High multidrug resistance of Listeria monocytogenes and association with water sources in sheep and goat dairy flocks in Jordan.

Listeria monocytogenes is a significant pathogen that causes listeriosis in humans and small ruminants. This study aimed to estimate the prevalence, antimicrobial resistance and risk factors of L. monocytogenes in small dairy ruminants in Jordan. A total of 948 milk samples were collected from 155 sheep and goat flocks across Jordan. L. monocytogenes was isolated from the samples, confirmed and tested for 13 clinically important antimicrobials. Data were also collected on the husbandry practices to identify risk factors for the presence of L. monocytogenes. The results showed that the flock-level prevalence of L. monocytogenes was 20.0% (95% CI; 14.46%-26.99%) and the prevalence in the individual milk samples was 6.43% (95% CI; 4.92%-8.36%). The univariable (UOR=2.65, p = 0.021) and multivariable (AOR=2.49, p = 0.028) analyses showed that using water from municipality pipelines as a water source in the flock reduced L. monocytogenes prevalence. All L. monocytogenes isolates were resistant to at least one antimicrobial. High percentages of the isolates were resistant to ampicillin (83.6%), streptomycin (79.3%), kanamycin (75.0%), quinupristin/dalfopristin (63.8%) and clindamycin (61.2%). About 83.6% of the isolates (94.2% and 75% of the sheep and goat isolates) exhibited multidrug resistance (resistance to ≥3 antimicrobial classes). In addition, the isolates exhibited fifty unique antimicrobial resistance profiles. Thus, it's recommended to restrict the misuse of clinically important antimicrobials and to chlorinate and monitor the water sources in sheep and goat flocks.

Sheep and goat milk in Jordan is a reservoir of multidrug resistant extended spectrum and AmpC beta-lactamases Escherichia coli.

Limited data is available on the prevalence and antimicrobial resistance of extended spectrum (ESBL) and AmpC ß-lactamases Escherichia coli in sheep and goats in Jordan. This study determined the molecular prevalence and antimicrobial-resistance of ESBL and AmpC ß-lactamases E. coli in 155 sheep and goat flocks across Jordan by testing 948 milk samples. The samples were enriched in MacConkey broth, and then plated on MacConkey agar with cefotaxime. The presence of ESBL and AmpC genes in the E. coli isolates was determined by PCR and the resistance toward critically important antimicrobials was tested by disc diffusion. In total, 1016 E. coli isolates were isolated from the cefotaxime supplemented MacConkey, 382 isolates harbored ESBL genes and 54 harbored blaCMY. The prevalence of blaCTX-M, blaTEM, blaCMY and blaSHVE. coli in the milk samples were 33.5 %, 31.7 %, 5.7 %. and 1.1 %, respectively. At the flock level, 30.3 % flocks had ß-lactamase E. coli, specifically 25.2 %, 20.7 %, 5.2 % and 2.6 % had blaCTX-M, blaTEM, blaCMY and blaSHV E. coli, respectively. About 52.2 % of the isolates harbored both blaCTX-M and blaTEM. A high percentage (>59 %) of ESBL and AmpC ß-lactamases E. coli resisted sulfamethoxazole/trimethoprim, tetracycline and nalidixic acid. Overall, 93.5 % and 96.3 % of ESBL and AmpC E. coli were resistant to ≥1 another antimicrobial class and 44.5 % and 44.4 % were resistant to ≥3 another antimicrobial class, respectively. This study shows that sheep and goat milk is a reservoir of multidrug resistant ESBL and AmpC ß-lactamases E. coli, thus good hygienic practices and judicious antimicrobials use are important in small ruminants' farming.

Urinary tract virulence genes in extended-spectrum beta-lactamase E. coli from dairy cows, beef cattle, and small ruminants.

Extended-spectrum ß-lactamase Escherichia coli is an important cause of urinary tract infections in humans. ESBL producers E. coli were reported in food-producing animals, but no previous study reported the virulence potential of these isolates. Thus, this study determined the virulence potential of ESBL producers E. coli isolates from 518 beef feces, 610 dairy cow feces, 305 dairy cow milk, 503 sheep milk and 445 goat milk samples. A total of 278 isolates; specifically, 130 from beef feces, 39 from the cow's feces, 42 from cow's milk, 44 from sheep milk and 23 from goats' milk were isolated and then tested for 14 virulence genes by polymerase chain reaction. After that, the correlation of virulence genes presence among the isolates was determined statistically. Overall, 97% of the isolates carried fimH, 39% carried iroN E. coli and 32% carried papC. The kpsMT K1, cnf1, papAH, papG allele II & III, papG allele II, and kpsMT II were carried by 6 to 23% of the isolates, while less than 6% of the isolates carried papG allele III, papG allele I, Univcnf, iutA and hlyA. About 68.2% of the isolates carried two or more virulence genes and 41.8% carried three or more. Moreover, the isolates had 71 different profiles of virulence genes, where the most common profiles were fimH alone (86 isolate), fimH + iroN E. coli (35 isolate), fimH + papC (20 isolate), and fimH + papC + iroN E. coli (13 isolate). The adhesion, capsule synthesis and toxins secretion genes were significantly associated (p Ë‚ 0.01) with each other. These results call for awareness about the risk of food animals as reservoirs of ESBL uropathogenic E. coli that would threaten public health and limits the treatment options for urinary tract infections.

Rift Valley Fever and Crimean-Congo Hemorrhagic Fever Viruses in Ruminants, Jordan.

The epidemiology of Rift Valley fever virus (RVFV) and Crimean-Congo hemorrhagic fever virus (CCHFV) in Jordan is unknown. Our investigation showed 3% of 989 tested dairy cattle, sheep, and goats were RVFV seropositive and 14% were CCHFV seropositive. Ongoing surveillance is needed to assess risk to humans and protect public health.

Seroepidemiology, Spatial Distribution, and Risk Factors of Francisella tularensis in Jordan.

There is a paucity of data on Francisella tularensis in the Middle East and North Africa. This is the first countrywide study to determine the seroprevalence, spatial distribution, and risk factors for F. tularensis in Jordan. A total of 828 Jordanians were serologically tested for F. tularensis by ELISA. These individuals filled out a self-administered questionnaire to collect demographic and risk factor information. Bivariate and multivariate logistic regressions were performed to determine which variables are associated with seropositivity. The overall seroprevalence of F. tularensis was 7.7% (95% CI: 6.10-9.75). The bivariate analyses showed that age, region of residence, small ruminant ownership, and practicing horticulture were significantly associated with seropositivity, and these variables were controlled for in the multivariate analysis. The multivariate analysis showed an increased odds of seropositivity among individuals living in northern desert, middle, and northern highland areas, compared with individuals living in the drier southern area, as 7.27 (95% CI: 2.49-21.19), 3.79 (95% CI: 1.53-9.39), and 3.52 (95% CI: 1.45-388.55), respectively. Individuals owning a small ruminant had 1.86 (95% CI: 1.02-3.40) greater odds for seropositivity than individuals who do not own a small ruminant. Individuals practicing horticulture had 2.10 (95% CI: 1.20-3.66) greater odds for seropositivity than individuals who do not practice horticulture. This is the first study to address the seroprevalence of F. tularensis in Jordan and the Middle East. Further research is needed to identify clinical cases of tularemia in Jordan and to determine the circulating F. tularensis subspecies.

Individual animal and herd level seroprevalence and risk factors of Hepatitis E in ruminants in Jordan.

OBJECTIVES: Hepatitis E virus (HEV) is zoonotic and endemic in several countries. There are no data on the farm level-prevalence and risk factors of HEV in ruminant farms in Jordan or elsewhere. This study aimed to estimate the seroprevalence and risk factors of HEV in ruminant farms in all regions of Jordan. MATERIAL AND METHODS: A total of 460 apparently healthy ruminants from 115 (31 cow, 51 sheep and 33 goat) farms were tested for HEV antibodies using a double antigen sandwich enzyme linked immunosorbent test. A validated questionnaire was used to collect data on animal health and husbandry practices. RESULTS: The results showed that 37.4% of the dairy farms under study (51.6%, 37.2% and 24.2% of dairy cow, sheep and goat farms; respectively) had at least one HEV seropositive animal. At the individual animal level, 12.1% of the tested animals were HEV positive; 14.5% (n = 18), 12.7% (n = 26) and 8.3% (n = 11) of cows, sheep and goats; respectively. Infrequent cleaning of feeders was associated with a significantly greater odds of HEV seropositivity in both large and small dairy ruminant farms (AOR = 16.0, p-val = 0.03, AOR = 3.4, p-val = 0.02, respectively). Farms which reported that small ruminants (sheep and goats) were mixed together had a greater odds of farm-level HEV seroprevalence (AOR = 3.1, p-val = 0.04). CONCLUSIONS: This study shows widespread and high farm-level HEV seroprevalence in dairy farms in Jordan. Husbandry practices and off-abattoir carcass processing in Jordan could amplify emergence and transmission of zoonotic HEV. Future studies should include HEV genotyping in ruminants, their products and humans to better understand HEV epidemiology in Jordan.

Prevalence and antimicrobial resistance of Listeria monocytogenes, Salmonella enterica and Escherichia coli O157:H7 in imported beef cattle in Jordan.

This study characterized Listeria monocytogenes, Salmonella enterica, and E. coli O157:H7 by collecting rectoanal mucosal swabs and fecal samples from 518 imported beef cattle at Jordan's major abattoir. A unique 53 L. monocytogenes, 287 S. enterica, and 17 E. coli O157:H7 were isolated from 37, 120 and 9 different animals; respectively. The prevalence of S. enterica, L. monocytogenes and E. coli O157:H7 were 23.2 % (95 % CI, 19.7-27.0 %), 7.1 % (95 % CI, 5.2-9.7 %) and 1.7 % (95 % CI, 0.9-3.3 %); respectively. All L. monocytogenes, all E. coli O157:H7 and 93.0 % of S. enterica isolates resisted at least one antimicrobial class. All L. monocytogenes, 94.1 % of E. coli O157:H7 and 69.7 % of S. enterica isolates exhibited multidrug resistance (resistant to ≥3 antimicrobials classes). Moreover, high percentages of L. monocytogenes (98.1 %), E. coli O157:H7 (64.7 %) and S. enterica (45.3 %) isolates resisted ≥5 antimicrobial classes. More than 90 % of the L. monocytogenes isolates resisted ampicillin, penicillin and erythromycin and more than 75 % resisted vancomycin. S. enterica isolates resisted several treatment-of-choice antimicrobials such as nalidixic acid (85.4 %), ciprofloxacin (26.8 %) and ceftriaxone (19.5 %). Furthermore, greater than 50 % of the E. coli O157:H7 isolates resisted streptomycin, nalidixic acid, tetracycline, ampicillin, sulfamethoxazole-trimethoprim, kanamycin, chloramphenicol and ciprofloxacin. The high prevalence and the high resistance percentages of the studied pathogens toward clinically important antimicrobials is alarming. Thus, applying strict sanitation procedures at the abattoirs in Jordan is crucial to lower the risk of carcasses contamination.

Prevalence, molecular characterization, and antimicrobial resistance profiles of Listeria monocytogenes, Salmonella enterica, and Escherichia coli O157:H7 on dairy cattle farms in Jordan.

This study determined the prevalence, pulsed-field gel electrophoresis profiles, and antimicrobial resistance profile of Listeria monocytogenes, Salmonella enterica, and Escherichia coli O157:H7 isolates from dairy cattle farms in Jordan. Samples from bulk tank milk (n = 305), cattle feces (n = 610), and rectoanal mucosal swabs (n = 610) were collected from 61 dairy cattle farms. We confirmed 32 L. monocytogenes, 28 S. enterica, and 24 E. coli O157:H7 isolates from the samples. The farm-level prevalence (at least 1 positive sample per farm) of L. monocytogenes, S. enterica, and E. coli O157:H7 was 27.9, 19.7, and 23.0%, respectively. The prevalence of L. monocytogenes, S. enterica, and E. coli O157:H7 in bulk tank milk was 7.5, 1.6, and 3.3%, respectively. The prevalence of L. monocytogenes and S. enterica in fecal samples was 1.5 and 3.8%, respectively, and the prevalence of E. coli O157:H7 in rectoanal mucosal swabs was 2.3%. Based on disk diffusion testing, all L. monocytogenes, S. enterica, and E. coli O157:H7 isolates exhibited resistance to at least 1 antimicrobial class. Multidrug resistance (resistance to 3 or more classes of antimicrobials) was exhibited by 96.9% of L. monocytogenes, 91.7% of E. coli O157:H7, and 82.1% of S. enterica isolates. Moreover, 93.8, 79.2, and 57.1% of the L. monocytogenes, E. coli O157:H7, and S. enterica isolates, respectively, were resistant to 5 or more antimicrobial classes. More than 50% of L. monocytogenes isolates were resistant to ampicillin, clindamycin, penicillin, erythromycin, quinupristin-dalfopristin, streptomycin, teicoplanin, linezolid, vancomycin, kanamycin, and tetracycline. More than 50% of S. enterica and E. coli O157:H7 isolates were resistant to ampicillin, cephalothin, nalidixic acid, kanamycin, streptomycin, amoxicillin-clavulanic acid, and tetracycline. The prevalence of the studied pathogens this study was comparable to reports from other countries. The isolated pathogens exhibited a high degree of antimicrobial resistance, suggesting that the bacterial flora of dairy cattle in Jordan are under intense antimicrobial selection pressure. Additional research is required to determine the causes and drivers of resistance, and to develop approaches to mitigating antimicrobial resistance.

Seroprevalence and Risk Factors for Coxiella burnetii in Jordan.

This is the first cross-sectional study of the seroprevalence and risk factors for Coxiella burnetii in Jordan. A total of 781 individuals from 11 governorates of Jordan were tested by SERION ELISA classic C. burnetii IgG Phase 2. A validated and pretested questionnaire was used to collect risk factors and demographic data. The overall seroprevalence for C. burnetii was 24.2% (95% CI; 21.3-27.3%). Unadjusted odds ratios showed that governorate of residence, consumption of raw milk, and ownership of sheep, goats, and dogs were significantly (P ≤ 0.05) associated with C. burnetii seropositivity. The multivariate logistic regression showed that individuals who own small ruminants had three times greater odds of seropositivity than those who do not own a small ruminant, after controlling for age, gender, raw milk consumption, and ownership of dogs. In addition, individuals who live in Al-Karak, Az-Zarqa, and Al-Tafilah had significantly greater odds of seropositivity compared with individuals who live in the capital city, Amman (OR = 3.6, 4.8, and 2.7, respectively). This study suggests that preventive measures should be practiced in ruminant farms in Jordan to avoid C. burnetii infection. Coxiella burnetii should also be considered in the differential diagnosis of febrile-like illnesses in Jordan, especially among farmers and veterinarians.

Anaplasma spp. in dairy ruminants in Jordan: high individual and herd-level seroprevalence and association with abortions.

We estimated the seroprevalence of, and associated risk factors for, anaplasmosis in dairy cows, sheep, and goats in all regions of Jordan. Apparently healthy animals from 135 farms (31 cow, 68 sheep, and 36 goat farms) were tested for Anaplasma spp. antibodies by a competitive ELISA. At the farm level, 36%, 94%, and 94% of cow, sheep, and goat farms, respectively, were seropositive for Anaplasma spp. At the individual animal level, 22%, 89%, and 82% of the tested cows, sheep, and goats, respectively, were seropositive, which demonstrates widespread and high seroprevalence of Anaplasma spp. in dairy farms in Jordan. Seroprevalence did not vary between regions. Using the Fisher exact test, there was a significant association between high seroprevalence and recent abortion in small ruminants. There is an urgent need for further investigation of this disease, and the potential role of Anaplasma spp. in abortions, on dairy farms in Jordan.

First nationwide seroepidemiology and risk factors report of Helicobater pylori in Jordan.

BACKGROUND AND AIM: Helicobacter pylori inhabits the gastric mucosa of humans and causes 89% of all gastric cancers. This is the first study of the seroprevalence, spatial distribution, and risk factors for H pylori in Jordan. MATERIALS AND METHODS: This is a cross-sectional study of 460 healthy participants (aged between 15 and 81 years) proportionately sampled across each region of Jordan. Sera samples were tested for H pylori using Enzygnost® anti-H pylori immunoglobulin G enzyme-linked immunosorbent assay. Participants completed a validated questionnaire about potential risk factors including food consumption habits and environmental and animal exposure. Multivariate generalized linear models identified risk factors for infection. RESULTS: The results showed a high seroprevalence (88.6%; 95% confidence interval [CI]: 85.3-91.2) of H pylori in the study population. After adjusting for possible confounders, age, consumption of raw milk, and location of residence were significantly associated with seropositivity. Older participants aged 30-49 years had an 11% greater risk of seropositivity compared to participants aged 15-29 years. Participants who consume raw milk and dairy products have a 9% decreased risk in seropositivity (prevalence ratio = 0.92; 95% CI: 0.84-0.99) compared to those who do not consume these products. CONCLUSION: This study reports a negative association between consumption of raw milk and seropositivity, and this is in line with several studies that report consumption of raw milk may be protective against H pylori. However, because of the risk of other serious pathogens associated with the consumption of raw dairy products, this study recommends pasteurization of raw milk. Future studies on the effect of fermented dairy products on H pylori colorization in gastric mucosa are recommended.

Seroprevalence, risk factors and spatial distribution of West Nile virus in Jordan.

Background: This is the first countrywide study of the seroprevalence, risk factors and spatial distribution of West Nile virus (WNV) in Jordan. Methods: A cross-sectional sample of 801 participants was administered a comprehensive questionnaire survey and tested for WNV immunoglobulin G antibodies. Results: The point seroprevalence rate for WNV infection was 8.61% (95% confidence interval 6.8 to 10.8). Multivariate regression analysis demonstrated that sex, age, climate, income and drinking water source were significantly associated with seropositivity (p≤0.05). Males had 1.73 greater odds of infection compared with females. Compared with 15 to 29-year-olds, adults 30-49 y old and adults ≥50 y old had 2.0 and 3.1 greater odds of infection, respectively. Individuals living in the Jordan Valley and Badia had 22.2 and 7.2 times greater odds of infection, respectively, compared with individuals living in the highlands. Households with an income of

Seroprevalence and risk factors for Campylobacter jejuni seropositivity in Jordan.

BACKGROUND: This is the first large-scale cross-sectional study to examine Campylobacter jejuni seropositivity in Jordan. METHODS: A total of 368 serum samples from nine governorates of Jordan were tested for IgA and IgG antibodies using enzyme-linked immunosorbent assay along with data collection to determine and rank possible risk factors by logistic regression analyses. RESULTS: The results showed that the rate of seroprevalence is 13.9%. Using chi-square test, six factors were significantly associated with C. jejuni seropositivity (p ≤ .05) including age, drinking raw milk, drinking spring lake water, small ruminant ownership, and dairy cow ownership; meanwhile, drinking filtered water was a protective factor. Chi-square test showed that people ≤19 years old and ≥60 years old had significantly higher seropositivity than other age groups. The multivariate logistic regression model showed that people drinking raw milk had higher odds (adjusted OR= 4.6, 95% CI 2.4-8.8, p-value <.001) for positivity compared with people who do not drink raw milk. Meanwhile, people who own a small ruminant had higher odds (adjusted OR= 1.9, 95% CI 1.0-3.8, p-value = .05) when compared with people who do not own a small ruminant. CONCLUSION: This study concludes that raw milk consumption and ruminant ownership are risk factors of campylobacter infection in Jordan. Thus, awareness regarding the adverse health consequences from raw milk consumption should be addressed, and campylobacteriosis should also be considered in the differential diagnosis of diarrhoea cases in farmers and their children. Further investigation of Campylobacter infection among younger age groups is recommended.

Zoonotic Anaplasma phagocytophilum, Ehrlichia canis, Dirofilaria immitis, Borrelia burgdorferi, and spotted fever group rickettsiae (SFGR) in different types of dogs.

Dogs can carry and share zoonotic pathogens with humans. This problem is understudied in different parts of the world, including Jordan. This study determined the prevalence of Anaplasma phagocytophilum, Ehrlichia canis, Dirofilaria immitis, and Borrelia burgdorferi using the SNAP 4Dx Plus test and spotted fever group rickettsiae (SFGR) using enzyme immunoassay IgG test in different types of dogs (farm/breeding, police, and stray) in Jordan. The results showed a very high seroprevalence (87%) of SFGR in dogs all over Jordan. Specifically, the seroprevalence was 97.0, 90.5 and 71.2% in farm, stray, and police dogs, respectively. Overall, 9.9% of dogs were seropositive for A. phagocytophilum. Specifically, 14.9% of farm, 14.3% of stray, and 0% of police dogs were seropositive. None of the studied dogs had D. immitis, E. canis, or B. burgdorferi. It can be concluded that SFGR and A. phagocytophilum are endemic in Jordan. This study suggests that controlling stray dogs and monitoring dog breeding farms should be considered as control measures to limit the transmission of SFGR and A. phagocytophilum and to limit their public health impact in Jordan. Moreover, further follow-up studies are needed to study these pathogens in the human population in Jordan.

First report on seroprevalence and risk factors of dengue virus in Jordan.

Background: There are no data available on dengue epidemiology in Jordan. This is the first study of the seroprevalence and risk factors of dengue virus (DENV) infection in Jordan. Methods: Sera samples from 892 apparently healthy individuals from all over Jordan were tested for DENV by enzyme-linked immunosorbent assay and a validated questionnaire was completed by all participants to identify and rank possible risk factors. Results: The seroprevalence was 24.6% (95% confidence interval 21.8 to 27.5). In univariate regression analysis, age, education, history of travel, living in rainy areas and practicing agriculture were significantly (p<0.05) associated with seropositivity. The multivariate logistic regression model showed that those who live in a rainy climate (odd ratio [OR] 1.7), are older (OR 2.3), have a history of international travel (OR 1.5) and are male with a history of international travel had a significantly greater odds of DENV seropositivity (OR 3.4). Conclusions: These data suggest that DENV circulates in Jordan and that cases may be imported or locally transmitted. Further research is needed to determine the circulating DENV serotypes and vectors in Jordan. Given the high rate of DENV seropositivity, dengue should be considered as a differential diagnosis in febrile diseases in Jordan, especially among populations living in rainy climates.

Major diseases, extensive misuse, and high antimicrobial resistance of Escherichia coli in large- and small-scale dairy cattle farms in Jordan.

This study aimed to determine the major diseases, antimicrobial use, and resistance in commensal Escherichia coli in dairy cattle in Jordan. Forty-three (large, n = 21; small, n = 22) farms were surveyed. A validated questionnaire was administered to the herdsmen to elicit information about disease prevalence, antimicrobial knowledge, and antimicrobial use. In addition, fecal samples were collected from 5 lactating animals on each farm. A total of 520 E. coli isolates were tested for resistance to 12 antimicrobials. From the herdsmen's perspective, the diseases that require use of veterinary services in large and small production systems were mastitis (51.2%), metritis (51.2%), and enteritis (39.5%), and the most commonly used antimicrobials were oxytetracycline and streptomycin. Dairy herdsmen (83.7%) reported that it is easy to purchase antimicrobials without a veterinary prescription and 97.7% of them more frequently changed the antimicrobial drug rather than increasing the dose when presented with nonresponse to treatment. Escherichia coli isolates exhibited high resistance to streptomycin (47.5%), tetracycline (45.4%), and ampicillin (34.2%). Less than 10% of isolates were resistant to chloramphenicol, kanamycin, gentamicin, ciprofloxacin, and ceftriaxone. Overall, 64.6 and 37.1% of the E. coli isolates exhibited resistance to ≥1 antimicrobial and multidrug resistance (resistance to ≥3 antimicrobial classes), respectively. The isolates exhibited 107 antimicrobial resistance profiles. This study indicates that antimicrobials are frequently misused in dairies in Jordan and that resistance among commensal E. coli toward antimicrobials of human and veterinary importance is high. Therefore, educational programs for herdsmen and enacting regulations and guidelines are necessary to promote the judicious use of antimicrobials in dairy animals in Jordan.

High prevalence and antimicrobial resistance of mecA Staphylococcus aureus in dairy cattle, sheep, and goat bulk tank milk in Jordan.

The aim of this study was to determine the prevalence and antimicrobial resistance of mecA and mecC methicillin-resistant Staphylococcus aureus (MRSA) in cattle, sheep, and goat dairy farms in Jordan. Milk samples were collected from bulk tanks at 117 dairy farms (44 cattle, 47 sheep, and 26 goat dairy farms) in each region of the country. MRSA were isolated on mecA and mecC chromogenic media and confirmed by PCR. The confirmed isolates were tested for resistance toward 15 antimicrobials by the disc diffusion method. None of the tested bulk milk samples were positive for mecC and 26% (95% CI 20-32%) were positive for mecA MRSA. Specifically, mecA MRSA was detected in 31.8% (95% CI 17.5-46.1) of cattle, 29.8% (95% CI 16.2-43.4) of sheep, and 11.5% (95% CI - 1.6-24.7%) of goat dairy farms. All isolates (n = 86) exhibited resistance to penicillin, oxacillin, cefoxitin; meanwhile, most isolates (70-85%) exhibited resistance toward gentamicin, clindamycin, rifampicin, neomycin, fusidic acid, erythromycin, tetracycline, and ciprofloxacin. All mecA MRSA isolates were resistant to at least one class of antimicrobials. Isolates from all goat milk, 88% of cattle milk, and 87% of sheep milk samples exhibited resistance to three classes of antimicrobials and were considered multidrug resistant (MDR). These data demonstrate widespread MDR MRSA in dairy ruminants in Jordan, and these rates are higher than those reported in other countries. Such high prevalence of MDR MRSA and mecA MRSA could lead to economic losses in the dairy industry in Jordan and poses a possible public health risk.

Seroprevalence and risk factors of Hepatitis E infection in Jordan's population: First report.

OBJECTIVES: Hepatitis E virus (HEV) is hyperendemic in many countries, but data on this virus are not available in Jordan. This study determined the seroprevalence, risk factors and zoonotic potential of HEV in a Jordanian population. METHODS: A total of 450 sera samples from 8 different governorates were tested for HEV-IgG. A pre-tested and validated questionnaire was used to collect risk factor data including animal interaction and environmental exposures. RESULTS: The overall seroprevalence was 30.9%. Eating undercooked meat was significantly associated with HEV seropositivity (OR=2.06, 95%CI 1.04-4.06) after controlling for age, gender, travel history and source of water. Age was also associated with HEV seropositivity; the youngest (≤14 years of age) and oldest age groups (60 and 80 years of age) had the highest prevalence (45.5% and 53.2%, respectively), compared to those between 20 to 29 years of age and 30 to 39 years of age (20.2 and 15.2%, respectively), although the small sample size among the youngest group tempers this association. There was evidence of a marginal association between owning camels and an increased odds of HEV seropositivity. Place of residence and source of drinking water were not associated with infection. CONCLUSION: This is the first study to report HEV seroprevalence in Jordan and shows that HEV exposure is high in Jordan. Surveillance for acute and chronic Hepatitis E is needed to estimate the frequency of the actual disease.

Virulence and Antibiotic Resistance of Vibrio parahaemolyticus Isolates from Seafood from Three Developing Countries and of Worldwide Environmental, Seafood, and Clinical Isolates from 2000 to 2017.

Vibrio parahaemolyticus is a leading cause of seafood-associated illness. This study investigated the prevalence, virulence, and antibiotic resistance of V. parahaemolyticus in three low- and middle-income countries. Freshly caught fish samples (n = 330) imported to Jordan from Yemen, India, and Egypt were tested. The overall prevalence of V. parahaemolyticus was 15% (95% confidence interval: 11 to 19%). Three isolates (6%) were positive for the thermostable direct hemolysin-related (trh) gene, and all isolates was negative for the thermostable direct hemolysin (tdh) gene. All isolates were resistant to colistin sulfate, neomycin, and kanamycin, and 51 and 43% of isolates were resistant to tetracycline and ampicillin, respectively. Only 4% of the isolates were resistant to cefotaxime and chloramphenicol, and no isolates were resistant to sulfamethoxazole-trimethoprim, streptomycin, gentamicin, ciprofloxacin, and nalidixic acid. All isolates were resistant to two classes of antibiotics, and 86% were multidrug resistant (resistant to at least one drug in three or more classes of antibiotics). A literature review of clinical, seafood, and environmental V. parahaemolyticus isolates worldwide revealed high rates of gentamicin and ampicillin resistance, emerging resistance to third-generation cephalosporins, and limited resistance to sulfamethoxazole-trimethoprim, ciprofloxacin, nalidixic acid, and chloramphenicol. Thus, last-resort antibiotics could be ineffective for treating V. parahaemolyticus infections. Several global reports also documented illness outbreaks in humans caused by trh- and tdh-negative V. parahaemolyticus strains. More research is needed to determine whether the presence of these genes is sufficient to classify the strains as virulent.

Prevalence and Risk Factors of Coxiella burnetii Antibodies in Bulk Milk from Cattle, Sheep, and Goats in Jordan.

This large-scale cross-sectional study was conducted to determine the prevalence, geographical distribution, and risk factors for the presence of antibodies against Coxiella burnetii in bulk tank milk derived from dairy cattle, sheep, and goats in Jordan. Bulk milk samples were collected from 78 dairy cattle, 48 sheep, and 23 goat farms from various places in Jordan according to the density of these animal species in each region of the country. The samples were tested for C. burnetii antibodies using the CHEKIT Q-Fever Antibody ELISA kit. A standardized questionnaire was also used to collect data from each farm to identify and rank the risk factors for the presence of C. burnetii antibodies. The results revealed that 62.9% (95% confidence interval: 55.1 to 70.0%) of the tested ruminant farms were positive for C. burnetii antibodies. Positive results were obtained from 70.9% (60.6 to 79.5%) of dairy cattle farms, 52.1% (38.3 to 65.5%) of sheep farms, and 56.0% (37.1 to 73.3%) of goat farms. Six factors were associated with the presence of these antibodies on cattle farms, and five factors were associated with these antibodies on sheep and goat farms (chi-square test). The multivariate logistic regression model revealed that large dairy cattle farms, farms that add new animals to the herd, farms that infrequently clean the feeders, and farms in particular areas are 28.6, 19.9, 8.0, and 6.4 times more likely, respectively, to have animals with C. burnetii antibodies. Sheep and goat farms that mix their animals with those from other farms, graze more than 5 km, and infrequently sanitize the feeders were 8.0, 0.06, and 13.6 times more likely, respectively, to have animals with C. burnetii antibodies. These data reveal the widespread exposure of Jordanian ruminants to C. burnetii and suggest a high risk for public health.