphasized occupational exposures and also revealed variations in prevalence levels by region and cattle production systems. To date, research linking pastoralist household income from dairy production to brucellosis and its transmission risk pathways do not exist in Uganda. We assessed whether spatial differences in unit milk prices can be explained by brucellosis prevalence in cattle along a distance gradient from Lake Mburo National Park in Uganda. Semi-structured interviews administered to 366 randomly selected household heads were supplemented with serological data on brucellosis in cattle. Statistical analysis included Pearson correlation test, multiple regression and analysis of variance (ANOVA) using SPSS version 17. Serological results showed that 44% of cattle blood samples were sero-positive for brucellosis. The results obtained from interviews put the statistical mean of household reported cattle abortions at 5.39 (5.08-5.70 at 95% CI, n=366). Post-hoc analysis of variance revealed that both sero-positive cattle and reported cattle abortions significantly were much lower when moving outwards from the park boundary (p<0.05), while the price of milk increased significantly (p<0.05) along the same distance gradient. Further studies should identify public and private partnerships needed to create and strengthen good zoonotic brucellosis management practices at the nexus of wildlife and livestock in Uganda.

Poor performance of the rapid test for human brucellosis in health facilities in Kenya

Human brucellosis is considered to be an important but typically under-diagnosed cause of febrile illness in many low and middle-income countries. In Kenya, and throughout East Africa, laboratory diagnosis for the disease is based primarily on the febrile antigen Brucella agglutination test (FBAT), yet few studies of the diagnostic accuracy of this test exist. Assessment of the performance of the FBAT is essential for its appropriate clinical use, as well as for evaluating surveillance data reported by public health systems. To assess FBAT performance, we collected sera from people with symptoms compatible with brucellosis attending two health facilities in Busia County, Kenya. Sera were tested using the FBAT and results compared with those from the Rose Bengal Test (RBT), an assay with well-known performance characteristics. Positives on either test were confirmed using the classical serum agglutination test (SAT)-Coombs test combination and a rapid IgM/IgG lateral flow immunochromatography assay (LFA). A questionnaire focussing on known risk factors for exposure to Brucella spp. was also conducted, and relationships with FBAT positivity examined using logistic regression. Out of 825 recruited individuals, 162 (19.6%) were classified as positive using the FBAT. In contrast, only eight (1.0%) were positive using the RBT. Of the 162 FBAT positives, one (0.62%) had an atypical agglutination in SAT and three (1.9%) showed low Coombs titres. Out of 148 FBAT positive individuals tested using the LFA, five (3.4%) were IgM positive and none were IgG positive. Poor or no correlation was observed between FBAT results and most established risk factors for Brucella infection. We observed substantial disagreement between the FBAT and a number of well-known serological tests, with the majority of reactive FBAT results appearing to be false positives. Poor FBAT specificity, combined with a lack of confirmatory testing, strongly suggests overdiagnosis of brucellosis is common in this low prevalence setting. This is expected to have important economic impacts on affected patients subjected to the long and likely unnecessary courses of multiple antibiotics required for treatment of the disease.

Brucellosis is a debilitating disease of people caused by infection with one of a number of different Brucella species. In almost all cases, people acquire the infection through exposure to infected animals or contaminated animal products. Human brucellosis is well known for its wide range of symptoms, and is often clinically indistinguishable from other infectious diseases, such as malaria or typhoid. Diagnosing the disease therefore typically relies on laboratory tests. A wide range of tests are available, but little is known about the accuracy of the principal test used in Government health facilities in Kenya, the febrile Brucella agglutination test (FBAT). In this study, we identified people with symptoms compatible with brucellosis attending health centres in Kenya. By comparing results from the FBAT performed on samples collected from these individuals with the results from a range of well-established diagnostic tests, we were able to show that the FBAT produces large numbers of false positive results. We expect that this leads to a high levels of overdiagnosis of brucellosis in some parts of Kenya. Treatment of the disease involves multiple weeks of multiple antibiotics, and these incorrect diagnoses may have important and unnecessary negative impacts on affected patients.

How do you get the Rose Bengal Test at the point-of-care to diagnose brucellosis in Africa? The importance of a systems approach

Brucellosis is a major neglected zoonotic disease, whose burden both in animals and humans is severely under-reported. Diagnosis in humans identifies cases in order to treat the disease at the individual level. In animals diagnosis is implemented at the population level in the context of appropriate control or eradication strategies. Molecular and bacteriological diagnosis are rarely undertaken in sub-Saharan Africa, at least outside research projects, due to cost, skills and laboratory infrastructure issues. The brucellosis toolbox contains a wide range of serological tests, but the perfect test for use in animals and humans respectively does not exist. Drug and diagnostic discovery for the neglected zoonoses are notoriously poor, and there is limited investment interest in developing new tools for brucellosis diagnosis. But are current tools being used to their full capacity? The rose Bengal test (RBT) stands out as an efficient, practical and very cheap test adapted for use in the resource-poor context. In this paper, we argue that a social science or system's approach to explore the practicality of improving diagnostic capacity at the point-of care in high-risk brucellosis areas of rural Africa may be a step towards solving the issue of under-diagnosis, but this must go hand-in-hand with implementation of control measures at source in the animal reservoir and capacity to treat human cases.

Interpretation Criteria for Comparative Intradermal Tuberculin Test for Diagnosis of Bovine Tuberculosis in Cattle in Maroua Area of Cameroon

Intradermal tuberculin test (TST) is the choice method for diagnosis of bovine tuberculosis (Tb) in live animals. This work was done to assess the performance of single intradermal comparative cervical tuberculin (SICCT) test in randomly selected cattle in Maroua, Cameroon, against detection of Tb lesions and detection of Tb lesions plus acid fast bacilli in lesions. While 22.28% of slaughtered cattle presented Tb lesions at meat inspection, detection rates of anti-bovine-Tb antibody, Tb lesions, and Tb lesions plus acid fast bacilli were 68.57%, 32.95%, and 22.35%, respectively. SICCT-bovine-Tb positive cattle were 35.29%, 29.41%, 25.88%, 24.7%, and 21.18% at ≥2 mm, ≥2.5 mm, ≥3 mm, ≥3.5 mm, and ≥4 mm cut-offs, respectively. Higher sensitivity and predictive values were obtained at severe interpretations. The best performance was at ≥3 mm and ≥3.5 mm cut-offs. Against detection of Tb lesions, ≥3 mm and ≥3.5 mm showed sensitivity of 67.8% and specificity of 94.7% and 96.5%, respectively. For detection of Tb lesions accompanied with acid fast bacilli in lesions, ≥3 mm and ≥3.5 mm showed sensitivity of 89.4% and specificity of 92.4% and 93.9%, respectively. These findings revealed that interpretations of SICCT-bovine-Tb should be at ≥3 mm and/or ≥3.5 mm cut-offs. Severe interpretation of TST is essential for optimal diagnosis of bovine Tb in cattle in Maroua, Cameroon.

One Health profile of a community at the wildlife-domestic animal interface, Mpumalanga, South Africa

We used a community engagement approach to develop a One Health profile of an agro-pastoralist population at the interface of wildlife areas in eastern South Africa. Representatives from 262 randomly-selected households participated in an in-person, cross-sectional survey. Questions were designed to ascertain the participants' knowledge, attitudes, and practices with regard to human health, domestic animal health, and natural resources including wildlife and water. Surveys were conducted within four selected villages by a team of trained surveyors and translators over four weeks in July-August 2013. Questions were a combination of multiple choice (single answer), multiple selection, open-ended, and Likert scale. The study found that nearly three-quarters of all households surveyed reported owning at least one animal (55% owned chickens, 31% dogs, 25% cattle, 16% goats, 9% cats, and 5% pigs). Among the animal-owning respondents, health concerns identified included dissatisfaction with government-run cattle dip facilities (97%) and frequent morbidity and mortality of chickens that had clinical signs consistent with Newcastle disease (49%). Sixty-one percent of participants believed that diseases of animals could be transmitted to humans. Ninety-six percent of respondents desired greater knowledge about animal diseases. With regard to human health issues, the primary barrier to health care access was related to transportation to/from the community health clinics. Environmental health issues revealed by the survey included disparities by village in drinking water reliability and frequent domiciliary rodent sightings positively associated with increased household size and chicken ownership. Attitudes towards conservation were generally favorable; however, the community demonstrated a strong preference for a dichotomous approach to wildlife management, one that separated wildlife from humans. Due to the location of the community, which neighbors the Great Limpopo Transfrontier Conservation Area, and the livestock-dependent lifestyle of the resource-poor inhabitants, a One Health approach that takes into consideration the interconnectedness of human, animal, and environmental health is necessary. The community profile described in this study provides a foundation for health research and planning initiatives that are driven by community engagement and consider the multitude of factors affecting health at the human-domestic animal-wildlife interface. Furthermore, it allows for the determination and quantification of the linkages between human, animal, and environmental health.

Sero-epidemiological survey and risk factors associated with bovine brucellosis among slaughtered cattle in Nigeria

Bovine brucellosis is endemic in Nigeria; however, limited data exist on nationwide studies and risk factors associated with the disease. Using a cross-sectional sero-epidemiological survey, we determined the prevalence of and risk factors for brucellosis in slaughtered cattle in three geographical regions of Nigeria. Serum samples from randomly selected unvaccinated cattle slaughtered over a period of 3 years (between December 2010 and September 2013) from northern, southern and south-western Nigeria were tested for antibodies to Brucella abortus using the Rose Bengal test. Data associated with risk factors of brucellosis were analysed by Stata Version 12. In all, 8105 cattle were screened. An overall seroprevalence of 3.9% (315/8105) was recorded by the Rose Bengal test, with 3.8%, 3.4% and 4.0% from the northern, southern and south-western regions, respectively. Bivariate analysis showed that cattle screened in northern Nigeria were less likely to be seropositive for antibodies to Brucella spp. than those from south-western Nigeria (odds ratio = 0.94; 95% confidence interval: 0.73–1.22). However, logistic regression analysis revealed that breed ( p = 0.04) and sex ( p £ 0.0001) of cattle were statistically significant for seropositivity to Brucella spp. The study found that brucellosis was endemic at a low prevalence among slaughtered cattle in Nigeria, with sex and breed of cattle being significant risk factors. Considering the public health implications of brucellosis, we advocate coordinated surveillance for the disease among diverse cattle populations in Nigeria, as is carried out in most developed countries.

Knowledge of Bovine Tuberculosis, Cattle Husbandry and Dairy Practices amongst Pastoralists and Small-Scale Dairy Farmers in Cameroon

BACKGROUND

Control of bovine tuberculosis (bTB) and zoonotic tuberculosis (zTB) has relied upon surveillance and slaughter of infected cattle, milk pasteurisation and public health education. In Cameroon, like many other sub-Saharan African countries, there is limited understanding of current cattle husbandry or milk processing practices or livestock keepers awareness of bTB. This paper describes husbandry and milk processing practices within different Cameroonian cattle keeping communities and bTB awareness in comparison to other infectious diseases.

STUDY DESIGN

A population based cross-sectional sample of herdsmen and a questionnaire were used to gather data from pastoralists and dairy farmers in the North West Region and Vina Division of Cameroon.

RESULTS

Pastoralists were predominately male Fulanis who had kept cattle for over a decade. Dairy farmers were non-Fulani and nearly half were female. Pastoralists went on transhumance with their cattle and came into contact with other herds and potential wildlife reservoirs of bTB. Dairy farmers housed their cattle and had little contact with other herds or wildlife. Pastoralists were aware of bTB and other infectious diseases such as foot-and-mouth disease and fasciolosis. These pastoralists were also able to identify clinical signs of these diseases. A similar proportion of dairy farmers were aware of bTB but fewer were aware of foot-and-mouth and fasciolosis. In general, dairy farmers were unable to identify any clinical signs for any of these diseases. Importantly most pastoralists and dairy farmers were unaware that bTB could be transmitted to people by consuming milk.

CONCLUSIONS

Current cattle husbandry practices make the control of bTB in cattle challenging especially in mobile pastoralist herds. Routine test and slaughter control in dairy herds would be tractable but would have profound impact on dairy farmer livelihoods. Prevention of transmission in milk offers the best approach for human risk mitigation in Cameroon but requires strategies that improved risk awareness amongst producers and consumers.

Narrative overview of animal and human brucellosis in Morocco: intensification of livestock production as a driver for emergence?

Brucellosis is one of the most widespread zoonoses in the world caused by several species of the genus Brucella. The disease, eradicated in many developed countries, is a re-emerging neglected zoonosis endemic in several zones especially in the Mediterranean region, impacting on human health and livestock production. A One Health approach could address brucellosis control in Morocco but scarcity of reliable epidemiological data, as well as underreporting, hinders the implementation of sustainable control strategies. Surveillance and control policies implemented by the Moroccan government in domestic animals (cattle and small ruminants) in the last few decades are assessed for disease impact. This study considers the origins of animal brucellosis in Morocco and the potential for emergence of brucellosis during a shift from extensive to intensive livestock production.

Effect of milk fermentation by kefir grains and selected single strains of lactic acid bacteria on the survival of Mycobacterium bovis BCG

Mycobacterium bovis that causes Bovine tuberculosis (BTB) can be transmitted to humans thought consumption of raw and raw fermented milk products from diseased animals. Lactic acid bacteria (LAB) used in popular traditional milk products in Africa produce anti-microbial compounds that inhibit some pathogenic and spoilage bacteria. M. bovis BCG is an attenuated non-pathogenic vaccine strain of M. bovis and the aim of the study was to determine the effect of the fermentation process on the survival of M. bovis BCG in milk. M. bovis BCG at concentrations of 6 log CFU/ml was added to products of kefir fermentation. The survival of M. bovis BCG was monitored at 12-h intervals for 72 h by enumerating viable cells on Middlebrook 7H10 agar plates enriched with 2% BD BACTEC PANTA™. M. bovis BCG was increasingly reduced in sterile kefir that was fermented for a period of 24h and longer. In the milk fermented with kefir grains, Lactobacillus paracasei subsp. paracasei or Lactobacillus casei, the viability of M. bovis BCG was reduced by 0.4 logs after 24h and by 2 logs after 48 h of fermentation. No viable M. bovis BCG was detected after 60 h of fermentation. Results from this study show that long term fermentation under certain conditions may have the potential to inactivate M. bovis BCG present in the milk. However, to ensure safety of fermented milk in Africa, fermentation should be combined with other hurdle technologies such as boiling and milk pasteurisation.

How to reach the poor? Surveillance in low-income countries, lessons from experiences in Cambodia and Madagascar

Surveillance of animal diseases in developing countries faces many constraints. Innovative tools and methods to enhance surveillance in remote and neglected areas should be defined, assessed and applied in close connection with local farmers, national stakeholders and international agencies. The authors performed a narrative synthesis of their own publications about surveillance in Madagascar and Cambodia. They analysed the data in light of their fieldwork experiences in the two countries' very challenging environments. The burden of animal and zoonotic diseases (e.g. avian influenza, African swine fever, Newcastle disease, Rift Valley fever) is huge in both countries which are among the poorest in the world. Being poor countries implies a lack of human and financial means to ensure effective surveillance of emerging and endemic diseases. Several recent projects have shown that new approaches can be proposed and tested in the field. Several advanced participatory approaches are promising and could be part of an innovative method for improving the dialogue among different actors in a surveillance system. Thus, participatory modelling, developed for natural resources management involving local stakeholders, could be applied to health management, including surveillance. Data transmission could benefit from the large mobile-phone coverage in these countries. Ecological studies and advances in the field of livestock surveillance should guide methods for enhancing wildlife monitoring and surveillance. Under the umbrella of the One Health paradigm, and in the framework of a risk-based surveillance concept, a combination of participatory methods and modern technologies could help to overcome the constraints present in low-income countries. These unconventional approaches should be merged in order to optimise surveillance of emerging and endemic diseases in challenging environments.

Brucellosis in low-income and middle-income countries

PURPOSE OF REVIEW

Human brucellosis is a neglected, underrecognized infection of widespread geographic distribution. It causes acute febrile illness and a potentially debilitating chronic infection in humans, and livestock infection has substantial socioeconomic impact. This review describes new information regarding the epidemiology of brucellosis in the developing world and advances in diagnosis and treatment.

RECENT FINDINGS

The highest recorded incidence of human brucellosis occurs in the Middle East and Central Asia. Fever etiology studies demonstrate brucellosis as a cause of undifferentiated febrile illness in the developing world. Brucellosis is a rare cause of fever among returning travelers, but is more common among travelers returning from the Middle East and North Africa. Sensitive and specific rapid diagnostic tests appropriate for resource-limited settings have been validated. Randomized controlled trials demonstrate that optimal treatment for human brucellosis consists of doxycycline and an aminoglycoside. Decreasing the burden of human brucellosis requires control of animal brucellosis, but evidence to inform the design of control programs in the developing world is needed.

SUMMARY

Brucellosis causes substantial morbidity in human and animal populations. While improvements in diagnostic options for resource-limited settings and stronger evidence for optimal therapy should enhance identification and treatment of human brucellosis, prevention of human disease through control in animals remains paramount.

Molecular characterization of Mycobacterium bovis isolates from pastoral livestock at Mikumi-Selous ecosystem in the eastern Tanzania

Domestic ruminants and Wild ungulates can act as reservoir hosts for Mycobacterium bovis, causative agent for bovine tuberculosis (BTB) in animals and man. Bovine tuberculosis (BTB) is endemic in pastoral livestock in Tanzania. There is lack of information on genotypic distribution of M. bovis in animals at wildlife-livestock interface areas and in wildlife conserved areas. The objectives of this study were to characterize and determine the spatial distribution of M. bovis isolates. Tissue samples from cattle and wildlife were cultured and analyzed using deletion typing and spoligotyping techniques. Eight (8.9%) M. bovis strains were isolated from cattle and confirmed by RD4 and RD9 polymerize chain reaction (PCR) assays. Spoligotype SB1467 was the dominant pattern 62.5% (n = 8) in infected animals, two isolates belonged to a newly reported type SB2190, and one isolate belonged to SB0133. The spoligotype patterns of SB1467 and SB0133 were closely related (96.9%) while SB2190 was less related (59.4%) to SB0133, the relatedness amongst spoligotypes were associated with spacer position 15. No M. bovis was isolated from hunted wild animals. The current study has identified a novel spoligotype SB2190. The current data suggest that wild animals in Mikumi-Selous ecosystem are at risk of acquiring M. bovis infection due to occasional interaction by sharing of pasture and water sources between wildlife and livestock. Integrated efforts by all stakeholders are crucial for controlling spread of tuberculosis at livestock/wildlife/human interface areas.

Relationship between burden of infection in ungulate populations and wildlife/livestock interfaces

In southern African transfrontier conservation areas (TFCAs), people, livestock and wildlife share space and resources in semi-arid landscapes. One consequence of the coexistence of wild and domestic herbivores is the risk of pathogen transmission. This risk threatens local livelihoods relying on animal production, public health in the case of zoonoses, national economies in the context of transboundary animal diseases, and the success of integrated conservation and development initiatives. The level of interaction between sympatric wild and domestic hosts, defining different wildlife/livestock interfaces, characterizes opportunities of pathogen transmission between host populations. Exploring the relationship between infection burden and different types of wildlife/domestic interfaces is therefore necessary to manage the sanitary risk in animal populations through control options adapted to these multi-host systems. Here, we assessed the infection burdens of sympatric domestic cattle (Bos taurus/Bos indicus) and African buffalo (Syncerus caffer) at an unfenced interface and compared the infection burdens of cattle populations at different wildlife/livestock interfaces in the Great Limpopo TFCA. Patterns of infection in ungulate populations varied between wild and domestic hosts and between cattle populations at different wildlife/livestock interfaces. Foot-and-mouth disease, Rift Valley fever and theileriosis infections were detected in buffalo and cattle at unfenced interfaces; bovine tuberculosis was only present in buffalo; and brucellosis and lumpy skin disease only in cattle. At unfenced interfaces, cattle populations presented significantly higher Theileria parva and brucellosis prevalence. We hypothesize that cattle populations at wildlife/livestock interfaces face an increased risk of infection compared to those isolated from wildlife, and that the type of interface could influence the diversity and quantity of pathogens shared. Additional host behavioural and molecular epidemiological studies need to be conducted to support this hypothesis. If it is confirmed, the management of wildlife/livestock interfaces will need to be considered through the prism of livestock and public health.

Prevalence and significant geospatial clusters of bovine tuberculosis infection at livestock-wildlife interface ecosystem in Eastern Tanzania

Bovine tuberculosis (BTB) is an important neglected zoonosis that affects livestock, wildlife and human. A study to determine prevalence and geospatial clusters for BTB was conducted from June 2010 to March 2012 at livestock-wildlife interface areas (LWIA). A total of 1,288 cattle located in vicinity of Mikumi-Selous ecosystem Tanzania were tested. Single Intradermal Comparative Tuberculin Test and spatial scan statistic analysis were applied to establish the status of the disease and identify significant spatial BTB clusters. Overall individual prevalence was 3.7 % (n=1,288) (95 % CI=2.8-4.9) and 7.8 % (95 % CI=6.4-9.4) with cut-off of >4 and >2 mm, respectively. Villages with at least one reactor were 55.8 % (n=43). Reactivity was significantly higher in Mvomero and Kilosa districts compared with Kilombero and Ulanga districts (χ (2) =15.9; P<0.001). Significant spatial BTB clusters were revealed at 11 villages. BTB clustering was significant in Kilosa and Mvomero districts compared with Kilombero and Ulanga districts. There was overlap and aggregation of BTB clusters covering south and south-east of Kilosa district bordering Mikumi National Park (MNP) and Mvomero. Generally, clustering occurred around major rivers. The current study provides useful information on the dynamics and epidemiological status of BTB around the wildlife-livestock-human interface, it reveals that the wildlife are at risk of BTB from infected livestock. The study revealed hotspots for BTB that can be applied to guide implementation of participatory intervention at LWIA and control strategies in marginalised pastoralist communities. This study calls for similar studies in other Tanzania's LWIA for efficient intervention of BTB countrywide.

Brucellosis among hospitalized febrile patients in northern Tanzania

Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a ≥ 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer ≥ 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with ≥ 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age (P = 0.024), leukopenia (odds ratio [OR] 7.8, P = 0.005), thrombocytopenia (OR 3.9, P = 0.018), and evidence of other zoonoses (OR 3.2, P = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania.

Development of a curriculum for training in One Health analytical epidemiology at the University of Zambia

Recently, the world has witnessed emergence of novel diseases such as avian influenza, HIV and AIDS, West Nile Virus and Ebola. The evolution of these pathogens has been facilitated mainly by a constantly evolving animal-human interface. Whilst infectious disease control was previously conceptualised as either public health or animal health related issues, the distinction between disciplinary foci have been blurred by multiple causal factors that clearly traverse traditional disciplinary divides. These multiple evolutionary pressures have included changes in land use, ecosystems, human-livestock-wildlife interactions and antibiotic use, representing novel routes for pathogen emergence. With the growing realisation that pathogens do not respect traditional epistemological divides, the ‘One Health’ initiative has emerged to advocate for closer collaboration across the health disciplines and has provided a new agenda for health education. Against this background, the One Health Analytical Epidemiology course was developed under the auspices of the Southern African Centre for Infectious Diseases Surveillance by staff from the University of Zambia with collaborators from the London School of Hygiene and Tropical Medicine and the Royal Veterinary College in London. The course is aimed at equipping scientists with multidisciplinary skill sets to match the contemporary challenges of human, animal and zoonotic disease prevention and control. Epidemiology is an important discipline for both public and animal health. Therefore, this two-year programme has been developed to generate a cadre of epidemiologists with a broad understanding of disease control and prevention and will be able to conceptualise and design holistic programs for informing health and disease control policy decisions.

The influence of cattle breed on susceptibility to bovine tuberculosis in Ethiopia

Bovine tuberculosis in domestic livestock such as cattle is an economically important disease with zoonotic potential, particularly in countries with emerging economies. We discuss the findings of recent epidemiological and immunological studies conducted in Ethiopia on host susceptibility differences between native zebu and the exotic Holstein–Friesian cattle that are increasingly part of the Ethiopian National herd, due to the drive to increase milk yields. These findings support the hypothesis that native Zebu cattle are more resistant to bovine tuberculosis. We also summarise the results of experimental infections that support the epidemiological data, and of laboratory experiments that suggest a role for the innate immune response, and in particular interleukin-6, in the outcome of bovine tuberculosis infection.

Implications of laboratory diagnosis on brucellosis therapy

Brucellosis is a worldwide zoonosis with a huge economic impact on animal husbandry and public health. The diagnosis of human brucellosis can be protracted because the disease primarily presents as fever of unknown origin with unspecific clinical signs and symptoms. The isolation rate of the fastidious etiologic agent from blood cultures is low, and therefore laboratory diagnosis is mainly based on serologic and molecular testing. However, seronegative brucellosis patients have been described, and antibody titers of diagnostic significance are difficult to define. Whether the molecular detection of Brucella DNA in clinical samples should be followed by long-term antibiotic treatment or not is also a matter of debate. The aim of this article is to review and discuss the implications of laboratory test results in the diagnosis of human brucellosis on disease therapy.

Brucellosis at the animal/ecosystem/human interface at the beginning of the 21st century

Following the recent discovery of new Brucella strains from different animal species and from the environment, ten Brucella species are nowadays included in the genus Brucella. Although the intracellular trafficking of Brucella is well described, the strategies developed by Brucella to survive and multiply in phagocytic and non-phagocytic cells, particularly to access nutriments during its intracellular journey, are still largely unknown. Metabolism and virulence of Brucella are now considered to be two sides of the same coin. Mechanisms presiding to the colonization of the pregnant uterus in different animal species are not known. Vaccination is the cornerstone of control programs in livestock and although the S19, RB51 (both in cattle) and Rev 1 (in sheep and goats) vaccines have been successfully used worldwide, they have drawbacks and thus the ideal brucellosis vaccine is still very much awaited. There is no vaccine available for pigs and wildlife. Animal brucellosis control strategies differ in the developed and the developing world. Most emphasis is put on eradication and on risk analysis to avoid the re-introduction of Brucella in the developed world. Information related to the prevalence of brucellosis is still scarce in the developing world and control programs are rarely implemented. Since there is no vaccine available for humans, prevention of human brucellosis relies on its control in the animal reservoir. Brucella is also considered to be an agent to be used in bio- and agroterrorism attacks. At the animal/ecosystem/human interface it is critical to reduce opportunities for Brucella to jump host species as already seen in livestock, wildlife and humans. This task is a challenge for the future in terms of veterinary public health, as for wildlife and ecosystem managers and will need a "One Health" approach to be successful.

The Rose Bengal Test in human brucellosis: a neglected test for the diagnosis of a neglected disease

Brucellosis is a highly contagious zoonosis affecting livestock and human beings. The human disease lacks pathognomonic symptoms and laboratory tests are essential for its diagnosis. However, most tests are difficult to implement in the areas and countries were brucellosis is endemic. Here, we compared the simple and cheap Rose Bengal Test (RBT) with serum agglutination, Coombs, competitive ELISA, Brucellacapt, lateral flow immunochromatography for IgM and IgG detection and immunoprecipitation with Brucella proteins. We tested 208 sera from patients with brucellosis proved by bacteriological isolation, 20 contacts with no brucellosis, and 1559 sera of persons with no recent contact or brucellosis symptoms. RBT was highly sensitive in acute and long evolution brucellosis cases and this related to its ability to detect IgM, IgG and IgA, to the absence of prozones, and to the agglutinating activity of blocking IgA at the pH of the test. RBT was also highly specific in the sera of persons with no contact with Brucella. No test in this study outperformed RBT, and none was fully satisfactory in distinguishing contacts from infected patients. When modified to test serum dilutions, a diagnostic titer >4 in RBT resulted in 87.4% sensitivity (infected patients) and 100% specificity (contacts). We discuss the limitations of serological tests in the diagnosis of human brucellosis, particularly in the more chronic forms, and conclude that simplicity and affordability of RBT make it close to the ideal test for small and understaffed hospitals and laboratories.

Ruminant brucellosis in the Kafr El Sheikh Governorate of the Nile Delta, Egypt: prevalence of a neglected zoonosis

Background

Brucellosis is a neglected tropical zoonosis allegedly reemerging in Middle Eastern countries. Infected ruminants are the primary source of human infection; consequently, estimates of the frequency of ruminant brucellosis are useful elements for building effective control strategies. Unfortunately, these estimates are lacking in most Middle East countries including Egypt. Our objectives are to estimate the frequency of ruminant brucellosis and to describe its spatial distribution in Kafr El Sheikh Governorate, Nile Delta, Egypt.

Methodology/Principal Findings

We conducted a cross-sectional study in which 791 sheep, 383 goats, 188 cattle milk tanks and 173 buffalo milk tanks were randomly selected in 40 villages and tested for the presence of antibodies against Brucella spp. The seroprevalence among different species was estimated and visualized using choropleth maps. A spatial scanning method was used to identify areas with significantly higher proportions of seropositive flocks and milk tanks. We estimated that 12.2% of sheep and 11.3% of goats in the study area were seropositive against Brucella spp. and that 12.2% and 12% of cattle and buffalo milk tanks had antibodies against Brucella spp. The southern part of the governorate had the highest seroprevalence with significant spatial clustering of seropositive flocks in the proximity of its capital and around the main animal markets.

Conclusions/ Significance

Our study revealed that brucellosis is endemic at high levels in all ruminant species in the study area and questions the efficacy of the control measures in place. The high intensity of infection transmission among ruminants combined with high livestock and human density and widespread marketing of unpasteurized milk and dairy products may explain why Egypt has one of the highest rates of human brucellosis worldwide. An effective integrated human-animal brucellosis control strategy is urgently needed. If resources are not sufficient for nationwide implementation, high-risk areas could be prioritized.

Brucellosis is a zoonosis of mammals caused by bacteria of the genus Brucella. It is responsible for a vast global burden imposed on human health through disability and on animal productivity. In humans brucellosis causes a range of flu-like symptoms and chronic debilitating illness. In livestock brucellosis causes economic losses as a result of abortion, infertility and decreased milk production. The main routes for human infection are consumption of contaminated dairy products and contact with infected ruminants. The control of brucellosis in humans depends on its control in ruminants, for which accurate estimates of the frequency of infection are very useful, especially in areas with no previous frequency estimates. We studied the seroprevalence of brucellosis and its geographic distribution among domestic ruminants in one governorate of the Nile Delta region, Egypt. In the study area, the seroprevalence of ruminant brucellosis is very high and has probably increased considerably since the early 1990s. The disease is widespread but more concentrated around major animal markets. These findings question the efficacy of the control strategy in place and highlight the high infection risk for the animal and human populations of the area and the urgent need for an improved control strategy.

Milk producers' awareness of milk-borne zoonoses in selected smallholder and commercial dairy farms of Zimbabwe

A cross-sectional questionnaire-based study was conducted to assess milk producers' awareness of milk-borne zoonoses in selected smallholder and commercial dairy farms of Zimbabwe. The questionnaire was designed to obtain information on dairy breeds, milk production, dairy farmers' knowledge and awareness of zoonoses with particular emphasis on milk-borne zoonoses and farmers' behavioural practices that may lead to increased risk of milk-borne zoonoses transmission. A total of 119 dairy farmers were interviewed, and 41.5% were aware of milk-borne zoonoses with a significantly (P<0.01) higher percentage of commercial dairy farmers (65.0%) being aware compared to smallholder dairy farmers (36.7%). The behavioural practices of dairy farmers observed to increase the risk of milk-borne zoonoses transmission were; consumption of raw milk (68.1%), sale of raw milk to the local public (25.2%), lack of cooling facilities by smallholder farmers (98%), and no routine testing (84.9%) and medical check-ups (89.1%) for milk-borne zoonoses. General hygienic and disease control practices need to be integrated in the milk production process particularly at the smallholder level. Awareness, teaching and training programmes for smallholder dairy farmers can improve disease control in animals and reduce the public health risk of milk-borne zoonoses.

The changing Brucella ecology: novel reservoirs, new threats

Brucellosis is a zoonosis that preceded humans but continues to cause significant medical, veterinary and socioeconomic problems, mainly because its overall burden remains underestimated and neglected. Its ecology, or what we know of it, has evolved rapidly in recent years. Two novel species, Brucella ceti and B. pinnipedialis, with the potential for causing human disease have been isolated from marine mammals. Another novel species, B. microti, has been isolated from wildlife animals, whilst B. inopinata has been isolated from a human case. An active spillover of Brucella between domestic animals and wildlife is also being recognised, with elk transmitting B. abortus to cattle, and freshwater fish becoming infected with B. melitensis from waste meat. In recent years the global epidemiology of the disease has not altered drastically, apart from increased awareness of brucellosis in sub-Saharan Africa and a rapid expansion of disease endemicity in the Balkan Peninsula. Isolated stories and events underline that Brucella knows no borders. The modern world has offered the pathogen the ability to travel and manifest itself anywhere and has also offered scientists the ability to track these manifestations better than ever before. This may allow the disease to be neglected no longer, or at least to be recognised as neglected.