Prevalence of brucellosis among patients attending Wau Hospital, South Sudan

Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis

Brucellosis is a commonly neglected zoonosis that remains a serious global public health concern. The epidemiological evolution of human brucellosis has considerably changed over the past few decades, and epidemic geography is continuously expanding. Human brucellosis is emerging and re-emerging, and is imported from areas where it is endemic due to travel, immigration, and international trade. The disease continues to be prevalent in Asia and Africa, including West Asia, Central Asia, North Africa, and East Africa, with the highest incidence in Syria, Kyrgyzstan, Mongolia, Iran, Algeria, and Kenya. Re-emerging cases are frequently recorded in places where brucellosis has been controlled, such as Bosnia, Herzegovina, Azerbaijan, and the USA. In countries with a high disease burden, disease control and eradication have been extremely difficult because of livestock farming being the only source of livelihood, unique religious beliefs regarding animals, nomadic lifestyle, and low socioeconomic levels. Interventions focused on protecting livestock keepers are needed, particularly for those assisting with goat and sheep births and the consumption of raw dairy products. Notably, in most countries with a high disease burden, each period of several years with a low incidence rate was followed by a subsequent increase in cases, highlighting the necessity of continuous investment and surveillance. In addition, advocacy for the inclusion of brucellosis as a globally mandated reported disease, strict restrictions on animal movement, mandated consumption of pasteurized milk, and health education are needed. This study will help form an evidence-based strategy for international organizations to curb the future spread of brucellosis.

Seroprevalence and risk factors of brucellosis in pastoralists and their livestock in Central Equatoria State, South Sudan

BACKGROUND

Brucellosis poses serious public health implications and substantial economic losses in pastoral rural settings in South Sudan. In humans, brucellosis is almost always originating from animals. Current literature provides scant data regarding the seroprevalence of brucellosis in South Sudan. This cross-sectional study investigates the seroprevalence of brucellosis among the pastoral community and livestock and identifies risk factors for the disease from two Counties, Terekeka and Juba in Central Equatoria State (CES), South Sudan.

METHODOLOGY

A total of 986 sera; from humans (n = 143), cattle (n = 478), sheep (n = 86), and goats (n = 279) were randomly collected from 17 cattle camps in CES. Sera for the humans, cattle and goats were screened for Brucella-specific antibodies using Rose Bengal plate test (RBPT) and further confirmed by competitive enzyme-linked immunosorbent assay (c-ELISA) in series due to the cost of testing. All the sera from sheep were tested in parallel using RBPT and c-ELISA as the sheep samples were few and were all tested negative on the RBPT. A camp was considered positive when at least one animal of either species tested positive on the c-ELISA. A structured questionnaire was used to collect information on potential individual and herd level risk factors. Univariate analysis using binary logistic regression with a confidence interval of 95% at a p-value of ≤ 0.05 was used to identify the association between the potential individual risk factors and Brucella seropositivity. The investigated risk factors for livestock included age, sex, species, prior abortion history, retained placenta, parity, and reproductive status. Variables found to have associations in univariate analysis (p = 0.25) with Brucella seropositivity were further included in multivariable logistic regression. The risk factors investigated for humans included, gender, age, educational level, occupation, marital status, drinking of raw milk, aiding female animals during delivery, eating undercooked meat and blowing of air into the cow's uterus through the vagina, a practice in South Sudan.

RESULTS

The study revealed seroprevalence of 21.7%, 11.8%, and 4.8% in cattle, goats, and humans, respectively. Our results indicated that all sheep serum samples were negative on both RBPT and c-ELISA. The seropositive in the 13 camps from Terekeka County was 100.0% (13/13) compared to 50.0% (2/4) seropositive from 4 camps in Juba County. All the variables investigated in the univariate analysis of risk factors in cattle were significantly associated with Brucella seropositivity: sex (OR:4.5, 95% CI: 2.2-8.9, p<0.001), age (OR:6.6, 95% CI: 2.3-19.1, p:<0.001), abortion history (OR:3.1, 95% CI: 1.8-5.2, p:<0.001), retained placenta (OR:2.5, 95% CI: 1.4-4.4, p = 0.001), parity (OR:2.3, 95% CI: 1.1-4.7, p = 0.020), However, in small ruminants, none of the potential risk factors were associated with Brucella seropositivity. In humans, blowing air through a cow's vagina (OR: 1.4, 95%CI: 0.782-2.434, p = 0.035) was the only variable found to be significantly associated with Brucella seropositivity in the univariate analysis. The forceful blowing of air into a cow's vagina to induce milk letdown is a common practice among the pastoral communities in South Sudan. The multivariable logistic regression model identified sex, age, and abortion history as statistically significant factors for Brucella seropositivity in cattle. The odds of seropositivity were nearly threefold (OR: 2.8; 95% CI: 1.3-5.8, p = 0.006) higher in cows compared to bulls (male cattle). Cattle over two years old had higher odds of Brucella seropositivity than young animals (OR: 3.5, 95% CI: 1.2-10.3-, p: 0.025). Cows with a history of abortion had higher odds of Brucella seropositivity (OR: 2.8, 95% CI: 1.6-4.7, p = 0.001).

CONCLUSION

This study reports the occurrence of brucellosis in goats and its absence in sheep in (CES), South Sudan. The present study also shows the occurrence of brucellosis in cattle, goats and people in the pastoral community and recommends for the implementation of the One Health approach and awareness campaigns for effective mitigation of this disease.

Understanding brucellosis: knowledge, perceptions, and self-reported prevalence among agro-pastoralists in Nakasongola, Uganda

BACKGROUND

Brucellosis is an infectious zoonotic disease that poses serious health threats around the world including Uganda. Brucellosis is caused by Brucella spp., the bacteria being transmitted via contact through skin breaks, via inhalation, or orally through the consumption of raw milk and other dairy products. The aim of this study was to investigate self-reported prevalence, knowledge, and perceptions towards brucellosis transmission, within agro-pastoralist communities in the Nakasongola district, central Uganda.

METHODS

This study employed a cross-sectional survey design. A semi-structured questionnaire was developed and administered to 398 participants selected through convenience sampling method. The survey gathered information on socio-demographic characteristics, knowledge of brucellosis transmission, symptoms, preventive measures, and self-reported prevalence of brucellosis. Qualitative data involved the use of six focus group discussions, identifying factors for transmission based on their perceived level of risk or impact using ranking by proportional piling.

RESULTS

A majority (99.2%, n = 398) had heard about brucellosis and 71.2% were aware of the zoonotic nature of the disease. There were varied responses regarding transmission routes, symptoms, and preventive measures. Self-reported prevalence was relatively high (55.5%). Following adjusted analysis, factors such as subcounty, source of income, knowledge about symptoms of brucellosis, whether brucellosis is treatable, perception, and living close to animals were statistically significant. Participants from Wabinyonyi had 2.7 higher odds of reporting brucellosis than those from Nabiswera, aOR = 2.7, 95%CI 1.4-5.5. Crop farming and livestock had much higher odds of reporting brucellosis than those earning from casual sources, aOR = 8.5, 95%C 1.8-40.1 and aOR = 14.4, 95%CI 3.1-67.6, respectively. Those who had knowledge about symptoms had 6.9 higher odds of reporting brucellosis than who mentioned fever, aOR = 4.5, 95%CI 2.3-18.3. Likewise, living close with animals and handling aborted fetuses (aOR = 0.4, 95%CI: 0.17-0.86), (aOR = 0.2,95% CI: 0.07-0.0.42,) had significantly lower odds for self-reported prevalence compared to those who believed did not cause brucellosis. Risk factors identified included, handling of aborted fetuses and living in close proximity with animals. Overall, there was a moderate statistical agreement in the ranking across the focus groups discussion (Wc = 0.48, p < 0.01; n = 6).

CONCLUSION

While awareness of brucellosis is high in the community, understanding of the transmission routes, clinical symptoms, and preventive measures varied. Investigating the understanding and assessing knowledge, perceptions and self-reported prevalence in this region indicated a necessity for risk communication strategies and community-based interventions to better control brucellosis transmission.

Seroprevalence of brucellosis antibodies and associated risk factors among the hospitalized patient, Aleppo, Syria: a hospital-based cross-sectional study

Introduction and importance

Brucellosis is one of the most common infectious diseases in the world, especially in developing countries. Recent reports show that Syria is among the top ten countries where brucellosis is most prevalent. The purpose of this study is to estimate the seroprevalence of brucellosis antibodies among the hospitalized patients, in one of the largest hospitals in northern Syria.

Materials and methods

A cross-sectional study was conducted among the hospitalized patients. The authors used a questionnaire to collect sociodemographic and brucellosis-related data from the patients. The authors also collected blood samples from these patients to be screened for brucellosis antibodies using Wright Coombs Agglutination and 2-mercaptoethanol tests, during the period from November 2021 and March 2022.

Results

Among the 776 patients who were recruited in the study, the seroprevalence of brucellosis antibodies was 13.1% (n=776). The highest prevalence was among the female sex (16.7%, n=298), middle aged group 12-40 years (24.1%, n=116), and patients with history of brucellosis (30.1%, n=53). Among the positive samples, the findings of 2-mercaptoethanol tests show that (14.7%, n=102) were positive (presence of IgG Antibodies), and (75.5%, n=102) were negative.

Conclusion

This study is the first to describe the epidemiology of brucellosis in northern Syria. It clearly shows high rates of positivity, which reflects immense challenges facing the public health sector in Syria. The best next step in light of this crisis is to raise awareness among population about brucellosis and its risk factor.

The incidence and clinical manifestations of human brucellosis in a referral hospital in Southern Saudi Arabia between 2015 and 2019

We determined the incidence and clinical manifestations of human brucellosis from patients who attended a referral hospital in South of Saudi Arabia. A record-based retrospective study was conducted from January 2015 to December 2019 at King Abdulla Hospital, Bisha, Saudi Arabia. Information on patients' demographic characteristics, detailed records of signs and symptoms, and the laboratory findings were reviewed. Of 6,586 patients included, 15.8% (n = 1,041) were infected with brucellosis. The age of infected individuals ranged from five to 95 years, with an average of 35.1 ± 21.2 years. Most infected patients were male (72.3%). Young adults (26-44 years) were the most common age group with the disease (34.1%). The annual rate of infection significantly decreased (P < 0.0001) from 33.2% in 2015 to 12.5% in 2019. An escalating number of brucellosis cases was seen in the spring and peaked during the summer. Fever (35.3%), joint pain (25.5%), generalized body ache (10.7%), and neurological symptoms (10.0%) were the most frequent clinical manifestation associated with brucellosis. Joint pain was commonly found among children (44.4%). Neurological findings were more frequent among adult patients. The study concluded that brucellosis is endemic in Southern Saudi Arabia and needs local health authority to implement preventive and educational program measures. Infected patients may present with diverse, nonspecific clinical manifestations that require intuition from clinicians to detect the disease.

Brucellosis: Prevalence with reference to East African community countries - A rapid review

Brucellosis is a zoonotic disease which is endemic to certain regions of the world including Sub-Saharan Africa. The aim of this article is to provide a recent and rapid review on brucellosis prevalence in East African Community (EAC) countries. Literature was obtained using Google Scholar search engine and screened for relevancy and fulfilment of criteria to 1, 17, 4, 4, 30 and 29 articles retained for brucellosis prevalence in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Recent literature (published in the last decade 2010 to 2019) was considered for prevalence results in this review. In EAC, livestock had an animal-level prevalence of 0.2% to 43.8%, 0.0% to 20.0% and 0.0% to 13.8% for cattle, goats and sheep respectively. In humans, the prevalence varied mostly between 0.0% and 35.8%. In conclusion, brucellosis is quite prevalent in the region. The reported prevalence calls for plans or more efforts from individual member countries and from EAC, as a region, to control brucellosis.