Global Estimate of Human Brucellosis Incidence.

Brucellosis is a major public health concern worldwide, especially for persons living in resource-limited settings. Historically, an evidence-based estimate of the global annual incidence of human cases has been elusive. We used international public health data to fill this information gap through application of risk metrics to worldwide and regional at-risk populations. We performed estimations using 3 statistical models (weighted average interpolation, bootstrap resampling, and Bayesian inference) and considered missing information. An evidence-based conservative estimate of the annual global incidence is 2.1 million, significantly higher than was previously assumed. Our models indicate Africa and Asia sustain most of the global risk and cases, although areas within the Americas and Europe remain of concern. This study reveals that disease risk and incidence are higher than previously suggested and lie mainly within resource-limited settings. Clarification of both misdiagnosis and underdiagnosis is required because those factors will amplify case estimates.

The research on TBATS and ELM models for prediction of human brucellosis cases in mainland China: a time series study.

BACKGROUND: Human brucellosis is a serious public health concern in China. The objective of this study is to develop a suitable model for forecasting human brucellosis cases in mainland China. METHODS: Data on monthly human brucellosis cases from January 2012 to December 2021 in 31 provinces and municipalities in mainland China were obtained from the National Health Commission of the People's Republic of China website. The TBATS and ELM models were constructed. The MAE, MSE, MAPE, and RMSE were calculated to evaluate the prediction performance of the two models. RESULTS: The optimal TBATS model was TBATS (1, {0,0}, -, {< 12,4 >}) and the lowest AIC value was 1854.703. In the optimal TBATS model, {0,0} represents the ARIMA (0,0) model, {< 12,4 >} are the parameters of the seasonal periods and the corresponding number of Fourier terms, respectively, and the parameters of the Box-Cox transformation ω are 1. The optimal ELM model hidden layer number was 33 and the R-squared value was 0.89. The ELM model provided lower values of MAE, MSE, MAPE, and RMSE for both the fitting and forecasting performance. CONCLUSIONS: The results suggest that the forecasting performance of ELM model outperforms the TBATS model in predicting human brucellosis between January 2012 and December 2021 in mainland China. Forecasts of the ELM model can help provide early warnings and more effective prevention and control measures for human brucellosis in mainland China.

Research on the predictive effect of a combined model of ARIMA and neural networks on human brucellosis in Shanxi Province, China: a time series predictive analysis.

BACKGROUND: Brucellosis is a major public health problem that seriously affects developing countries and could cause significant economic losses to the livestock industry and great harm to human health. Reasonable prediction of the incidence is of great significance in controlling brucellosis and taking preventive measures. METHODS: Our human brucellosis incidence data were extracted from Shanxi Provincial Center for Disease Control and Prevention. We used seasonal-trend decomposition using Loess (STL) and monthplot to analyse the seasonal characteristics of human brucellosis in Shanxi Province from 2007 to 2017. The autoregressive integrated moving average (ARIMA) model, a combined model of ARIMA and the back propagation neural network (ARIMA-BPNN), and a combined model of ARIMA and the Elman recurrent neural network (ARIMA-ERNN) were established separately to make predictions and identify the best model. Additionally, the mean squared error (MAE), mean absolute error (MSE) and mean absolute percentage error (MAPE) were used to evaluate the performance of the model. RESULTS: We observed that the time series of human brucellosis in Shanxi Province increased from 2007 to 2014 but decreased from 2015 to 2017. It had obvious seasonal characteristics, with the peak lasting from March to July every year. The best fitting and prediction effect was the ARIMA-ERNN model. Compared with those of the ARIMA model, the MAE, MSE and MAPE of the ARIMA-ERNN model decreased by 18.65, 31.48 and 64.35%, respectively, in fitting performance; in terms of prediction performance, the MAE, MSE and MAPE decreased by 60.19, 75.30 and 64.35%, respectively. Second, compared with those of ARIMA-BPNN, the MAE, MSE and MAPE of ARIMA-ERNN decreased by 9.60, 15.73 and 11.58%, respectively, in fitting performance; in terms of prediction performance, the MAE, MSE and MAPE decreased by 31.63, 45.79 and 29.59%, respectively. CONCLUSIONS: The time series of human brucellosis in Shanxi Province from 2007 to 2017 showed obvious seasonal characteristics. The fitting and prediction performances of the ARIMA-ERNN model were better than those of the ARIMA-BPNN and ARIMA models. This will provide some theoretical support for the prediction of infectious diseases and will be beneficial to public health decision making.

The incidence and clinical manifestations of human brucellosis in a referral hospital in Southern Saudi Arabia between 2015 and 2019.

We determined the incidence and clinical manifestations of human brucellosis from patients who attended a referral hospital in South of Saudi Arabia. A record-based retrospective study was conducted from January 2015 to December 2019 at King Abdulla Hospital, Bisha, Saudi Arabia. Information on patients' demographic characteristics, detailed records of signs and symptoms, and the laboratory findings were reviewed. Of 6,586 patients included, 15.8% (n = 1,041) were infected with brucellosis. The age of infected individuals ranged from five to 95 years, with an average of 35.1 ± 21.2 years. Most infected patients were male (72.3%). Young adults (26-44 years) were the most common age group with the disease (34.1%). The annual rate of infection significantly decreased (P < 0.0001) from 33.2% in 2015 to 12.5% in 2019. An escalating number of brucellosis cases was seen in the spring and peaked during the summer. Fever (35.3%), joint pain (25.5%), generalized body ache (10.7%), and neurological symptoms (10.0%) were the most frequent clinical manifestation associated with brucellosis. Joint pain was commonly found among children (44.4%). Neurological findings were more frequent among adult patients. The study concluded that brucellosis is endemic in Southern Saudi Arabia and needs local health authority to implement preventive and educational program measures. Infected patients may present with diverse, nonspecific clinical manifestations that require intuition from clinicians to detect the disease.

Laboratory Diagnosis of Human Brucellosis.

The clinical presentation of brucellosis in humans is variable and unspecific, and thus, laboratory corroboration of the diagnosis is essential for the patient's proper treatment. The diagnosis of brucellar infections can be made by culture, serological tests, and nucleic acid amplification assays. Modern automated blood culture systems enable detection of acute cases of brucellosis within the routine 5- to 7-day incubation protocol employed in clinical microbiology laboratories, although a longer incubation and performance of blind subcultures may be needed for protracted cases. Serological tests, though they lack specificity and provide results that may be difficult to interpret in individuals repeatedly exposed to Brucella organisms, nevertheless remain a diagnostic cornerstone in resource-poor countries. Nucleic acid amplification assays combine exquisite sensitivity, specificity, and safety and enable rapid diagnosis of the disease. However, long-term persistence of positive molecular test results in patients that have apparently fully recovered is common and has unclear clinical significance and therapeutic implications. Therefore, as long as there are no sufficiently validated commercial tests or studies that demonstrate an adequate interlaboratory reproducibility of the different homemade PCR assays, cultures and serological methods will remain the primary tools for the diagnosis and posttherapeutic follow-up of human brucellosis.

Association between polymorphisms of cytokine genes and brucellosis: A comprehensive systematic review and meta-analysis.

OBJECTIVE: Owing to involvement of host genetic factors in susceptibility to brucellosis infection and its outcome, this study aimed to carry out a comprehensive systematic review and meta-analysis to derive a precise evaluation of the association between the risk of brucellosis and its focal complication and all cytokines examined in case-control studies, including Interferon gamma (IFN-γ), Tumor Necrosis Factor (TNF)-α, TNF-ß, Transforming Growth Factor(TGF)-ß, IL-2, IL-4, IL-6, IL-10, IL-12B, IL-15, and IL-18 polymorphisms. METHODS: A systematic literature search in PubMed, Web of Science, Google Scholar, and Scopus was performed to identify the relevant studies, and related information was extracted. The effect size (ES) and corresponding 95% confidence intervals (CIs) were calculated to estimate the association. RESULTS: From 158 initial results, twenty-five eligible studies were included in the meta-analysis. Overall, the pooled results showed that the dominant models of IFN-γ UTR5644, TGF-ß rs1800470 and rs1800471, TNF-α rs1800629, and IL-10 rs1800872 were significantly less frequent in brucellosis patients than the controls. Also, the pooled analysis of the mutant allele vs. wild allele of TGF-ß rs1800471 and IL-10 rs1800872 showed negative association with brucellosis risk. On the other hand, our pooled analysis demonstrated that the mutant allele of IL-4 rs2243250 and IL-18 rs1946519 were associated with increased susceptibility to brucellosis. In addition, the IFN-γ UTR5644 and TGF-ß rs1800470 were more frequent in the patients without focal forms. CONCLUSIONS: IL-4 rs2243250 and IL-18 rs1946519 have a positive correlation with brucellosis whereas the IFN-γ UTR5644, TGF-ß rs1800470 and rs1800471, TNF-α rs1800629, and IL-10 rs1800872 showed a negative association with this disease. The association between the other single nucleotide polymorphisms (SNP) and brucellosis risk was not confirmed in the current meta-analysis. PROSPERO Registration: CRD42018117203.

A primary investigation of the relation between the incidence of brucellosis and climatic factors in Iran.

Brucella spp. are Gram-negative coccobacilli that may grow in different media and environmental conditions for extended periods of time. The survivals of these bacteria in the environment have an important impact on the epidemiology of brucellosis worldwide. The effect of climate on the incidence of certain zoonotic infectious diseases, (recently referred to as climate-sensitive zoonosis) is now well established. The aim of this study was to evaluate the relation between the incidence of brucellosis and climatic parameters in Iran, an important endemic region for brucellosis with diverse climate. The information on the incidence of human brucellosis in different Iranian provinces for 2016 has been provided by the Ministry of Health and Medical Education, Iran. Annual meteorological data collected between 2015 and 2016 were obtained from the Iranian Meteorological organization (IMO). A regression analysis of the incidence of brucellosis was performed via STATA 14.0 and the heterogeneity among observations was determined via Cochrane's Q-test and I2 statistic. If I2 index was higher than 50%, heterogeneity was considered as considerable. The results of regression analyses revealed a negative significant association between mean ambient air temperature and brucellosis incidence (C = - 0.022, P value = 0.004). Likewise, a positive significant association was found between number of frosty days and brucellosis incidence (C = 0.002, p value = 0.003). Other metrological parameters showed no significant effect on the human brucellosis incidence. Although our results suggest a high degree of temperature sensitivity in regards to the brucellosis incidence in Iran, this study opens up prospects for further investigations regarding environmental conditions and climatic changes influencing the spatial distributions and seasonal/annual cycle of this zoonotic pathogen worldwide.

The spatiotemporal distribution of human brucellosis in mainland China from 2007-2016.

BACKGROUND: Despite the considerable efforts made to address the issue of brucellosis worldwide, its prevalence in dairy products continues to be difficult to estimate and represents a key public health issue around the world today. The aim of the present study was to better understand the epidemiology of this disease in mainland China. We set out to investigate the yearly spatial distribution and possible hotspots of the disease. METHODS: Human brucellosis data from mainland China between 2007 and 2016 were collected from the China Information System for Disease Control and Prevention. A geographic information system ArcGIS10.3 (ESRI, Redlands) was used to identify potential changes in the spatial and temporal distribution of human brucellosis in mainland China during the study period. These distributions were evaluated using three-dimensional trend analysis and spatial autocorrelation analyse. A gravity-center was used to analyse the migration track of human brucellosis. RESULTS: A total of 399,578 cases of human brucellosis were reported during the 10-year study period. The monthly incidence of brucellosis in China demonstrates clear seasonality. Spring and summer are the peak seasons, while May is the peak month for brucellosis. Three-dimensional trend analysis suggests that brucellosis is on the rise from south to north, and that the epidemic situation in northern China is more severe. Between 2007 and 2016, the overall migration distance of the brucellosis incidence gravity-center was 906.43 km, and the direction was southwest. However, the overall gravity center of brucellosis was still in the northern part of China. In the global autocorrelation analysis, brucellosis in China demonstrated a non-random distribution between 2013 and 2014, with spatial autocorrelation (Z > 1.96, P < 0.05) and a clustering trend, while no clustering trend was found from 2007 to 2012 or from 2015 to 2016. In the local autocorrelation analysis, a Low-Low cluster phenomenon was found in the south of China in 2013 and 2014. CONCLUSION: Human brucellosis remains a widespread challenge, particularly in northern China. The hotspots highlight potential high-risk areas which may require special plans and resources for monitoring and controlling the disease.

Effect of climatic factors on the seasonal fluctuation of human brucellosis in Yulin, northern China.

BACKGROUND: Brucellosis is a serious public health problem primarily affecting livestock workers. The strong seasonality of the disease indicates that climatic factors may play important roles in the transmission of the disease. However, the associations between climatic variability and human brucellosis are still poorly understood. METHODS: Data for a 14-year series of human brucellosis cases and seven climatic factors were collected in Yulin City from 2005 to 2018, one of the most endemic areas in northern China. Using cross-correlation analysis, the Granger causality test, and a distributed lag non-linear model (DLNM), we assessed the quantitative relationships and exposure-lag-response effects between monthly climatic factors and human brucellosis. RESULTS: A total of 7103 cases of human brucellosis were reported from 2005 to 2018 in Yulin City with a distinct peak between April and July each year. Seasonal fluctuations in the transmission of human brucellosis were significantly affected by temperature, sunshine duration, and evaporation. The effects of climatic factors were non-linear over the 6-month period, and higher values of these factors usually increased disease incidence. The maximum separate relative risk (RR) was 1.36 (95% confidence interval [CI], 1.03-1.81) at a temperature of 17.4 °C, 1.12 (95% CI, 1.03-1.22) with 311 h of sunshine, and 1.18 (95% CI, 0.94-1.48) with 314 mm of evaporation. In addition, the effects of these three climatic factors were cumulative, with the highest RRs of 2.27 (95% CI, 1.09-4.57), 1.54 (95% CI, 1.10-2.18), and 1.27 (95% CI, 0.73-2.14), respectively. CONCLUSIONS: In Yulin, northern China, variations in climatic factors, especially temperature, sunshine duration, and evaporation, contributed significantly to seasonal fluctuations of human brucellosis within 6 months. The key determinants of brucellosis transmission and the identified complex associations are useful references for developing strategies to reduce the disease burden.

Spatial-temporal distribution of human brucellosis in mainland China from 2004 to 2017 and an analysis of social and environmental factors.

BACKGROUND: This study aimed to describe the changing distribution of human brucellosis between 2004 and 2017 in mainland China and seek scientific evidence of the relationship between socio-economic, environmental, and ecological factors and human brucellosis incidence. METHODS: The annual numbers of brucellosis cases and incidence rates from 31 provinces in mainland China between 2004 and 2017 were obtained from the Data-Center for China Public Health Science. The number of monthly brucellosis cases in 2018 was obtained from the Chinese Center for Disease Control and Prevention. The electronic map of the People's Republic of China was downloaded from the National Earth System Science Data Sharing Platform. Human population density, gross domestic product (GDP), and an inventory of cattle and sheep at the end of each year from 2004 to 2017 were obtained from the National Bureau of Statistics of China. Annual rainfall data from 31 provinces in the People's Republic of China from 2004 to 2017 were collected from the China Meteorological Data Service Center. The risk distribution and changing trends of human brucellosis were mapped with ArcGIS. A cluster analysis was employed to identify geographical areas and periods with statistically significant incidence rates. Multivariate linear regression was used to determine possible factors that were significantly correlated with the presence of human brucellosis cases. RESULTS: Human brucellosis cases have spread throughout the whole country. Human brucellosis cases occurred mostly from March to August and were concentrated from April to July. The inventory of sheep, GDP, and climate were significantly correlated with the presence of brucellosis cases in mainland China. CONCLUSIONS: The geographical expansion of human brucellosis in mainland China was observed, so did the high-incidence clusters between 2004 and 2017. Most of the cases were reported during the early spring to early summer (February-August). Results from the multivariate linear regression suggested that the inventory of sheep, GDP, and climate were significantly associated with the incidence of human brucellosis in mainland China.

Time series analysis of human brucellosis in mainland China by using Elman and Jordan recurrent neural networks.

BACKGROUND: Establishing epidemiological models and conducting predictions seems to be useful for the prevention and control of human brucellosis. Autoregressive integrated moving average (ARIMA) models can capture the long-term trends and the periodic variations in time series. However, these models cannot handle the nonlinear trends correctly. Recurrent neural networks can address problems that involve nonlinear time series data. In this study, we intended to build prediction models for human brucellosis in mainland China with Elman and Jordan neural networks. The fitting and forecasting accuracy of the neural networks were compared with a traditional seasonal ARIMA model. METHODS: The reported human brucellosis cases were obtained from the website of the National Health and Family Planning Commission of China. The human brucellosis cases from January 2004 to December 2017 were assembled as monthly counts. The training set observed from January 2004 to December 2016 was used to build the seasonal ARIMA model, Elman and Jordan neural networks. The test set from January 2017 to December 2017 was used to test the forecast results. The root mean squared error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE) were used to assess the fitting and forecasting accuracy of the three models. RESULTS: There were 52,868 cases of human brucellosis in Mainland China from January 2004 to December 2017. We observed a long-term upward trend and seasonal variance in the original time series. In the training set, the RMSE and MAE of Elman and Jordan neural networks were lower than those in the ARIMA model, whereas the MAPE of Elman and Jordan neural networks was slightly higher than that in the ARIMA model. In the test set, the RMSE, MAE and MAPE of Elman and Jordan neural networks were far lower than those in the ARIMA model. CONCLUSIONS: The Elman and Jordan recurrent neural networks achieved much higher forecasting accuracy. These models are more suitable for forecasting nonlinear time series data, such as human brucellosis than the traditional ARIMA model.

Seroprevalence of Human Brucellosis in Wadi Al Dawaser region of Saudi Arabia.

BACKGROUND AND OBJECTIVE: Brucellosis is an important zoonotic disease and a major public health problem in the Middle East countries including Saudi Arabia. This study has evaluated the seroprevalence of human brucellosis in Wadi Al Dawaser region of Central Saudi Arabia. METHODS: The study was conducted for three years (2015-2018) at Wadi Al Dawaser general hospital. A total of 6721 clinically suspected serum samples were collected over three years and tested by Rose Bengal Plate Test (RBPT), Serum Agglutination Test (SAT), IgM and IgG ELISA. A standard questionnaire to determine the risk factors were used among patients. RESULTS: Of the total 6721 samples tested, 576 (8.6%) were seropositive for brucellosis. RBPT identified 427 (74.1%), SAT titers 493 (85.6%) cases. IgM ELISA and IgG ELISA were positive for 501 (86.9%) and 558 (96.8%) cases respectively. Among the positive cases, 77.3% were male with the male to female ratio of 3.3:1. Nearly, 82% were Saudi Nationals. Direct contact with domestic animals and consumption of raw milk were the risk factors identified. No seasonal variation was seen. Diagnostic yield of IgM ELISA showed 86.9% sensitivity and 100% specificity; IgG ELISA showed 96.8% sensitivity and 100% specificity. Both IgG and IgM ELISAs showed 100% Positive predictive value, 98.9% and 95.6% Negative predictive value respectively. CONCLUSION: A seroprevalence of 8.6% of human brucellosis was documented from this rural region. This is the first report from Wadi Al Dawaser. Frequent surveillance among risk group, vaccination of livestock, creating awareness and health education among the public and school children are recommended.

Use of Rifabutin as an Alternative Agent for Human Brucellosis: A Case Report.

Drugs that have a good intracellular passage are used in the treatment of brucellosis. According to our knowledge, there is no report in English about rifabutin usage in brucellosis. We present a case that developed intolerance to many anti-brucella drugs, who was then successfully treated with a combination of rifabutin, ofloxacin, and ceftriaxone.

Trends of reported human brucellosis cases in mainland China from 2007 to 2017: an exponential smoothing time series analysis.

BACKGROUND: The main objective of this study was to describe the temporal distribution of monthly reported human brucellosis cases in mainland China and develop an appropriate time series model for short-term extrapolation forecast. METHODS: Surveillance data of the monthly reported human brucellosis cases occurring from April 1, 2007, to March 31, 2017, in mainland China were obtained. The spectrum analysis was first adopted to find the cyclic and seasonal features, the existence of the seasonality and trend was determined by exponential smoothing method and the seasonal-trend decomposition. The candidate models of exponential smoothing included the additive model and multiplicative model; R2 was selected as the indicator for the selection of candidate model, and the stability of the model was verified by adjusting the training data and test data set. Finally, the extrapolations of monthly incident human brucellosis cases in 2017 were made. RESULTS: From April 1, 2007, to March 31, 2017, a total of 435,108 cases of Brucellosis occurred in mainland China were reported, with an average of 3626 cases per month and a standard deviation of 1834 cases. The R2 of the exponential smoothing method that based on additive model increased steadily from 0.927 to 0.949 with the increase of the data volume. Ten of 12 actual values fell in the confidence interval of predicted value. CONCLUSIONS: Human brucellosis cases peaked during the months from March to August in mainland China, with clear seasonality. The exponential smoothing based on the additive model method could be effectively used in the time series analysis of human brucellosis in China. Control methods, such as vaccination, quarantine, elimination of infected animals, and good hygiene within the production cycle, should be strengthened with paying more attention to the seasonality. Further research is warranted to explore the drivers behind the seasonality.

Human brucellosis in the Emirate of Abu Dhabi, United Arab Emirates, 2010-2015.

BACKGROUND: Worldwide, human brucellosis remains an important and widespread infection. In the past, there were limited data on the occurrence of human brucellosis in the United Arab Emirates and the reported incidence appeared to be low compared with similar areas. In 2009, a new web-based infectious disease surveillance system was introduced in the Emirate of Abu Dhabi. This paper reports data from this new system on human brucellosis for the 6 years 2010 to 2015. METHODS: A dataset was extracted for each case of human brucellosis reported to the notification system for the 6 year period January 2010 to December 2015. Annual brucellosis rates by age-group, gender, nationality and, geographical region were calculated and compared. RESULTS: A total of 480 cases of brucellosis were reported. The overall crude notification rate was 3 · 3 per 100,000 population but higher rates were seen in certain population subgroups notably expatriate males of working age in the Eastern Region (approximately 10 per 100,000) and UAE nationals of all ages and both genders in Abu Dhabi (between 4 -- 24 per 100,000). CONCLUSIONS: These findings reflect environmental and behavioral factors linked to occupation and leisure time activities associated with the large number of small non-commercial livestock farms in Abu Dhabi. Controlling human brucellosis in these circumstances will be challenging.

Epidemic characteristics, high-risk townships and space-time clusters of human brucellosis in Shanxi Province of China, 2005-2014.

BACKGROUND: Brucellosis, one of the world's most important zoonosis, has been re-emerging in China. Shanxi Province, located in northern China, where husbandry development has been accelerated in recent years, has a rather high incidence of human brucellosis but drew little attention from the researchers. This study aimed to describe the changing epidemiology of human brucellosis in Shanxi Province from 2005 to 2014 and explore high-risk towns and space-time clusters for elucidating the necessity of decentralizing disease control resource to township level in epidemic regions, particularly in hotspot areas. METHODS: We extracted data from the Chinese National Notifiable Infectious Disease Reporting System to describe the incidence and spatiotemporal distribution of human brucellosis in Shanxi Province. Geographic information system was used to identify townships at high risk for the disease. Space-Time Scan Statistic was applied to detect the space-time clusters of human brucellosis during the past decade. RESULTS: From 2005 to 2014, a total of 50,002 cases of human brucellosis were recorded in Shanxi, with a male-to-female ratio of 3.9:1. The reported incidence rate increased dramatically from 7.0/100,000 in 2005 to 23.5/100,000 in 2014, with an average annual increase of 14.5%. There were still 33.8% cases delaying diagnosis in 2014. The proportion of the affected towns increased from 31.5% in 2005 to 82.5% in 2014. High-risk towns spread from the north to the center and then south of Shanxi Province, which were basins and adjacent highlands suitable for livestock cultivation. During the past decade, there were 55 space-time clusters of human brucellosis detected in high risk towns; the clusters could happen in any season. Some clusters' location maintained stable over time. CONCLUSIONS: During the last decade, Shanxi province's human brucellosis epidemic had been aggravated and high-risk areas concentrated in some towns located in basins and adjacent highlands. Space-time clusters existed and some located steadily over time. Quite a few cases still missed timely diagnosis. Greater resources should be allocated and decentralized to mitigate the momentum of rise and improve the accessibility of prompt diagnosis treatment in the high-risk townships.

The spatiotemporal epidemiological study on human brucellosis in shenyang, China from 2013 to 2022.

Background: Epidemiological characteristics of human brucellosis (HB) have changed over the last decade. In this study, we depicted the spatiotemporal features of HB in Shenyang, China, from 2013 to 2022 and the objective was to visualise spatiotemporal patterns and identify high-risk regions with the purpose to provide evidence for HB prevention and control. Methods: We performed an observational epidemiological study using HB data obtained from the National Notifiable Disease Reporting System (NNDRS). Joinpoint regression analysis was employed to determine the changing trends in the annual incidence. A vector boundary map of Shenyang was used to visualise spatial distribution. Spatial autocorrelation was identified using both global and local Moran's autocorrelation coefficients, while hotspot areas were determined using the Getis-Ord statistic. Results: A combined sum of 4103 HB cases were analysed, and the average level of annual incidence of HB was 5.52 per 100,000. The incidence of HB showed obvious seasonality, with a notable peak observed from April to July (summer peak). The annual incidence in Shenyang has been on the rise since 2013, with an annual percentage change (APC) of 6.39% (95%CI 1.29%, 12.39%). Xinmin County exhibited the most elevated average annual incidence rate, with Faku County ranking second. The average annual incidence in rural areas exhibited a significantly greater disparity compared to suburban areas (P < 0.001), whereas the incidence rate in suburban areas demonstrated a significantly higher contrast when compared to urban areas (P < 0.001). A clustered distribution of the annual incidence of HB was observed for all years from 2013 to 2022. Abnormally high values were found in suburban areas, and no abnormally high values were found after 2017. The low-low clustering areas were found in urban as well as suburban areas from 2013 to 2022. Hotspots (P < 0.05) were located in rural areas, while cold spots (P < 0.05) were found in both urban and suburban areas. Since 2020, there have been no hotspots in Shenyang. Conclusions: Rural areas are high-risk areas for HB and may be key to controlling HB epidemics. Although the annual incidence of HB in rural areas has increased, owing to the stability of spatial relationships and the disappearance of hotspots, there is little possibility of outbreaks; however, stricter monitoring should be applied in rural areas to prevent the emergence of new transmission routes.

Epidemiological changes and molecular characteristics of Brucella strains in Ningxia, China.

Objective: Human brucellosis causes serious public health concerns in Ningxia, China. Methods: This study employed epidemiological, bacteriological, and multiple-locus variable-number tandem repeat analysis (MLVA) methods to conduct an epidemiological investigation, which is necessary for devising tailored control strategies. Results: Between 1958 and 2022, 29,892 cases were reported, with an average annual number of cases and incidence of 467 and 7.1/100,000, respectively. The epidemic situation gradually worsened, with cases escalating from 26 cases in 2005 to 6,292 in 2022, with the incidence rate rising from 0.441 in 2005 to 86.83 in 2022. Geographically, the disease spread from a single affected county in 2004 to encompass all 22 counties in 2022. Yanchi County had the highest incidence, followed by the Hongsibao and Tongxin counties. These data suggest that Brucella infection has become a rampant regional concern in human brucellosis. Between 1958 and 2019, a total of 230 Brucella strains were identified across four studied hosts. These strains comprised four species with 12 biovars, including B. melitensis bv. 1, bv. 2, bv. 3, B. abortus bv. 1, bv. 3, bv. 4, bv. 5, bv. 6, bv. 7, B. suis bv. 1 and bv. 3, and B. canis. These data highlight the high species/biovars and host diversity of the Brucella population, posing a substantial challenge to brucellosis surveillance. There was an apparent transition from multiple species/biovars historically to the current dominance of a single species, B. melitensis, emphasizing the requirement for strengthening surveillance of B. melitensis. Genotypes 42 and 116, constituting 96.2% of the total number of genotypes, predominated in panel 1 and MLVA-11, indicating that all strains belong to the East Mediterranean lineage. MLVA cluster analysis revealed persistent transmission of dominant circulating genotypes, presenting an epidemic pattern characterized primarily by epidemiologically related cases with a few sporadic cases. Strains in this study exhibited high genetic homogeneity with strains from the Northwest, and those from Kazakhstan and Mongolia. Conclusion: The epidemic situation of human brucellosis has gradually worsened; the rampant epidemic of the disease has become a regional concern. The present study highlights that implementing the of targeted surveillance and intervention strategies is urge.

Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis.

Brucellosis is a commonly neglected zoonosis that remains a serious global public health concern. The epidemiological evolution of human brucellosis has considerably changed over the past few decades, and epidemic geography is continuously expanding. Human brucellosis is emerging and re-emerging, and is imported from areas where it is endemic due to travel, immigration, and international trade. The disease continues to be prevalent in Asia and Africa, including West Asia, Central Asia, North Africa, and East Africa, with the highest incidence in Syria, Kyrgyzstan, Mongolia, Iran, Algeria, and Kenya. Re-emerging cases are frequently recorded in places where brucellosis has been controlled, such as Bosnia, Herzegovina, Azerbaijan, and the USA. In countries with a high disease burden, disease control and eradication have been extremely difficult because of livestock farming being the only source of livelihood, unique religious beliefs regarding animals, nomadic lifestyle, and low socioeconomic levels. Interventions focused on protecting livestock keepers are needed, particularly for those assisting with goat and sheep births and the consumption of raw dairy products. Notably, in most countries with a high disease burden, each period of several years with a low incidence rate was followed by a subsequent increase in cases, highlighting the necessity of continuous investment and surveillance. In addition, advocacy for the inclusion of brucellosis as a globally mandated reported disease, strict restrictions on animal movement, mandated consumption of pasteurized milk, and health education are needed. This study will help form an evidence-based strategy for international organizations to curb the future spread of brucellosis.

Human Brucellosis in Iraq: Spatiotemporal Data Analysis From 2007-2018.

Background: Brucellosis is both endemic and enzootic in Iraq, resulting in long-term morbidity for humans as well as economic loss. No previous study of the spatial and temporal patterns of brucellosis in Iraq was done to identify potential clustering of cases. Objective: This study aims to detect the spatial and temporal distribution of human brucellosis in Iraq and identify any changes that occurred from 2007 to 2018. Methods: A descriptive, cross-sectional study was conducted using secondary data from the Surveillance Section at the Communicable Diseases Control Center, Public Health Directorate, Ministry of Health in Iraq. The trends of cases by sex and age group from 2007 to 2018 were displayed. The seasonal distribution of the cases from 2007 to 2012 was graphed. We calculated the incidence of human brucellosis per district per year and used local Getis-Ord Gi* statistics to detect the spatial distribution of the data. The data were analyzed using Microsoft Excel and GeoDa software. Results: A total of 51,508 human brucellosis cases were reported during the 12-year study period, with some missing data for age groups. Human brucellosis persisted annually in Iraq across the study period with no specific temporal clustering of cases. In contrast, spatial clustering was predominant in northern Iraq. Conclusions: There were significant differences in the geographic distribution of brucellosis. The number of cases is the highest in the north and northeast regions of the country, which has borders with nearby countries. In addition, people in these areas depend more on locally made dairy products, which can be inadequately pasteurized. Despite the lack of significant temporal clustering of cases, the highest number of cases were reported during summer and spring. Considering these patterns when allocating resources to combat this disease, determining public health priorities, and planning prevention and control strategies is important.