Human infection with a zoonotic orthopoxvirus in the country of Georgia.

During 2013, cutaneous lesions developed in two men in the country of Georgia after they were exposed to ill cows. The men had never received vaccination against smallpox. Tests of lesion material with the use of a quantitative real-time polymerase-chain-reaction assay for non-variola virus orthopoxviruses were positive, and DNA sequence analysis implicated a novel orthopoxvirus species. During the ensuing epidemiologic investigation, no additional human cases were identified. However, serologic evidence of exposure to an orthopoxvirus was detected in cows in the patients' herd and in captured rodents and shrews. A third case of human infection that occurred in 2010 was diagnosed retrospectively during testing of archived specimens that were originally submitted for tests to detect anthrax. Orthopoxvirus infection should be considered in persons in whom cutaneous lesions develop after contact with animals.

Changing livestock vaccination policy alters the epidemiology of human anthrax, Georgia, 2000-2013.

Anthrax is a widely spread zoonotic disease found on nearly every continent. To control the disease in humans and animals, annual livestock vaccination is recommended. However, in 2007, the country of Georgia ended its policy of compulsory annual livestock anthrax vaccination. Our objective was to assess how the epidemiology of human anthrax has evolved from 2000-2013 in Georgia, in the wake of this cessation. We used passive surveillance data on epidemiological surveys of human anthrax case patients. Risk factors and rates of self-reported sources of infection were compared, before and after the change in livestock vaccination policy. We mapped ethnicity-adjusted incidence during the two periods and assessed changes in the spatial pattern of risk. The overall risk of human anthrax increased >5-fold, from 0.7 cases per 100,000 in 2000 to 3.7 cases per 100,000 by 2013. Ethnic disparities in risk became pronounced; from 2000 to 2013, incidence increased >60-fold in Azerbaijanis from 0.35 to 21.1 cases/100,000 Azerbaijanis compared to 0.61 to 1.9 cases/100,000 among ethnic Georgians. Food-borne exposures from purchasing meat increased from 11% in 2000-2006 to 21% in 2007-2013. Spatial analyses revealed a shift from a random pattern of reporting pre-policy change to clustering among district municipalities following the change in policy. Our findings indicate there were unintended human health consequences associated with changing livestock vaccination policy. Following a reduction in the immunizations administered, there was a major shift in the epidemiology of human anthrax in Georgia. Current infection risk is now highest among ethnic minorities. Increased reporting among individuals uncharacteristically at risk for anthrax from foodborne exposures suggests spillover from modes of agricultural production. Given the importance of human-livestock health linkages, careful evaluations of policy need to be undertaken before changes to animal vaccination are made.

The human-animal interface of domestic livestock management and production and its relationship to brucellosis in the country of Georgia 2010: a rapid assessment analysis.

CONTEXT: Brucellosis is endemic in the country of Georgia, with the highest incidence of disease in the east of Georgia, in the Kakheti region--which is also home to the majority of sheep and a large portion of the national cattle herd (two species that are natural hosts of zoonotic Brucella spp.). OBJECTIVE: Our purpose was to understand the ruminant livestock management and dairy production as well as the sociological factors in order to relate it to the disease ecology of brucellosis and to understand the framework that contributes too brucellosis transmission in the region. METHODS: In 2010, we examined the aspects of livestock management and production through the use of a semi-structured questionnaire that was administered to 198 villagers and 41 key informants (physicians, veterinarians, dairy production specialists, and laboratory personnel) who were identified by convenience sampling. Results were primarily qualitative, but some were quantified to reveal trends and compared with non-parametric tests. RESULTS: We found that animals are managed at the village level. Male villagers take turns shepherding and herding on both summer pastures (highlands) and winter pastures (lowlands or around the village). Men also do all the sheep-dairy production. Women care for milk cattle as well as make the dairy products from cow milk. Of the households that own livestock, 28% own sheep (50 per flock) and 96% own cattle (3 per herd). The northern-most part of Kakheti (Akhmeta) has the widest distribution of its cheese; the guda cheese from this area is sold all over Kakheti and central Georgia. Typically, cheese is aged in 20% brine for 3d (white cheeses) or 21d (guda cheeses). In addition, raw milk is used for cheese production and heating the milk is believed to decrease the quality of the final product. CONCLUSIONS: Interventions at the animal level will be best carried out in the fall when animals return to winter pastures. Under-employed private veterinarians would be available for extension work and contact with local villagers. Control will be best achieved at the animal level because the local people have a social and cultural resistance to the use of heated or pasteurized milk for cheese production.