Boletim epidemiológico: perfil epidemiológico dos casos de brucelose humana em Goiás entre 2018 e abril de 2023 / Epidemiological bulletin: epidemiological profile of cases of human brucellosis in Goiás between 2018 and April 2023

Boletim que tem como objetivo demosntrar qual é o perfil epidemiológico dos casos humanos de brucelose no estado de Goiás, além de fazer o comparativo dos municípios com focos da doença em animais , haja vista que se trata de uma zoonose de ampla distribuição mundial e que gera impactos econômicos e sociais. Trata-se de um estudo desenvolvido baseado no banco de dados do Sistema de Agravos e Notificação (SINAN-NET), do Gerenciador de Ambiente Laboratorial (GAL), de dados fornecidos pela agência Goiana de Defesa Agropecuária (AGRODEFESA) e da Coordenação Estadual de Zoonoses da Gerência de Vigilância Epidemiológica de Doenças Transmissíveis GVEDT/SUVISA-SES-GO da Secretaria de Estado da Saúde de Goiás (SES/GO). É um estudo de caráter quantitativo, descritivo e retrospectivo entre janeiro de 2018 e abril de 2023, com dados analisados baseados em casos notificados e confirmados de brucelose humana por município de residência

Bulletin that aims to demonstrate the epidemiological profile of human cases of brucellosis in the state of Goiás, in addition to comparing municipalities with outbreaks of the disease in animals, given that it is a zoonosis with a wide worldwide distribution and that generates economic and social impacts. This is a study developed based on the database of the Diseases and Notification System (SINAN-NET), the Laboratory Environment Manager (GAL), data provided by the Goiana Agricultural Defense agency (AGRODEFESA) and the State Coordination of Zoonoses of the Epidemiological Surveillance of Communicable Diseases Management GVEDT/SUVISA-SES-GO of the State Department of Health of Goiás (SES/GO). It is a quantitative, descriptive and retrospective study between January 2018 and April 2023, with analyzed data based on reported and confirmed cases of human brucellosis by municipality of residence

Latent class evaluation of the performance of serological tests for exposure to Brucella spp. in cattle, sheep, and goats in Tanzania.

BACKGROUND: Brucellosis is a neglected zoonosis endemic in many countries, including regions of sub-Saharan Africa. Evaluated diagnostic tools for the detection of exposure to Brucella spp. are important for disease surveillance and guiding prevention and control activities. METHODS AND FINDINGS: Bayesian latent class analysis was used to evaluate performance of the Rose Bengal plate test (RBT) and a competitive ELISA (cELISA) in detecting Brucella spp. exposure at the individual animal-level for cattle, sheep, and goats in Tanzania. Median posterior estimates of RBT sensitivity were: 0.779 (95% Bayesian credibility interval (BCI): 0.570-0.894), 0.893 (0.636-0.989), and 0.807 (0.575-0.966), and for cELISA were: 0.623 (0.443-0.790), 0.409 (0.241-0.644), and 0.561 (0.376-0.713), for cattle, sheep, and goats, respectively. Sensitivity BCIs were wide, with the widest for cELISA in sheep. RBT and cELISA median posterior estimates of specificity were high across species models: RBT ranged between 0.989 (0.980-0.998) and 0.995 (0.985-0.999), and cELISA between 0.984 (0.974-0.995) and 0.996 (0.988-1). Each species model generated seroprevalence estimates for two livestock subpopulations, pastoralist and non-pastoralist. Pastoralist seroprevalence estimates were: 0.063 (0.045-0.090), 0.033 (0.018-0.049), and 0.051 (0.034-0.076), for cattle, sheep, and goats, respectively. Non-pastoralist seroprevalence estimates were below 0.01 for all species models. Series and parallel diagnostic approaches were evaluated. Parallel outperformed a series approach. Median posterior estimates for parallel testing were ≥0.920 (0.760-0.986) for sensitivity and ≥0.973 (0.955-0.992) for specificity, for all species models. CONCLUSIONS: Our findings indicate that Brucella spp. surveillance in Tanzania using RBT and cELISA in parallel at the animal-level would give high test performance. There is a need to evaluate strategies for implementing parallel testing at the herd- and flock-level. Our findings can assist in generating robust Brucella spp. exposure estimates for livestock in Tanzania and wider sub-Saharan Africa. The adoption of locally evaluated robust diagnostic tests in setting-specific surveillance is an important step towards brucellosis prevention and control.

Lay attitudes and misconceptions and their implications for the control of brucellosis in an agro-pastoral community in Kilombero district, Tanzania.

Brucellosis is a priority zoonotic disease in Tanzania that causes ill-health in people and affects livestock productivity. Inadequate awareness and behavior risking transmission can impede control efforts. We conducted a cross-sectional survey of 333 livestock owners in three villages in the Kilombero district, Tanzania, to understand their awareness, knowledge and behavior associated with brucellosis. Six Focus Group Discussions (FGDs), two in each village, were conducted, as well as an additional FGD with male herders from one of the villages. Factors associated with knowledge on brucellosis, food consumption and animal husbandry behavior risking transmission of this disease, were identified using generalized linear models. Predictors for knowledge of brucellosis were being male and having a higher educational level, while age was positively associated with a higher level of knowledge. Faith and ethnicity were associated with the performance of practices risking transmission. Following traditional religion and belonging to the Wamaasai ethnicity significantly increased the odds of carrying out these practices. Qualitative analysis gave insight into risk practices and reasoning. Of the 333 respondents, 29% reported that they had experienced abortions in their herds, 14% witnessed retained placentas, and 8% had seen still-births in their cattle within the previous year. However, survey results also showed that only 7.2% of participants had heard about brucellosis as a disease in livestock. Of those who had heard about brucellosis in livestock, 91% associated abortions with it and 71% knew that humans can get infected through raw milk consumption. People overwhelmingly attributed symptoms and transmission of brucellosis in livestock to infection with trypanosomiasis and to supernatural reasons instead. In the community, consumption of raw milk was valued and handling of aborted material was not considered a risk for infection. This agro-pastoralist community holds on to long-held beliefs and practices and lacks understanding of the biomedical concept of brucellosis. Transmission routes and symptoms of brucellosis in humans and livestock are completely unknown. The disparity between risk perception and actual transmission risk related to animal handling and consumption of animal products presents a challenge for disease awareness communication. This study recommends focused community engagement and sensitization to address the limited awareness and misconceptions among agro-pastoralists.

Serological evidence of single and mixed infections of Rift Valley fever virus, Brucella spp. and Coxiella burnetii in dromedary camels in Kenya.

Camels are increasingly becoming the livestock of choice for pastoralists reeling from effects of climate change in semi-arid and arid parts of Kenya. As the population of camels rises, better understanding of their role in the epidemiology of zoonotic diseases in Kenya is a public health priority. Rift Valley fever (RVF), brucellosis and Q fever are three of the top priority diseases in the country but the involvement of camels in the transmission dynamics of these diseases is poorly understood. We analyzed 120 camel serum samples from northern Kenya to establish seropositivity rates of the three pathogens and to characterize the infecting Brucella species using molecular assays. We found seropositivity of 24.2% (95% confidence interval [CI]: 16.5-31.8%) for Brucella, 20.8% (95% CI: 13.6-28.1%) and 14.2% (95% CI: 7.9-20.4%) for Coxiella burnetii and Rift valley fever virus respectively. We found 27.5% (95% CI: 19.5-35.5%) of the animals were seropositive for at least one pathogen and 13.3% (95% CI: 7.2-19.4%) were seropositive for at least two pathogens. B. melitensis was the only Brucella spp. detected. The high sero-positivity rates are indicative of the endemicity of these pathogens among camel populations and the possible role the species has in the epidemiology of zoonotic diseases. Considering the strong association between human infection and contact with livestock for most zoonotic infections in Kenya, there is immediate need to conduct further research to determine the role of camels in transmission of these zoonoses to other livestock species and humans. This information will be useful for designing more effective surveillance systems and intervention measures.

Epidemiology of brucellosis in cattle and dairy farmers of rural Ludhiana, Punjab.

Brucellosis is a zoonotic disease imposing significant impacts on livestock production and public health worldwide. India is the world's leading milk producer and Punjab is the state which produces the most cattle and buffalo milk per capita. The aim of this study was to investigate the epidemiology of bovine brucellosis to provide evidence for control of the disease in Punjab State, India. A cross-sectional study of dairy farms was conducted in humans and livestock in rural Ludhiana district using a multi-stage sampling strategy. The study suggests that brucellosis is endemic at high levels in cattle and buffalo in the study area with 15.1% of large ruminants testing seropositive and approximately a third of dairy farms having at least one animal test seropositive. In total, 9.7% of those in direct contact with livestock tested seropositive for Brucella spp. Persons that assisted with calving and/or abortion within the last year on a farm with seronegative livestock and people which did not assist with calving/abortion had 0.35 (95% CI: 0.17 to 7.1) and 0.21 (0.09 to 0.46) times the odds of testing seropositive compared to persons assisting with calving/abortion in a seropositive farm, respectively. The study demonstrated that persons in direct contact with cattle and buffalo in the study area have high risk of exposure to Brucella spp. Control of the disease in livestock is likely to result in benefits to both animal and public health sectors.

Seroprevalence of and Risk Factors Associated with Exposure to Brucella Spp. in Dairy Cattle in Three Different Agroecological Zones in Rwanda.

Livestock production is a key element for poverty alleviation, food security, and economic growth in Rwanda. In 2017, the national average milk production per cow was about 2.5 L per day; in 2020-2021, it is projected to increase to 3.5 L per day if improvement interventions including those designed to reduce the burden of brucellosis in cattle are implemented. The objective of the study reported here was to estimate the seroprevalence of and identify risk factors associated with dairy farms and cattle classified as seropositive to Brucella spp. in three different agroecological zones in Rwanda. Most study farms (40/85 or 47%) had one head of cattle only. Using the Rose Bengal test, the seroprevalence of brucellosis was 28/85 or 33% (95% CI = 24%, 43%) at the farm level and 63/465 or 14% (95% CI = 11%, 17%) at the animal level. Using logistic regression, at the farm level, the presence of seropositive cattle was associated with herd size (2-45 cattle, odds ratio = 21.2; 95% CI = 2.4, 184.5) (46-220 cattle, OR = 288.5; 95% CI = 24.3, 3,423.1) compared to farms with one animal, after controlling for main breed (local breeds, crossbreeds) on the farm. In addition, the odds of testing seropositive were 10.7 (95% CI = 2.3, 49.1) and 149.5 (95% CI = 19.3, 1,158.7) times higher in farms in Nyabihu district and Nyagatare district, respectively, than in farms in Muhanga district, after controlling for main breed on the farm. The odds of seropositivity to Brucella spp. were 2.8 times higher in farms with mostly local breeds, than in those with mostly crossbreeds; but the association was confounded by herd size and geographic location. At the animal level, the odds of seropositivity to Brucella spp. were 2.6 times higher in adult cattle than in young cattle (95% CI = 1.1, 6.3). Finally, we observed a high frequency of adult cattle (86%) and a high seroprevalence of brucellosis in adult cattle (25%) in Nyagatare; an indication that, in the absence of culling and other control measures, Brucella spp. infection pressure can be relatively constant and a steady source of disease transmission in pastoral systems in that district.

Brucellosis screening and follow-up of seropositive asymptomatic subjects among household members of shepherds in China.

To measure the seroprevalence of high-exposure populations in brucellosis endemic areas and report the outcome and duration of seropositive asymptomatic subjects, we screened 595 family members of shepherds in Jilin Province, China and then followed up 15 seropositive asymptomatic subjects for 18 months. We found that the seropositive rate of 15.5%. Nearly half of seropositive asymptomatic subjects (7/15) developed into brucellosis in the short term; others were still seropositive asymptomatic or had decreased SAT titer in a longer time.

Seroprevalence of brucellosis in small ruminants and related risk behaviours among humans in different husbandry systems in Mali.

Mali has a high pastoral potential with diverse coexisting production systems ranging from traditional (nomadic, transhumant, sedentary) to commercial (fattening and dairy production) production systems. Each of those systems is characterised by close interactions between animals and humans, increasing the potential risk of transmission of zoonotic diseases. The nature of contact network suggests that the risks may vary according to species, production systems and behaviors. However, the study of the link between small ruminants and zoonotic diseases has received limited attention in Mali. The objective of this study was to assess brucellosis seroprevalence and determine how the husbandry systems and human behaviour expose animal and human to infection risk. A cross-sectional study using cluster sampling was conducted in three regions in Mali. Blood was collected from 860 small ruminants. The sera obtained were analysed using both Rose Bengal and cELISA tests. In addition, 119 farmers were interviewed using a structured questionnaire in order to identify the characteristics of farms as well as the risk behaviors of respondents. Husbandry systems were dominated by agro-pastoral systems followed by pastoral systems. The commercial farms (peri-urban and urban) represent a small proportion. Small ruminant individual seroprevalence was 4.1% [2.8-5.6% (95% CI)]. Herd seroprevalence was estimated at 25.2% [17.7-33.9% (95% CI)]. Peri-urban farming system was more affected with seroprevalence of 38.1% [18.1-61.5 (95% CI)], followed by pastoral farming system (24.3% [11.7-41.2 (95% CI)]). Identified risk behaviors of brucellosis transmission to animals were: exchange of reproductive males (30.2%); improper disposal of placentas in the farms (31.1%); and keeping aborted females in the herd (69.7%). For humans, risk factors were: close and prolonged contact with animals (51.2%); consumption of unpasteurized dairy products (26.9%); and assisting female animals during delivery without any protection (40.3%). This study observed a high seroprevalence of brucellosis in small ruminants and also identified risky practices that allow cross transmission between the two populations. This calls for control strategy using a multi-sectoral and multidimensional approach.

First genome sequence of Chilean Brucella canis SCL strain provides insights on the epidemiology and virulence factors, explaining differences between geographical origins

BACKGROUND: Brucella canis is the etiological agent of canine brucellosis, a worldwide neglected zoonosis that constitutes one of the major infectious causes of infertility and reproductive failure in dogs. Although genomic information available for this pathogen has increased in recent years, here we report the first genome sequencing of a B. canis strain in Chile, and the differences in virulence genes with other B. canis strains. RESULTS: Genome assembly produced a total length of 3,289,216 bp, N50 of 95,163 and GC% of 57.27, organized in 54 contigs in chromosome I, and 21 contigs in chromosome II. The genome annotation identified a total of 1981 CDS, 3 rRNA and 36 tRNA in chromosome I, and 1113 CDS and 10 tRNA in chromosome II. There is little variation between the different strains and the SCL isolate. Phylogenetic analysis showed that the Chilean SCL strain is closely related to B. canis and B. suis strains. Small differences were found when compared to the Serbian isolate, but all strains shared the same recent common ancestor. Finally, changes in the sequence of some virulence factors showed that the SCL strain is similar to other South American B. canis strains. CONCLUSIONS: This work sequenced and characterized the complete genome of B. canis strain SCL, evidencing the complete presence of all the genes of the virB operon, and minor changes in outer membrane proteins and in the urease operon. Our data suggest that B. canis was introduced from North America and then spread throughout the South American continent.

An epidemiological study of brucellosis on mainland China during 2004-2018.

Brucellosis has re-emerged in China in recent years, resulting in an increasing health burden and economic losses for humans and the livestock industries. This study integrated data from human and livestock brucellosis surveillance systems to explore the changing epidemiology of brucellosis from 2004 to 2018 in China. A total of 524,980 human cases of brucellosis were reported, with the average annual incidence in humans being significantly higher for the period 2012-2018 than for 2004-2011 (3.3 vs. 1.9 per 100,000 residents). An autoregressive integrated moving average (ARIMA) model predicted an upward trend in the monthly incidence of brucellosis in humans in 2019 and 2020. Characteristics including being male, aged 45-54 years, working in the livestock industries, and residing in the northern provinces of China increased the risk of people contracting brucellosis. The percentage of provinces with infected people increased from 67.7% (21/31) in 2004 to all provinces in 2018. A total of 29,115 outbreaks were reported in livestock from 2004 to 2018, with 443,883 seropositive animals although only 381,224 (85.9%) of these were culled. The monthly incidence of brucellosis in humans was strongly positively correlated (r = .539, p < .001) with the number of outbreaks of brucellosis in livestock reported 3 months prior to the human cases. At the provincial level, the annual incidence of brucellosis in humans was significantly positively correlated with the sheep population (r = .786, p < .01). In conclusion, brucellosis in humans and livestock has been spreading in mainland China in the past decade. A more active surveillance of brucellosis in both livestock and humans in China should be coordinated and adjusted by adopting an evidence-based 'One Health' approach, particularly in high-risk regions and livestock industries.

Status of human brucellosis in district Malakand, Khyber Pakhtunkhwa, Pakistan.

BACKGROUND: Brucellosis is a zoonotic disease caused by the bacteria, Brucella genus. Human is always an accidental host, infected from domesticated or wild animals. METHODS: This study was conducted from September 2017 to April 2018. A total of 304 samples were collected in eight months duration from female of high-risk population connected with domesticated animals to investigate the sero-prevalence of Brucellosis using ELISA (Igm) in District Malakand, Khyber Pakhtunkhwa, Pakistan. RESULTS: The high age wise prevalence was recorded as 32.25% in female with age group 21-30 by ELISA (P<0.05). The prevalent rate was significantly high (P<0.05) in Tehsil Batkhela (32.8%) than Dargai (22.75%). It was also recorded in the present study that the prevalence was higher from January to April. It was found 20.58%, 17.64%, 14.70%, 20.58%, 17.6%, 38.23%, 45.71% and 44.11% from September to April respectively. CONCLUSION: The present study concluded that the prevalence of brucellosis is significantly high among the age group 20-40 and from January to April 2018. Further studies will be required to show the prevalence of the Brucellosis all over the country.

Pathological changes, distribution and detection of Brucella melitensis in foetuses of experimentally-infected does.

BACKGROUND: Brucellosis of goats is caused by Brucella melitensis. It is a re-emerging zoonotic disease in many countries due to transmission from domestic animals and wildlife such as ibex, deer and wild buffaloes. OBJECTIVE: To describe the pathological changes, identification and distribution of B. melitensis in foetuses of experimentally infected does. METHODS: Twelve female goats of approximately 90 days pregnant were divided into 4 groups. Group 1 was exposed intra-conjunctival to 100 µL of sterile PBS while goats of Groups 2, 3 and 4 were similarly exposed to 100 µL of an inoculum containing 109 CFU/mL of live B. melitensis. Goats of these groups were killed at 15, 30 and 60 days post-inoculation, respectively. Foetal fluid and tissues were collected for bacterial identification (using direct bacterial culture, PCR and immuno-peroxidase staining) and histopathological examination. RESULTS: Bilateral intra-conjunctival exposure of pregnant does resulted in in-utero infection of the foetuses. All full-term foetuses of group 4 were either aborted or stillborn, showing petechiations of the skin or absence of hair coat with subcutaneous oedema. The internal organs showed most severe lesions. Immune-peroxidase staining revealed antigen distribution in all organs that became most extensive in group 4. Brucella melitensis was successfully isolated from the stomach content, foetal fluid and various other organs. CONCLUSION: Vertical transmission of caprine brucellosis was evident causing mild to moderate lesions in different organs. The samples of choice for isolation and identification of B. melitensis are stomach content as well as liver and spleen tissue.

Neglected paths of transmission of milkborne brucellosis and tuberculosis in developing countries: novel control opportunities.

Brucellosis and tuberculosis are lingering zoonotic infections that are endemic in many developing parts of the world, with considerable economic and health costs. Although guidelines for the control of these diseases exist, we highlight neglected transmission routes of these diseases. We show that informal, door-to-door marketing of unpasteurized milk provides an important route for disease transmission through kitchen cross-contamination. Furthermore, the practice of discarding the first strippings of milk at farms needs adjustment to avoid floor and environmental contamination. Herein, we propose handling guidelines and a design for a milk stripping collection vessel. We believe that taking action to block these hitherto unrecognized transmission routes will complement existing efforts and guidelines.

Modeling the Impact of Seasonal Weather Variations on the Infectiology of Brucellosis.

A deterministic mathematical model for brucellosis that incorporates seasonality on direct and indirect transmission parameters for domestic ruminants, wild animals, humans, and the environment was formulated and analyzed in this paper. Both analytical and numerical simulations are presented. From this study, the findings show that variations in seasonal weather have the great impact on the transmission dynamics of brucellosis in humans, livestock, and wild animals. Thus, in order for the disease to be controlled or eliminated, measures should be timely implemented upon the fluctuation in the transmission of the disease.

Evolutionary history and current distribution of the West Mediterranean lineage of Brucella melitensis in Italy.

Ovine and caprine brucellosis, caused by Brucella melitensis, is one of the world's most widespread zoonoses and is a major cause of economic losses in domestic ruminant production. In Italy, the disease remains endemic in several southern provinces, despite an ongoing brucellosis eradication programme. In this study, we used whole-genome sequencing to detail the genetic diversity of circulating strains, and to examine the origins of the predominant sub-lineages of B. melitensis in Italy. We reconstructed a global phylogeny of B. melitensis, strengthened by 339 new whole-genome sequences, from Italian isolates collected from 2011 to 2018 as part of a national livestock surveillance programme. All Italian strains belonged to the West Mediterranean lineage, which further divided into two major clades that diverged roughly between the 5th and 7th centuries. We observed that Sicily serves as a brucellosis burden hotspot, giving rise to several distinct sub-lineages. More than 20 putative outbreak clusters of ovine and caprine brucellosis were identified, several of which persisted over the 8 year survey period despite an aggressive brucellosis eradication campaign. While the outbreaks in Central and Northern Italy were generally associated with introductions of single clones of B. melitensis and their subsequent dissemination within neighbouring territories, we observed weak geographical segregation of genotypes in the southern regions. Biovar determination, recommended in routine analysis of all Brucella strains by the World Organisation for Animal Health (OIE), could not discriminate among the four main global clades. This demonstrates a need for updating the guidelines used for monitoring B. melitensis transmission and spread, both at the national and international level, and to include whole-genome-based typing as the principal method for identification and tracing of brucellosis outbreaks.

Assessing the Impact of Optimal Health Education Programs on the Control of Zoonotic Diseases.

To better understand the dynamics of zoonotic diseases, we propose a deterministic mathematical model to study the dynamics of zoonotic brucellosis with a focus on developing countries. The model contains all the relevant biological details, including indirect transmission by the environment. We analyze the essential dynamic behavior of the model and perform an optimal control study to design effective prevention and intervention strategies. The sensitivity analysis of the model parameters is performed. The aim of the controls is tied to reducing the number of infected humans, through health promotional programs within the affected communities. The Pontryagin's Maximum Principle is used to characterize the optimal level of the controls, and the resulting optimality system is solved numerically. Overall, the study demonstrates that through health promotional programs on zoonotic diseases among villagers, it is vital that they should be conducted with high efficacy.

Molecular investigation of infection sources and transmission chains of brucellosis in Zhejiang, China.

In the present study, a total of 7793 samples from 5 different types of hosts were collected and tested, with a seroprevalence of 2.4% (184/7793). Although the seroprevalence of human and animal brucellosis is relatively low, numbers of human brucellosis cases reported have increased continuously from 2004 to 2018. A total of 118 Brucella strains containing 4 biotypes were obtained, including Brucella melitensis bv.1 (n = 8) and bv.3 (n = 106), Brucella abortus bv.3 (n = 3) and bv.7 (n = 1). Twenty-one shared MLVA-16 genotypes, each composed of 2 to 19 strains obtained from different hosts, suggest the occurrence of a brucellosis outbreak epidemic with multiple source points and laboratory infection events. Moreover, 30 shared MLVA-16 genotypes were observed among 59.6% (68/114) B. melitensis isolates from Zhejiang and strains from other 21 different provinces, especially northern provinces, China. The analysis highlighted the imported nature of the strains from all over the northern provinces with a dominant part from the developed areas of animal husbandry. These data revealed a potential transmission pattern of brucellosis in this region, due to introduced infected sheep leading to a brucellosis outbreak epidemic, and eventually causing multiple laboratory infection events. It is urgent to strengthen the inspection and quarantine of the introduced animals.

An outbreak of Brucellosis via air-born transmission in a kitchen wastes disposing company in Lianyungang, China.

Brucellosis is a bacterial zoonotic disease caused by pathogenic Brucella spp. An outbreak caused by B. melitensis at Jinchi Biotechnological Company engaged in collecting and disposing of kitchen wastes from catering units in Lianyungang is reported here. An epidemiological investigation and serosurvey were conducted, and pathogen detection was performed. Three confirmed brucella cases, one probable case and two recessive infectors were found out; the attack rate was 33.3%, the screening positive rate by RBPT was 25.0%. The pathogen was B. melitensis identified from three patients: two for B. melitensis, biovars 1, and one for B. melitensis, biovars 2. The main symptoms included fever, sweating, headache, arthralgia, weakness and chill. The epidemiological investigation found that the transmission mode in this outbreak was air-born transmission through aerosols from the process of unloading the food residues and wastes into the feeding inlet. This outbreak of brucellosis was confirmed with patients' clinical symptoms, laboratory testing and epidemiological finds. The disinfection and personal protection were complemented by the kitchen wastes disposing company.

Brucellosis: The Current Situation in Iran and Neighboring Countries.

It is frequently discussed that Brucella spp is an endemic infection in Iran and the Middle Eastern countries. The average incidence of brucellosis rate has been increasing and the zoonotic infections like brucellosis are being easily transmitted in these lands through the trafficking of livestock and chattels. A survey has been conducted to evaluate the pitfalls surrounding the diagnostic and clinical exposures of brucellosis in developing and undeveloped countries.

Incidence and Risk Factors of Brucellosis in Kermanshah Province, Iran During 2010-2014.

INTRODUCTION: Incidence of brucellosis was growing up in Iran during the past years. Kermanshah province-west of Iran is one of the endemic regions of the disease. The aim of this study was to evaluate the incidence and risk factors of brucellosis in Kermanshah province during a recent five-year period. METHODS: This study was an observational cross-sectional study performed on registries of the patients with brucellosis at the center for the zoonotic disease of Kermanshah University of medical sciences during 2010-2014. The data was collected using a questionnaire containing demographic data and the risk factor of brucellosis. Collected data were analyzed by SPSS-22 software using descriptive statistic, Chi-square, and student t-test. RESULTS: The five-years mean incidence of brucellosis in our study was 46.5 in one hundred thousand, and male to female ratio was 1.37/1. The most common risk factors of brucellosis in our patients were unpasteurized dairy products' consumption (47%) and occupational contact with livestock (14.4%). 84% of the patients were rural. The most common diagnostic method was the standard agglutination test within 1/160 and 1/320 titers. CONCLUSION: Risk factors of brucellosis in our study were like other studies, but in more than onethird of the patients, no risk factor was identified. Lack of livestock vaccination history and incomplete registered data about other possible transmission routes of transmission were the limitations of the study.