Occupational exposure to Brucellaspp.: Asystematic review and meta-analysis.

Carine Rodrigues Pereira,Luciano José Pereira,João Vitor Fernandes Cotrim De Almeida,Márcio Gilberto Zangerônimo,Luciana Faria De Oliveira,Elaine Maria Seles Dorneles,Izabela Regina Cardoso De Oliveira,Andrey Pereira Lage,Tao Lin

doi:10.1371/journal.pntd.0008164

Abstract

Brucellosis is a neglected zoonotic disease of remarkable importance worldwide. The focus of this systematic review was to investigate occupational brucellosis and to identify the main infection risks for each group exposed to the pathogen. Seven databases were used to identify papers related to occupational brucellosis: CABI, Cochrane, Pubmed, Scielo, Science Direct, Scopus and Web of Science. The search resulted in 6123 studies, of which 63 were selected using the quality assessment tools guided from National Institutes of Health (NIH) and Case Report Guidelines (CARE). Five different job-related groups were considered greatly exposed to the disease: rural workers, abattoir workers, veterinarians and veterinary assistants, laboratory workers and hunters. The main risk factors and exposure sources involved in the occupational infection observed from the analysis of the articles were direct contact with animal fluids, failure to comply with the use of personal protective equipment, accidental exposure to live attenuated anti-brucellosis vaccines and non-compliance with biosafety standards. Brucella species frequently isolated from job-related infection were Brucella melitensis, Brucella abortus, Brucella suis and Brucella canis. In addition, a meta-analysis was performed using the case-control studies and demonstrated that animal breeders, laboratory workers and abattoir workers have 3.47 [95% confidence interval (CI); 1.47-8.19] times more chance to become infected with Brucella spp. than others individuals that have no contact with the possible sources of infection. This systematic review improved the understanding of the epidemiology of brucellosis as an occupational disease. Rural workers, abattoir workers, veterinarians, laboratory workers and hunters were the groups more exposed to occupational Brucella spp. infection. Moreover, it was observed that the lack of knowledge about brucellosis among frequently exposed professionals, in addition to some behaviors, such as negligence in the use of individual and collective protective measures, increases the probability of infection.

Highlights

Brucellosis is one of the most common anthropozoonosis in the world, with approximately 500,000 new human cases reported annually to the World Health Organization (WHO) [1]
This systematic review addressed the main occupations affected by Brucella spp. infection, due to the regular exposure to aerosol and contact of non-intact skin with infected materials, such as carcasses, viscera and live attenuated anti-brucellosis vaccines
These damages are more intense in groups frequently exposed to microorganisms of the genus Brucella: the Disability-Adjusted Life Year (DALY), a metric that quantifies the burden of mortality and morbidity caused by a disease, were found to be 0.13 [95% uncertainty interval (UI) 0.06–0.18] per thousand persons per year in non-occupational adult and 0.29 [95% UI; 0.08–0.70] per thousand persons per year in occupational population for human brucellosis in India [10], in which one DALY can be thought of as one lost year of "healthy" life

Summary

Introduction

Brucellosis is one of the most common anthropozoonosis in the world, with approximately 500,000 new human cases reported annually to the World Health Organization (WHO) [1]. Damage caused by the disease in individuals’ quality of life is intangible and the economic losses attributed to the infection in humans are associated to the costs of hospital treatment, drugs and absence from work due to disabling feature of the disease in its severe form [6] These damages are more intense in groups frequently exposed to microorganisms of the genus Brucella: the Disability-Adjusted Life Year (DALY), a metric that quantifies the burden of mortality and morbidity caused by a disease, were found to be 0.13 [95% uncertainty interval (UI) 0.06–0.18] per thousand persons per year in non-occupational adult and 0.29 [95% UI; 0.08–0.70] per thousand persons per year in occupational population (farmers, abattoir workers and veterinarians) for human brucellosis in India [10], in which one DALY can be thought of as one lost year of "healthy" life

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Conclusion