1. 1 ZOONOTIC DISEASES  Diseases & infections that are naturally transmitted between vertebrate animals and man

2. 2 MODE OF TRANSMISSION Direct or direct contact with affected animals or contaminated products. Intermediate hosts. Vectors (arthropods)

3. 3 Factors Affecting The Occurrence of Zoonoses Size and density of animal populations. Customs and standards of human society increasing human exposure. Prevalence of occupational exposure. Environmental factors. Inadequate attention to animal health.

4. 4 Impact of Zoonotic Diseases on Man Morbidity & overall deterioration of health and reduction of work ability. Contribution to human malnutrition. Reducing resistance to other diseases. Mortality.

5. 5 Socio-Economic Losses Loss of millions of human working hours. Cost of health care. Livestock and animal reduced reproduction. Reduced export and loss of foreign exchange.

6. 6 SURVEILLANCE Collection of epidemiological information of sufficient accuracy, completeness, distribution and determinants of infection and disease for ACTION.

7. 7 Problems & Constraints Administrative Problems Insufficient coordination among national institutions and authorities responsible for VPH. Inadequate/Inappropriate legislation for zoonoses control. Insufficient budgetary allocations. Inefficient information system and poor exchange of information at country and inter- country levels. Inadequate trained man power. Insufficient community involvement. Inadequate inter-country and international cooperation.

8. 8 Technical Problems Inadequate diagnostic facilities. Inadequate reference laboratories. Insufficient supply of high quality vaccines for veterinary and medical services (quality and potency of locally produced vaccines need improvement) Limited introduction of appropriate technologies for production and inspection of food, for prevention and control of zoonotic diseases.

9. 9 Educational Obstacles Inadequate inclusion of zoonotic disease subjects in the curricula of medical professionals. Insufficient availability of learning and training materials. Inadequate health education to achieve involvement of communities. Weak participation of institutions in design of health education programs and materials

10. 10 Brucellosis

11. 11 Brucella Bacterial Type In Palestine Br. melitensis Br. abortus Nearly all of the human brucellosis in Palestine will be caused by Br. melitensis Diagnostic test is : - Rose Bengal test - Agglutination - Elisa test

12. 12 Source of infection 1- Dairy products ( 80% ) 2- Animal contact ( Farmers, Veterinarians, Abattoir workers, Laboratory technicians) 10% 3- Unknown 10%

13. 13 Means of Animal to Human Transmission Skin & mucous penetration. Inhalation Ingestion of contaminated dairy products made with non heat treated milk

14. 14 Patho Genesis Brucellosis abortus. Brucellosis meletensis Opsonized by Normal Human Serum Phagocytosis Promotion By PMNs

15. 15 Host immunity Acute infection : IgM rises first. The only IG detectable in the first week (s) Begin dropping off 3 months after onset IgG begin to rise in the second week Remain elevated for at least 1 year In untreated patient Decrease to very low level or disappear to months after onset in treated patient During re infection IgG +++, IgM+++ Recently increases IgG+++, IgM+++

16. 16 PMNs Killing Brucellosis abortus Little ability of killing itracelular Brucellosis melitensis For the production of 5 guanoosine monophosphate & adinine Inhibit degranulation of peroxides- positive granules in PMNs

17. 17 Clinical manifestation Severity 1.Brucella melitensis 2.Brucella seuis 3.Brucella abortus, canis 1/3 with impresive systemic toxicity 2/3 symptom over 1 or more weeks 90%sweats,chills,fever, weakness, Common, malaise, headache, anorexia. 25-50%weight loss, myalgias, artharlgias,back pain. 12-21%lymphadenopathy(cervical inguinal) 20-30% splenomegaly.

18. 18 Complications Less treated early More treated late 1- Skeletal Arthritis, spondyhtis, osteomyelitis, sacrolitis,……… 2- Neurologic Meningoencephalitis, myelititis, paresis,depression, psychosis(2-5%) 3- Genitourinary Unilateral epidiolymo- orchitis(2-4%)-(2-10%)Acute interstizial nephritis or pyelonephritis 4- CardioVascular Endocarditis less than 2% The most common cause of death

19. 19 5- Gastrointestinal Hepatomegaly, caseating or non caseating granuloma ( Brucella abortus ) Hepatitis, abscess- GI discomfort 6- Spleen Spleen megaly, abscess formation 7- Pulmonary Inhelation or bacterimia ( 15-25 ) cough 8- Hematology Anemia,leucopenia, thrombocytopenia 9- Cutaneous ( 5% ) Transient & non specific skin lesions.

20. 20 Brucella melitensis 1- Resist the bactericidal effect of serum 2- Resist intracellular killing by PMNs Greater Virulence Brucellosis not killed by PMNs Migrate to regional lymph nodes Blood stream Localization in the R.E.S

21. 21 Uterine exudates 200 days Water 10-20 days Street dust/ soil 21 days 10weeks Vegetable 15 days Milk & milk product 20-60 days Feces ( bovine) 120 days Urine( animal & human) 2-49( 70days) Frozen tissue for many years Aborted fetus 75 days

22. 22 Temperature 180 m 55 C 90 m 60C 15 m 65C

23. 23 Treatment: 1- Streptomycin 2- Tetracycline 3- Doxycycline 4- Rifampicin 5- Trimethoprim- Sulfa methoxazole 6- Gentamycin 7- Corticosteroids 8- Cephalosporine 3 generation