Dr. Salwa Tayel (Brucellosis) 21/1/2008 Dr. Salwa Tayel (Brucellosis)

Family and Community Medicine Department Brucellosis By Dr. Salwa Tayel Associate Professor Family and Community Medicine Department King Saud University 21/1/2008 Dr. Salwa Tayel (Brucellosis)

Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Introduction Brucellosis is primarily a disease affecting animals. It can be transmitted to humans. Brucellosis is a major health and economic problem in many parts of the world . It is an old disease, Sir David Bruce, isolated the causative agent from a soldier in Malta in 1886 It remains the commonest zoonotic disease worldwide. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Magnitude of the problem Globally: More than 500 000 new human cases of brucellosis annually Associated with substantial residual disability An important cause of travel-associated morbidity. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Bioterrorism CDC has declared Brucella as one of three major bioterrorist agents (anthrax, tularemia, brucella) the epidemic potential the absence of a human vaccine the drawbacks of current vaccine strains in animals the efficiency of aerosol infection the expense required for the treatment of human brucellosis patients the financial impact of brucellosis in society. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Other animal species affected Etiologic Agent: Brucella species Human disease Other animal species affected Natural host Species Less severe Wild animals, water buffalo, camels Cattle Brucella abortus Severe Wild ruminant cattle Sheep and Goat & camel Brucella melitensis ( except biovar 2) Various wild species Swine Brucella suis Benign None Dog Brucella canis Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Resistance of brucella Heating at 60ºC For 10 minutes Phenol 1% For 15 minutes Direct sunlight In a few hours Milk For several days (till the milk turns sour) Fresh cheese For 3 months Tap-water For 57 days Human urine For 1 week Dust For 6 weeks Damp soil For 10 weeks Animal feces For 100 days Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) The new global map of human brucellosis 2006 Dr. Salwa Tayel (Brucellosis) 21/1/2008

The new global map of human brucellosis The global epidemiology of human brucellosis has drastically changed over the past decade. because of various sanitary, Socioeconomic, political reasons the evolution of international travel. Dr. Salwa Tayel (Brucellosis) 21/1/2008

The new global map of human brucellosis Countries traditionally considered to be endemic -e.g. France, Israel, and most of Latin America, Now, they achieved control of the disease. New foci of human brucellosis have emerged, particularly in central Asia Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Middle East & Asia The situation in central and western Asia is dramatic: Syria has the highest annual incidence worldwide reaching an alarming 1603 cases per million per year Mongolia, is ranked second (605·9 cases per million) ***In USA the annual incidence of 0·48 cases per million for last ten years (only 100-200 cases annually) Dr. Salwa Tayel (Brucellosis) 21/1/2008

Incidence (annual cases per million population) Syria 1,603·4 Iraq 278·4 Turkey 262·2 Iran 238·6 Saudi Arabia 214·4 Dr. Salwa Tayel (Brucellosis) 21/1/2008

Situation in Saudi Arabia: Distribution: Central & Eastern regions & Asir Regional endemicity varies in Saudi Arabia Due to climatic factors: rainy season---- increased grass growth. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) 21/1/2008

Situation in Saudi Arabia: Between 1956 and 1982 only Sporadic human cases of brucellosis. During early 1980s: brucellosis emerged as a major public health problem. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Reasons of the surge in incidence of brucellosis: Intensive sheep/cattle breeding projects minimal veterinary resources Uncontrolled importation of live animals both for Hajj periods and for commercial reasons. They were poorly screened for infection In addition to, prevailing local custom of drinking raw and warm milk of sheep, goats, and camels, among the population of nomadic background. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Voting Miss Goat Universe ملكة جمال الماعز Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Transmission Dr. Salwa Tayel (Brucellosis) 21/1/2008

The most important route of animal to human transmission of Brucella Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Ingestion Consumption of potentially infected unpasteurized milk, milk products, or meat. Unpasteurized cheese, called "village cheese," from endemic areas is a particular risk for tourists. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Direct contact with infected animals, aborted fetus, the placenta and the discharge from vagina. Accidental self inoculation of vaccines. High Risk Groups slaughter-house workers, meat inspectors, animal handlers and veterinarians. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Inhalation of aerosols containing the bacteria aerosol contamination of the conjunctiva In the lab, transmission is via aerosolization High Risk Groups Laboratory workers. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Other Modes of transmission!! Dr. Salwa Tayel (Brucellosis) 21/1/2008

Can brucellosis be spread from person to person? Human-to-human transmission is rare. Bone marrow transplantation from infected donors Blood transfusion Sexual intercourse Neonatal infection; trans-placentally or during delivery Or probably through breast milk. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Summary In the Middle East and Africa ingestion of contaminated dairy products is an important route of infection. In USA, Human brucellosis is primarily an occupational hazard (Lab, Vet) Whether human beings can become infected via person-to-person spread is rare or uncertain. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Prevention 1. Eradication of brucellosis in animals is the key to prevention in humans. surveillance, serologic testing, quarantine and massive immunization of animals in areas with high infection rates legislation to control marketing and movement of animals. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Prevention 2. Brucellosis acquired from milk is preventable Legislation to pasteurization of milk and dairy products. Public health education to avoid drinking untreated milk and dairy products. 3. Health education for those occupationally at risk (Use of Safety measures). 4. For other modes of transmission……. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Vaccination?! A human Brucella vaccine does not exist. For animals: all are live-attenuated. Currently, B. abortus RB51 is used to immunize cattle B. melitensis REV.1 is used to immunize goats and sheep. Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) Bibliotheca Alexandrina Thank you salwatayel@hotmail.com Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) CDC Case Definition Brucellosis Clinical description An illness characterized by acute or insidious onset of fever, night sweats, undue fatigue, anorexia, weight loss, headache, and arthralgia Dr. Salwa Tayel (Brucellosis) 21/1/2008

Dr. Salwa Tayel (Brucellosis) CDC Case Definition Laboratory criteria for diagnosis Isolation of Brucella sp. from a clinical specimen, or Fourfold or greater rise in Brucella agglutination titer between acute- and convalescent-phase serum specimens obtained greater than or equal to 2 weeks apart and studied at the same laboratory, or Demonstration by immunofluorescence of Brucella sp. in a clinical specimen Dr. Salwa Tayel (Brucellosis) 21/1/2008

CDC Case classification Probable: a clinically compatible case that is epidemiologically linked to a confirmed case or that has supportive serology (Brucella agglutination titer of greater than or equal to 160 in one or more serum specimens obtained after onset of symptoms) Confirmed: a clinically compatible case that is laboratory confirmed Dr. Salwa Tayel (Brucellosis) 21/1/2008