A Review on Crimean-Congo Hemorrhagic Fever Infections in Tunisia

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic tick-borne disease, caused by an arbovirus of the genus Orthonairovirus and the family Nairoviridae. Crimean-Congo hemorrhagic fever virus (CCHFV) is widespread in several regions of the world. While the virus is not pathogenic to all susceptible livestock and wild mammals, it can lead to severe hemorrhagic fever in humans. In this review, we compiled published data on CCHFV infections in humans, animals, and ticks in Tunisia. Based on that, we discussed the epidemiology and the distribution patterns of CCHFV infections highlighting the risk factors for this virus in the country. CCHF infection prevalence in humans was estimated to 2.76% (5/181) and 5% (2/38) in Tunisian febrile patients and Tunisian slaughterhouse workers, respectively. Concurrently, seroprevalence in domestic ungulates (sheep, goats, cattle, and dromedaries) ranged from zero to 89.7%, and only one Hyalomma impeltatum tick specimen collected from dromedaries in southern Tunisian was positive for CCHFV by reverse transcriptase-polymerase chain reaction (0.6%; 1/165). As Tunisian studies on CCHFV are geographically scattered and limited due to very small sample sizes, further studies are needed to improve the knowledge on the epidemiology of CCHF in Tunisia.

Presence of antibodies to Crimean Congo haemorrhagic fever virus in sheep in Tunisia, North Africa

Crimean–Congo haemorrhagic fever (CCHF) is an emerging tick‐borne disease causing severe and fatal haemorrhagic syndrome in humans. Hyalomma spp. ticks are the primary vectors and sheep are important CCHF virus (CCHFV)‐amplifying hosts. In this study, blood samples and ticks collected in October 2019 from 270 sheep from 15 farms across Tunisia constituted the main research material. Moreover, the sera of the same animals taken at different periods between 2018 and 2019 were also used to obtain comparative results. To investigate the presence of anti‐CCHFV antibodies in sheep, all sera were tested using ELISA. Reactive sera were further characterised by a virus neutralisation test (VNT). Overall, one out of the 270 tested sheep was both ELISA‐ and strongly VNT‐positive to CCHFV. Another two sheep were borderline ELISA‐positive but did not exhibit neutralising antibodies. Ninety‐one ticks were collected from all sampled sheep, of which 34 (37.4%) belonged to Hyalomma spp. This is the first report of anti‐CCHFV antibodies in sheep from Tunisia. Both the results of this study and the recent CCHFV detection in ticks collected from camels in southern Tunisia indicate that further studies are needed to determine the competent tick vector in the country and to characterise the epidemiological cycle of CCHFV.

Coronaviruses in farm animals: Epidemiology and public health implications

Coronaviruses (CoVs) are documented in a wide range of animal species, including terrestrial and aquatic, domestic and wild. The geographic distribution of animal CoVs is worldwide and prevalences were reported in several countries across the five continents. The viruses are known to cause mainly gastrointestinal and respiratory diseases with different severity levels. In certain cases, CoV infections are responsible of huge economic losses associated or not to highly public health impact. Despite being enveloped, CoVs are relatively resistant pathogens in the environment. Coronaviruses are characterized by a high mutation and recombination rate, which makes host jumping and cross-species transmission easy. In fact, increasing contact between different animal species fosters cross-species transmission, while agriculture intensification, animal trade and herd management are key drivers at the human-animal interface. If contacts with wild animals are still limited, humans have much more contact with farm animals, during breeding, transport, slaughter and food process, making CoVs a persistent threat to both humans and animals. A global network should be established for the surveillance and monitoring of animal CoVs.

Presence of antibodies against tick-borne encephalitis virus in sheep in Tunisia, North Africa

BACKGROUND

Tick-borne encephalitis virus (TBEv) is a flavivirus that circulates in a complex cycle involving small mammals as amplifying hosts and ticks as vectors and reservoirs. The current study aimed to investigate the presence of TBEv in Tunisian sheep. A sample of 263 adult sheep were selected from 6 localities where Ixodes ricinus is well established. Sera were screened using ELISA for TBEv IgG detection, then the doubtful and positive sera were tested by the seroneutralisation test (SNT) and screened for West Nile Virus (WNv) IgG for cross-reaction assessment.

RESULTS

The ELISA for TBEv IgG detected one positive serum and 17 borderlines. The SNT showed one positive serum among the 18 tested, giving an overall antibody prevalence of 0.38% (95% CI = 0.07-2.12%). All but one serum tested negative to WNv ELISA. None of the sheep farmers reported neurological signs among sheep or humans in their households.

CONCLUSIONS

The results may indicate the circulation of TBEv for the first time in Tunisia and in North Africa. Further studies based on either virus isolation or RNA detection, are needed to confirm the presence of TBEv in North Africa.

Epidemiological investigation of Crimean-Congo haemorrhagic fever virus infection among the one-humped camels (Camelus dromedarius) in southern Tunisia

Crimean-Congo haemorrhagic fever is a viral tick-borne zoonotic disease caused by a Nairovirus, Crimean-Congo haemorrhagic fever virus (CCHFV). The present survey aimed to determine the exposure of one-humped camels (Camelus dromedarius) from southern Tunisia to CCHFV. A total of 273 sera from extensively reared camels were collected from Tataouine district, Tunisia, and tested by CCHFV-specific enzyme linked immunosorbent assays. By combining the results of three serological tests, the overall seroprevalence of CCHFV was estimated as 89.7% (245/273). No viral RNA was detected from camel sera using quantitative real-time PCR (RT-qPCR). A total of 165 ticks were collected from camels and tested with RT-qPCR, and only one Hyalomma impeltatum tick was positive for virus RNA.

Current status of tropical theileriosis in Northern Africa: A review of recent epidemiological investigations and implications for control

Tropical theileriosis caused by the apicomplexan hemoparasite Theileria annulata is a tick-borne disease that constraints livestock production in parts of Europe, Asia and Africa. Four Hyalomma tick species transmit T. annulata in at least eight Africa countries (Mauritania, Morocco, Algeria, Tunisia, Egypt, Sudan, South Sudan and Ethiopia). The two dominant T. annulata vector ticks present in Africa, H. scupense and H. anatolicum, underlie two different patterns of transmission, which in turn greatly influence the epidemiology of tropical theileriosis. H. dromedarii and H. lusitanicum are also capable of transmitting T. annulata in North Africa, but their roles are associated with specific production systems and agro-ecological contexts. The emergence of resistance to the most widely used theilericidal compound, buparvaquone, continues to limit the effectiveness of chemotherapy. In addition, acaricide use is increasingly becoming unsustainable. Deployable T. annulata attenuated live vaccines established from local strains in Tunisia, Sudan and Egypt are available, and recent work has indicated that these vaccines can be protective under conditions of natural transmission. However, vaccination programmes may vary over space and time due to differences in the prevalence of disease amongst cattle populations, as well seasonal variation in vector activity. We review recent descriptive and analytical surveys on the epidemiology of T. annulata infection with reference to (a) demographic aspects such as breeds and ages of cattle herds previously exposed to distinct T. annulata infection pressures and (b) seasonal dynamics of tick activity and disease transmission. We then discuss how the wider endemic patterns that we delineate can underpin the development and execution of future vaccination programmes. We also outline options for integrated control measures targeting tick vectors and husbandry practices.

Knowledge and perception on ticks and tick-borne diseases among veterinary medicine students from the North African countries of Algeria, Egypt, and Tunisia

Ticks are important vectors of both animal and human pathogens. The epidemiology of tick-borne diseases (TBDs) has dramatically changed in several regions in the world. As parasitology is a continuously growing field, assessing the knowledge of veterinary medicine students provides useful indicators and information on the level of intervention required to adapt parasitological courses to meet the demands in a changing world.

This study aimed to assess, in three North African veterinary education establishments, the basic parasitology knowledge of veterinary medicine students. Such a study is essential to build up core competencies regarding ticks and TBDs, and to suggest suitable adjustment measures to parasitology courses.

The present study was based on a self-administered and anonymous questionnaire on ticks and TBDs basic knowledge and perception. The survey was completed by 558 veterinary medicine students in Algeria, Egypt, and Tunisia in 2018. The students were divided into two groups: the “before” group – students who had not yet completed the parasitology course, and the “after” group – students who had already completed it.

In all studied countries, the “after” students' group gave significantly more correct answers (83.16%) than the “before” students' group (16.84%) (p < 0.001). Similarly, the percentage of “no answer” was higher in the “before” students' group (51.02%) compared to the “after” students' group (48.98%) (p < 0.001). The most frequent false answers provided by the “after” students' group regarded the number of tick species present in their own countries (5.14% of correct answers), and the most common tick species in their countries (18.11% of correct answers).

Almost 58.38% (216/370) of the “after” students' group knew that ticks transmit zoonotic pathogens to humans; among them, only 63 (29.17%) gave the correct names of the zoonotic diseases in their country.

Among the three countries, more than 80% of the “after” students' group thought that climate has an influences on ticks. According to this group, the most frequent factor that has influences on ticks' abundance is heat (53.02%).

As North African countries share several similitudes, we suggest creating a network of parasitological teachers where common teaching sources and resources could be developed for both teachers and students in the region. This network would allow the exchange of teaching approaches and materials to introduce harmonization into veterinary parasitological courses across North African countries. This is particularly important when considering the increasing incidence of ticks and TBDs in the region.

Seroprevalence of anti-Mycobacterium avium subsp. paratuberculosis antibodies in female sheep in Tunisia

Paratuberculosis (Ptb) is a widespread chronic infection caused by Mycobacterium avium subsp. paratuberculosis (Map) that affects both domestic and wild ruminants. Most of the studies focused on cattle while, the prevalence of Ptb in sheep in different regions of the world is not well investigated. This study aimed to address this gap of knowledge by screening adult female sheep for paratuberculosis antibodies in different geographical regions of Tunisia. A total number of 338 female sheep from 15 small to middle-sized, extensively managed sheep farms in six regions across Tunisia were sampled. Animals were clinically examined before blood sampling. Sera were tested for the presence of anti-Mycobacterium avium subsp. paratuberculosis antibodies using a commercial ELISA kit. Six farms out of 15 comprised at least one seropositive animal and 11 female sheep out of 338 tested animals (3.25%; 95% CI = [1.83-5.73]) were seropositive to M. avium subsp. paratuberculosis. The seroprevalence was significantly lower in 5-year-old females (p = .04) and animals that do not graze (p = .02). Due to its huge economic and social impacts, paratuberculosis represents a health problem in Tunisia and several other countries Further investigations are needed to rank sheep Ptb in Tunisia among other diseases and to assess the main risk factors using a larger nation-wide survey.

Knowledge and attitudes of Tunisian dog owners regarding leishmaniasis

BACKGROUND

Visceral leishmaniasis is a zoonotic disease of major public health concern in several countries in the world. The local population awareness would improve prevention, early detection and treatment of both human and animal leishmaniasis.

METHODS

The aim of this survey was to assess the knowledge about visceral leishmaniasis in a sample of dog owners visiting the National School of Veterinary Medicine of Sidi Thabet, Tunisia, through a structured questionnaire.

FINDINGS

Two hundred dog owners were interviewed, 87% were men and 47% had higher education level. Ninety four per cent were from neighbouring districts to Ariana, where the National School of Sidi Thabet is located. Out of 200 respondents, 79 confirmed knowing leishmaniasis. The correct answers concerning canine visceral leishmaniasis (CVL) (77%) were significantly higher than those concerning human visceral leishmaniasis (HVL) (23%). Correct answers concerning CVL were given in part by previously diseased dogs' owners. The respondent could not explain what is exactly leishmaniasis, but the majority of questioned persons know that human and dogs are the most important hosts. Forty-four out 79 (56%) of the persons think that mosquitoes or insects are the vectors of leishmaniasis and 63% (53/79) knows that it is a zoonotic disease but 72% (38/53) were not able to define how.

CONCLUSION

Despite the frequent visits to veterinarians for vaccination or other medical issues and their long experience in dog breeding, the sample of dog owners had not enough knowledge and several misconceptions regarding leishmaniasis. Large education programmes should be implemented in Tunisia to improve the knowledge of the Tunisian population, especially dog owners, concerning leishmaniasis.

First case-control study of zoonotic brucellosis in Gafsa district, Southwest Tunisia

A case-control study was conducted, aimed to describe the clinical human brucellosis (CHB) pattern during 2015 in the Gafsa region (Southwest Tunisia) and to investigate the main risk factors involved in the disease occurrence. One hundred and four CHB cases were notified in 2015 in Gafsa district. All CHB cases that own ruminants were contacted, but only 32 accepted to participate in a matched case-control study. Thirty-two and thirty-one CHB cases and controls, respectively, were included in the study. The subjects were interviewed using a structured questionnaire. A total of 662 domestic ruminants (cattle, sheep and goats) belonging to cases and controls, were screened using the Rose Bengal Test, as recommended by the World Organisation of Animal Health. During 2015, the incidence of CHB was estimated to 30.8 per 100,000 inhabitants affecting mainly males aged between 30 and 39 years. The overall animal seropositivity to Brucella, was 21 and 1.9% in case and control farms, respectively (p < 0.0001). Only five risk factors were found to be significant: overall animal seropositivity (OR = 65.2; 95%CI: 13.3–318.7); handling aborted females (OR = 43.1; 95%CI: 8.3–222.7); presence of male ruminants in the herds (OR = 18.5; 95%CI: 5.18–66); owning seropositive goats (OR = 18.3; 95%CI: 2.4–137.6), owning seropositive sheep (OR = 9.66; 95%CI: 2.9–31.5) and history of abortion during the previous year in the herd (OR = 4.6; 95%CI: 1.3–12.6). Vaccination of animals against brucellosis was associated with lower odds of human brucellosis (OR = 0.03; 95%CI: 0.004–0.2). Raw milk and derivatives consumption was not a risk factor of human brucellosis. Based on this study, ruminants' vaccination coverage should be increased by enhancing the number of vaccinated animals and systematically including male ruminants in Tunisia. Comprehensive education programmes targeting both farmers and general population should be implemented.

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The human brucellosis in Gafsa district (Southwest Tunisia) was estimated to 30.8 per 100,000 inhabitants.

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Handling aborted females increase significantly the risk of human brucellosis.

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Comprehensive education programmes targeting both farmers and general population should be implemented.

High frequency of seropositivity of Leptospira in cattle in North Tunisia

The authors report a survey carried out in a cattle farm between January and April 2009 in Mateur region (Northern Tunisia). Seroprevalence by Microscopic Agglutination Test (MAT) was estimated to 81.4 ± 6% and 35 ± 2% in cows and calves, respectively. Seropositivity to more than one serovar was noticed in 91% (81/89) of infected animals. The examination of the distribution pattern of Leptospira serovars involved in this outbreak indicates that serovar Pomona was the predominant one (75.3%), followed by Autumnalis (59.5%), Bim (58.4%) and Munchen (55%). High titres (between 400 and 6400) were found in 68.7% of the tested animals and were correlated with clinical onset of leptospirosis. Leptospirosis is an underestimated pathogen in Tunisia; further investigations are needed to study the epidemiology both in man and animals and to implement effective control measures.