A Multidisciplinary "One Health" Tool for Tackling Brucellosis.

Introduction: The Epizootiological Investigation Form (EIF) is a document issued for every notified human brucellosis case, with the aim to convey information from public health to veterinary authorities for farm animals epidemiologically linked with the patient. We assessed the integration of EIF to the routine collaboration among stakeholders and the efficiency in directing the veterinary efforts to identify Brucella-infected animals. Methods: EIFs were evaluated for the implementation, timeliness, and completeness of the shared information provided by the public health and the veterinary authorities. The efficiency of EIFs in identifying infected farms was compared with the Brucella infection rate of routinely screened farms in the frame of the national brucellosis program. Results: During 2017-2022, 344 EIFs were issued for equal number of human brucellosis cases and 118 (34.3%) were circulated successfully among all stakeholders, whereas 226 (65.7%) went missing. The highest rate of intersectoral circulation occurred in May (47.8%, p = 0.007). Veterinary investigation was performed, and result was provided in 62 (57.4%) of the 108 circulated EIFs that disclosed the contact details of the epidemiologically linked animal farms. Brucella was detected at a significantly higher rate (51.7%) in the investigated sheep and goats' farms than the infection rate (2.7%) of the national brucellosis program (p < 0.00001). Among the screened bovine herds, two were found infected of the eight tested (25%). The circulation among all competent authorities of EIFs with a farm screening outcome required a median (interquartile range) of 50 days (22, 88). The likelihood of a "complete" EIF per human case differed among geographic Regions (p = 0.010), and was higher for patients diagnosed in April (p = 0.001) and occupied as stockbreeders (p = 0.025). Conclusions: EIF is a useful tool for pinpointing suspected animals for brucellosis screening. Training of the collaborating personnel is essential for improving the implementation of EIF in the everyday practice.

Risk factors for nasopharyngeal carriage of drug-resistant Streptococcus pneumoniae: data from a nation-wide surveillance study in Greece.

BACKGROUND: A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers. METHODS: A study group was organized with the responsibility to collect nasopharyngeal samples from children. Questionnaires provided demographic data, data on antibiotic consumption, family and household data, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and resistant strains were serotyped. RESULTS: Between February and May 2004, from a total population of 2536 healthy children, a yield of 746 pneumococci was isolated (carriage rate 29.41%). Resistance rates differed among geographic regions. Recent antibiotic use in the last month was strongly associated with the isolation of resistant pneumococci to a single or multiple antibiotics. Serotypes 19F, 14, 9V, 23F and 6B formed 70.6% of the total number of resistant strains serotyped. CONCLUSION: Recent antibiotic use is a significant risk factor for the colonization of otherwise healthy children's nasopharynx by resistant strains of S pneumoniae. The heptavalent pneumococcal conjugate vaccine could provide coverage for a significant proportion of resistant strains in the Greek community. A combined strategy of vaccination and prudent antibiotic use could provide a means for combating pneumococcal resistance.

Crimean-Congo hemorrhagic fever.

PURPOSE OF REVIEW: Crimean-Congo hemorrhagic fever is a tick-borne viral zoonosis with the potential of human-to-human transmission, affecting wide areas in Asia, Southeastern Europe, and Africa. Hemorrhagic manifestations constitute a prominent symptom of late stage disease with case fatality rates from 10% to 50%. The purpose of this article is to review recent literature on Crimean-Congo hemorrhagic fever with emphasis on its epidemiology and management. RECENT FINDINGS: Climate and environmental changes may affect Crimean-Congo hemorrhagic fever epidemiology and trigger community outbreaks. Risk factors for acquisition of infection have been well studied. In the hospital, high-risk activities include interventions for gastrointestinal bleeding and needle stick injuries. Reverse transcription-polymerase chain reaction may rapidly diagnose Crimean-Congo hemorrhagic fever with high sensitivity and specificity. Ribavirin is the only promising therapeutic agent currently available but case-control studies have not been conducted. Recently, the Mx proteins have been found to act against Crimean-Congo hemorrhagic fever virus and deserve further research. SUMMARY: Clinicians should be aware of the potential of importation of Crimean-Congo hemorrhagic fever cases from endemic areas and nosocomial transmission. Studies on the efficacy of ribavirin are needed.