Brucellosis in India: results of a collaborative workshop to define One Health priorities.

Brucellosis is an important zoonosis worldwide. In livestock, it frequently causes chronic disease with reproductive failures that contribute to production losses, and in humans, it causes an often-chronic febrile illness that is frequently underdiagnosed in many low- and middle-income countries, including India. India has one of the largest ruminant populations in the world, and brucellosis is endemic in the country in both humans and animals. In November 2017, the International Livestock Research Institute invited experts from government, national research institutes, universities, and different international organizations to a one-day meeting to set priorities towards a "One Health" control strategy for brucellosis in India. Using a risk prioritization exercise followed by discussions, the meeting agreed on the following priorities: collaboration (transboundary and transdisciplinary); collection of more epidemiological evidence in humans, cattle, and in small ruminants (which have been neglected in past research); Economic impact studies, including cost effectiveness of control programmes; livestock vaccination, including national facilities for securing vaccines for the cattle population; management of infected animals (with the ban on bovine slaughter, alternatives such as sanctuaries must be explored); laboratory capacities and diagnostics (quality must be assured and better rapid tests developed); and increased awareness, making farmers, health workers, and the general public more aware of risks of brucellosis and zoonoses in general. Overall, the meeting participants agreed that brucellosis control will be challenging in India, but with collaboration to address the priority areas listed here, it could be possible.

Brucella spp. in Wildlife of the Lombardy Region, Northern Italy.

Surveillance data collected in the period 2017-20 for Brucella spp. in wildlife of the Lombardy Region in northern Italy were used to describe the exposure of the wildlife species to Brucella spp. in wild boar (Sus scrofa), European brown hare (Lepus europaeus), fallow deer (Dama dama), red deer (Cervus elaphus), and roe deer (Capreolus capreolus). Among the tested species, wild boar (n=6,440) showed the highest percentage of seropositive samples (5.9%). Notably, wild boars of perifluvial area of the Po River showed higher percentages of positivity than those of the pre-Alpine district. In addition, during the hunting season in 2018, 95 organs (uterus or testes, spleen, and submandibular lymph nodes) from wild boar of the perifluvial area of the Po River were collected for bacteriological examination. Brucella suis was isolated in culture from 18.9% of tested lymph nodes. These serological and microbiological results highlight the presence of B. suis in wild boar and suggest the importance of wild boar as a reservoir for B. suis. Comparison of the spatial distribution of Brucella-seropositive wild boars with the location of backyard swine farms revealed a higher chance of contact between the two populations only in the areas where the lower percentage of seropositive samples was observed. Conversely, the high percentage of seropositive samples observed in the Po River area coupled with positive microbiological cultures suggest a greater risk of infection for the humans directly or indirectly involved in wild boar hunting activity. These results may serve as a basis to establish sound wildlife management and to adopt education campaigns aimed at reducing the risk of human infection in people involved in wild boar hunting related activities.

The Role of Feral Swine in Human Aortic Infection With Brucella Species.

Brucellosis is one of the most common zoonotic infections in the world. Human infections are the result of direct exposure to infected animals or ingestion of unprocessed dairy products. While Brucella sp. infection has largely been eliminated from commercial cattle and swine with aggressive vaccination, there is a significant prevalence of Brucella sp. infection in the expanding population of feral swine in the US. We report the surgical treatment of a ruptured mycotic aneurysm of the abdominal aorta due to Brucella suis in a woman living in a rural community with a large population of feral swine. Vascular surgeons should be aware that brucellosis can result in arterial infection and should be considered in the differential diagnosis in patients with a history of exposure to feral swine or the ingestion of unprocessed dairy products.

Assessing and Prioritizing Zoonotic Diseases in Punjab, India: A One Health Approach.

Zoonotic diseases have a significant impact on both human and animal health globally. The present study was planned to prioritize the zoonoses in Punjab state of India. To develop a zoonotic disease prioritization scoring system, a comprehensive approach has been taken, including literature review, key person interviews with animal health experts (n = 12) and medical professionals (n = 7), and nine focus group discussions (FGDs) with veterinary academicians, medical professionals, and field veterinary doctors. The scoring system comprises of seven major criteria, each assigned a weightage score (ws): prevalence/incidence of the disease (ws = 0.20), severity of illnesses in humans (ws = 0.18), epidemic potential (ws = 0.16), socio-economic burden (ws = 0.16), availability of effective control and prevention measures (ws = 0.15), inter-sectoral collaborations (ws = 0.1), and bioterrorism potential (ws = 0.05). The finalized scoring system, accompanied by a list of 15 selected zoonotic diseases, was implemented among a group of 23 professionals engaged in zoonoses research (n = 7), animal health (n = 10), and medical health (n = 6) to determine their prioritization. The zoonotic diseases prioritized for the Punjab (India) included, Brucellosis (0.70) > Rabies (0.69) > Anthrax (0.64) > Leptospirosis (0.62) = Toxoplasmosis (0.62) = Highly Pathogenic Avian Influenza (HPAI) (0.62) > Bovine tuberculosis (0.61) > Q fever (0.60) > Cysticercosis (0.59) > Listeriosis (0.58) > Crimean-Congo haemorrhagic fever (CCHF) (0.57) > Japanese encephalitis (0.56) = Echinococcosis (0.56) > Dermatophytosis (0.53) > and Scrub typhus (0.48), respectively. Higher priority is suggested for endemic zoonoses (e.g., brucellosis and rabies) as compared to those with epidemic potential (e.g., CCHF, HPAI etc.) in Punjab. Results of the current study will help in the development of targeted control and prevention strategies for zoonotic diseases in Punjab and other geographical regions facing similar challenges.

Update on Brucella canis: Understanding the Past and Preparing for the Future.

The genus Brucella is known by veterinarians as a primary cause of reproductive diseases. It is widely known to cause financial devastation in livestock species, and is lesser known as a problem for dog breeders and fanciers with similar reproductive diseases seen in dogs. Now there are concerns about the dispersal of Brucella canis into countries that have enjoyed a fairly low incidence, through the importation of dogs from endemic countries. B canis, much like Brucella abortus, suis or mellitensis, is zoonotic and handling or working with infected dogs can lead to human disease. Only within the last few decades has the risk of brucellosis in dogs, and the people who own and work with them, been more fully acknowledged. This review will focus on new information that has been obtained since our last B canis article in 2018. Readers are encouraged to look to that article for information not presented within this update. Current B canis epidemiology along with a complete review of diagnostic testing options will be covered. Regulations for the international movement of dogs will be discussed in addition to concerns for increased zoonosis potential. Future goals would include better management of this disease including proposed screening of all imported dogs. Canine brucellosis prevention, owner and shelter/rescue education along with proposed therapies for the future will also be explored.

A systematic review of economic assessments for brucellosis control interventions in livestock populations.

Brucellosis in livestock is a disease of paramount importance to animal and human health authorities due to its socio-economic and public health consequences. Benefit cost analyses can help policymakers decide whether allocation of resources is economically beneficial to cover the costs of brucellosis control interventions in populations. One broad question of interest is: what are the consequences of acting, or failing to act, on policy options of selected intervention scenarios (e.g., vaccination, test-and-slaughter, vaccination combined with test-and-slaughter, versus a status-quo scenario). The objective of the systematic review reported here was to conduct a critical appraisal of published research reports of economic assessments of brucellosis control interventions in livestock populations. The systematic review followed standard guidelines using a Population, Intervention, Comparison, Outcome, and Context framework and Preferred Reporting Items for Systematic Review and Meta-Analysis. The review targeted research reports focused on brucellosis control interventions in livestock populations at the national or regional level. Economic outcomes of interest were benefit-cost ratio (BCR), net present value, internal rate of return, or payback period. Eleven studies conducted in Brazil, China, India, Iraq, Mexico, Mongolia, Spain, Turkey, or the USA met the inclusion criteria and were included. The baseline prevalence of brucellosis in selected study populations ranged from 1.4% in cattle in Turkey to 20% in goats in Mexico. In six studies, selected intervention scenarios of vaccination alone produced BCRs that ranged from 3.2 in yaks in China or in cattle, sheep and goats in Mongolia, to 21.3 in cattle and/or buffalo in India. In three studies, interventions of test-and-slaughter produced BCRs that ranged from - 1.2 in goats in Mexico to 0.6 in cattle in Spain. In four studies, vaccination in combination with test-and-slaughter produced BCRs that ranged from 0.2 in yaks in China to 3.7 in cattle and buffalo in India. In seven studies, using sensitivity analysis, different input parameters (prevalence of brucellosis, meat price, cashmere price, vaccination coverage, test-and-slaughter coverage, milk price, vaccination protection, abortion cost, abortion rate, or price of lamb) had an impact on economic outcomes. Vaccination alone was cost-effective, but test-and-slaughter was not, for brucellosis control in selected livestock populations in focus countries. Vaccination in combination with test-and-slaughter produced profitable or nonprofitable economic outcomes. While most studies reported the cost and benefits of implementing brucellosis control interventions, only one study explained socio-economic consequences of economic outcomes, when acting, or failing to act, on selected interventions in livestock populations.

One Health evaluation of brucellosis control in Kazakhstan.

Brucellosis is one of the main livestock disease risks in Kazakhstan. It's been endemic there since 1930, accounting for over 1300 human cases per annum. The economic loss was 45 million USD in 2015 alone. Since 1952, Kazakhstan has implemented various control strategies with little success. One Health approaches have been suggested to tackle brucellosis, however, there is a lack of evidence for best practices to operationalise One Health in the literature, and methods for implementation are not established. The intention of this study was to introduce the One Health approach during the evaluation phase of the policy cycle. A two-day workshop was organized by the authors to familiarize participants with the evaluation methodology. Twenty-one specialists representing veterinary and public health sector, together with researchers, took part in this study. For two weeks following the workshop, first author conducted individual interviews with workshop participants to obtain individual scorings to assess knowledge integration capacity (One Health-ness). The evaluation results show that there is a lack of knowledge about the perceived damage caused by brucellosis to animal owners and other stakeholders. There is insufficient data available about farmers' practices, interests and motivations, and also data is missing for important transmission processes such as the amount of unsafe dairy consumption. The absence of such data illustrates the extent of the uncertainty to which decision-makers are exposed despite well-elaborated transmission models and supports the importance of co-producing solutions with participatory methods. The results suggest the need for broader involvement of stakeholders. Outputs of this study could help navigate the initial stages of One Health operationalization.

Are Italian-Polish veterinarians and breeders prepared to control an outbreak of Brucella canis infection in dogs?

Brucella canis infection is one of the most important causes of infertility in dogs and is a zoonosis for which no effective treatment or vaccines exist. It is not a mandatory notifiable disease. Following an increase of cases in Europe and worldwide, an investigation was performed to evaluate how much Italian and Polish veterinarians and breeders know about canine brucellosis and understand their perceptions of this infection. For this reason, two questionnaires were prepared, in Italian and Polish. Eighteen Italian and Polish veterinarians, specialists in canine reproduction, responded to the first survey and 44.4% of them affirmed having diagnosed canine brucellosis at least once in their clinical practice, and different perceptions emerged regarding the infection in the two countries. The second survey was completed by 145 Italian and Polish breeders; the disease was completely unknown to 22.8% of them, whereas 2.1% had diagnosed infection by B. canis in their kennels. In conclusion, knowledge of B. canis infection differs between these countries, with extremes ranging from diagnosed cases to complete underestimation of the presence of the problem. However, based on international data and reporting of a recent large outbreak in Italy, awareness of this contagious infectious disease and its management must be increased.

Human Brucellosis in Greece, 2005-2020: A Persistent Public Health Problem.

Brucellosis remains an important zoonosis in various parts of the world. In Greece, brucellosis is endemic in sheep and goats. Since 1998, animal control measures include vaccination of sheep and goats older than 3 months of age in the mainland (vaccination zone) and slaughtering of infected livestock on the islands (eradication zone). We retrieved data from the mandatory notification system for 2005-2020 to describe the epidemiology in humans and assess current public health measures. Overall, 1786 notifications and an additional 111 cases related to an outbreak in 2008 (eradication zone) were recorded. The mean annual notification rate was 0.9/100,000 population (standard deviation [SD]: 0.35). A substantial mean annual decline in notification rate was reported in 2019 and 2020. A statistically significant decreasing trend of brucellosis notification rate was observed over the whole 16-year period (p < 0.001). The mean annual notification rate was significantly higher in the vaccination zone (1.2/100,000) (SD: 036) compared with the eradication zone (0.2/100,000) (SD: 0.14) (p < 0.001). Seventy percent of cases was male (n = 1175) and the highest mean notification rate was recorded in the 45-64 age group (1.3/100,000). The majority of cases (71%) reported animal contact and almost half of the cases (49%) were stockbreeders by occupation. Consumption of unpasteurized dairy products, mainly of their own production, was reported by 57% of cases; for 115 (6.5%) cases, animal exposure or consumption of unpasteurized dairy products were not recorded. Despite animal control measures, brucellosis remains endemic in Greece with cases in the vaccination zone, as well as the eradication zone. We recommend re-evaluation and strengthening of animal control programs and training of people working in stock breeding regarding disease transmission in co-operation with local farmers' associations.

Evaluation of the safety profile of the vaccine candidate Brucella melitensis 16MΔvjbR strain in goats.

Small ruminant brucellosis is caused by the Gram negative cocci-bacillus Brucella (B.) melitensis, the most virulent Brucella species for humans. In goats and sheep, middle to late-term gestation abortion, stillbirths and the delivery of weak infected offspring are the characteristic clinical signs of the disease. Vaccination with the currently available Rev. 1 vaccine is the best option to prevent and control the disease, although it is far from ideal. In this study, we investigate the safety of the B. melitensis 16MΔvjbR strain during a 15-month period beginning at vaccination of young goats, impregnation, delivery and lactation. Forty, 4 to 6 months old, healthy female crossbreed goats were randomly divided into four groups (n = 10) and immunized subcutaneously with a single vaccine dose containing 1x109 CFU of B. melitensis 16MΔvjbR delivered in alginate microcapsules or non-encapsulated. Controls received empty capsules or the commercially available Rev.1 vaccine. Seven months post-vaccination, when animals were sexually mature, all goats were naturally bred using brucellosis-free males, and allowed to carry pregnancies to term. Blood samples to assess the humoral immune response were collected throughout the study. At two months post-delivery, all dams and their offspring were euthanized and a necropsy was performed to collect samples for bacteriology and histology. Interestingly, none of the animals that received the vaccine candidate regardless of the formulation exhibited any clinical signs associated with vaccination nor shed the vaccine strain through saliva, vagina or the milk. Gross and histopathologic changes in all nannies and offspring were unremarkable with no evidence of tissue colonization or vertical transmission to fetuses. Altogether, these data demonstrate that vaccination with the mutant strain 16MΔvjbR is safe for use in the non-pregnant primary host.

Animal brucellosis control or eradication programs worldwide: A systematic review of experiences and lessons learned.

Brucellosis is one of the most common zoonoses worldwide, causing huge economic losses in the animal industry and posing a serious threat to human health. Although the World Health Organization (WHO) and World Organization for Animal Health (OIE) has recommended strategies or measures to control or eradicate brucellosis, only some developed countries have achieved freedom from animal brucellosis. In developing countries, brucellosis remains a serious problem, and the importance of its control has attracted little attention. The strategies and measures are difficult to implement effectively in countries with limited resources because the eradication of brucellosis is an expensive, time-consuming and labor-intensive project. Therefore, more effort is needed to explore the appropriate strategies and measures in developing countries. In this study, we collected the available publications regarding brucellosis control or eradication programs in different countries and areas, and summarized the main strategies and measures, supplementary measures, effects, and lessons learned during their implementation. Results showed that the freedom from animal brucellosis was only achieved in three countries among the 23 included countries and areas after the implementation of the programs, which had lasted several decades. Either alone or together, vaccination and test-and-slaughter programs can effectively reduce brucellosis prevalence. Supplementary measures involve a number of aspects, and their effective implementation is crucial to the success of disease control and cannot be ignored. While disease control or eradication requires extensive resources, some studies have shown that a well-designed and well-implemented disease control or eradication program is economically effective. Experience has revealed that even if significant results have been achieved, the project could not be terminated without careful consideration due to the potential for recurrence.

Brucellosis in Venezuela.

Brucellosis is a public health problem in Venezuela and affects large numbers of animals. The most important biovar in the country is Brucella abortus. In cattle and buffalo it causes high rates of abortions in females and infertility in males; it is transmissible to occupationally exposed humans. In 1968, an official program was set up for the control and eradication of the disease and it is still in place. Amongst the control provisions, this program provides for the vaccination of female calves with strain 19 and the slaughtering of positive reactors following the official diagnosis (rapid agglutination in plate test). According to the official reports, the positive reactors ranged from 0.8 to 1.2% in the past few years. These values do not corroborate reports showing an average positive rate of 10.5% and even higher values in some areas of the country. The government is working to approve a new resolution that will replace the rapid agglutination in plate test with the Card Test, the use of 2-Mercaptoetanol, fixation of complement and competitive ELISA as confirmatory tests. In addition, there will be an obligatory vaccination with B. abortus strain 19 or B. abortus RB51 of all female calves between 3- and 8-month-old and a recommended revaccination at 10-15-month-old and adult cows in high prevalence areas. These measures should allow help to reduce the prevalence of the disease in cattle herds and thus minimize the risk for human populations.

The Zoonoses Order, 1975.

The coming into effect on July 14 of the Zoonoses Order 1975, marks a new and important step in veterinary public health. The Order makes available powers to investigate and control Salmonella and Brucella infections in animals and Salmonella infections in birds which present a threat to human health. Any Salmonella and Brucella infection becomes reportable in certaain species when organisms have been isolated by laboratory test. Veterinary surgeons and livestock owners may be involved in this obligatory procedure. The statutory powers to investigate incidents and apply restrictions on the movement of animals, birds and their products are not limited to reportable species: they cover a much wider range of animals and birds. They will be held in reserve and used only when necessary because of a hazard to public health; the use of restrictions will be limited to cases involving a very serious threat to man. The information collected from reports and investigations will add considerably to the epidemiological knowledge of these infections and so allow improved methods of control to be developed. Some of these measures already in operation are described, together with others possible for the future.

Control and eradication of Brucella melitensis infection in sheep and goats.

Brucella melitensis is the main etiological agent of brucellosis in sheep and goats, and is also the main agent responsible for human brucellosis, a predominantly occupational disease related to professions in direct contact with livestock. As there is currently no viable method of preventing human brucellosis to safeguard people attention must be directed toward effectively controlling the disease in sheep and goats. This review focuses on the different strategies in different socioeconomic and epidemiologic situations that can be applied to either control or eradicate brucellosis in sheep and goats.

Brucellosis control in small ruminants in the Republic of Macedonia.

AIM: To present the main goals and activities of the strategy for control of brucellosis caused by B. melitensis in sheep and goats in the Republic of Macedonia. METHODS: Relevant documents and reports from the Veterinary Directorate were used to present the approaches for control of the disease in small ruminants in R. Macedonia. The new strategy for control and eradication of brucellosis started its implementation in 2008 with combination of measures for test and slaughter of the sero-positive sheep and goats, mass vaccination and vaccination of young replacements. RESULTS: In 2008, a total of 596,213 animals have been tested in 5,820 flocks out of which 16,853 (2.8%) had Brucella positive results in 636 (10.9%) flocks. In 2009, a total of 543,011 sheep and goats had been tested in 5,507 flocks out of which 9,606 (1.8%) animals showed positive results in 666 (12.1%) flocks. While the number of positive flocks does not indicate great improvement, the individual number of Brucella-positive animals has decreased dramatically. The number of human cases in 2008 and 2009 were 490 and 287 respectively. Direct savings only from compensation to farmers for slaughtered animals for 2008 and 2009 are estimated to be more than 100,000,000 denars (~1.6 million Euro). CONCLUSION: RESULTS from 2009 have been evaluated and foreseen amendments will allow that the country will be systematically divided in a more detailed epidemiological fashion, i.e. division of the country into epidemiological units based on the disease status and accepted risk and implementation of appropriate measures therein.