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

2. 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)

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

4. 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

5. Magnitude of the problem
Globally:
More than 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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 cases annually)
Dr. Salwa Tayel (Brucellosis)
21/1/2008

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

14. 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

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

16. 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

17. 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

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

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

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

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

22. 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

23. 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

24. 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

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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Dr. Salwa Tayel (Brucellosis)
Bibliotheca Alexandrina
Thank you
Dr. Salwa Tayel (Brucellosis)
21/1/2008

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

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

34. 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

35. 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

36. 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