Human Brucellosis Cases Research Articles

Epidemiology and time series analysis of human brucellosis in Tebessa province, Algeria, from 2000 to 2020.

Background: Brucellosis runs rampant endemically with sporadic outbreaks in Algeria. The present study aimed to provide insights into the epidemiology of brucellosis and compare the performance of some prediction models using surveillance data from Tebessa province, Algeria. Study Design: A retrospective study.Methods: Seasonal autoregressive integrated moving average (SARIMA), neural network autoregressive (NNAR), and hybrid SARIMA-NNAR models were developed to predict monthly brucellosis notifications. The prediction performance of these models was compared using root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE). Results: Overall, 13670 human brucellosis cases were notified in Tebessa province from 2000-2020 with a male-to-female ratio of 1.3. The most affected age group was 15-44 years (56.2%). The cases were reported throughout the year with manifest seasonality. The annual notification rate ranged from 30.9 (2013) to 246.7 (2005) per 100000 inhabitants. The disease was not evenly distributed, rather spatial and temporal variability was observed. The SARIMA (2,1,3) (1,1,1)12', NNAR (12,1,6)12' , and SARIMA (2,0,2) (1,1,0)12- NNAR (5,1,4)12 were selected as the best-fitting models. The RMSE, MAE, and MAPE of the SARIMA and SARIMA-NNAR models were by far lower than those of the NNAR model. Moreover, the SARIMA-NNNAR hybrid model achieved a slightly better prediction accuracy for 2020 than the SARIMA model. Conclusion: As evidenced by the obtained results, both SARIMA and hybrid SARIMA-NNAR models are suitable to predict human brucellosis cases with high accuracy. Reasonable predictions, along with mapping brucellosis incidence, could be of great help to veterinary and health policymakers in the development of informed, effective, and targeted policies, as well as timely interventions.

Analysis on epidemiologic characteristics of human brucellosis in Nanxun district of Huzhou, Zhejiang, 2012–2020

Objective To analyze the epidemiologic characteristics of human brucellosis in Nanxun district of Huzhou, Zhejiang province, from 2012 to 2020, identify the main factors affecting the incidence of human brucellosis in Nanxun and provide evidence for the prevention and control of human brucellosis. Methods The incidence data of human brucellosis in Nanxun were collected for a descriptive epidemiologic analysis. Results A total of 86 cases of human brucellosis were reported in Nanxun from 2012 to 2020, without death, the incidence was lowest in 2016 (0.55/100 000) and the incidence was highest in 2020 (4.39/100 000), the annual reported incidence rate showed a fluctuant increase (trend χ2=3.897, P=0.048). The incidence was higher in local areas, the cases were mainly men and farmers, occupational exposure was the main route of infection, but there was spread to general population. Conclusion The incidence of human brucellosis in Nanxun was in increase, the main reasons were that the occupational population took no protective measures, the sick sheep entered the market without quarantine, and sick sheep were raised with local sheep. It is still necessary to strengthen the joint prevention and control, focus on the prevention and control in occupational groups and at sheep source, expand the health education coverage and improve the awareness of the disease prevention in general population.

Seroprevalence trend of human brucellosis and MLVA genotyping characteristics of Brucella melitensis in Shaanxi Province, China, during 2008-2020.

In this study, a total of 179,907 blood samples from populations with suspected Brucella spp. infections were collected between 2008 and 2020 and analyzed by the Rose Bengal plate test (RBPT) and serum agglutination test (SAT). Moreover, conventional biotyping, B. abortus-melitensis-ovis-suis polymerase chain reaction (AMOS-PCR), and multiple-locus variable-number tandem repeat analysis (MLVA) was applied to characterize the isolated strains. A total of 8103 (4.50%) samples were positive in RBPT, while 7705 (4.28%, 95% confidence interval (CI) 4.19-4.37) samples were positive in SAT. There was a significant difference in seroprevalence for human brucellosis over time, in different areas and different cities (districts) (χ2 = 2 = 32.23, 1984.14, and 3749.51, p < .05). The highest seropositivity (8.22% (4, 965/60393; 95% CI 8.00-8.44) was observed in Yulin City, which borders Inner Mongolia, Ningxia, and Gansu Province, China, regions that have a high incidence of human brucellosis. Moreover, 174 Brucella strains were obtained, including nine with B. melitensis bv. 1, 145 with B. melitensis bv. 3, and 20 with B. melitensis variants. After random selection, 132 B. melitensis were further genotyped using MLVA-16. The 132 strains were sorted into 100 MLVA-16 genotypes (GTs) (GT 1-100), 81 of which were single GTs represented by singular independent strains. The remaining 19 shared GTs involved 51 strains, and each GT included two to seven isolates from the Shaan northern and Guanzhong areas. These data indicated that although sporadic cases were a dominant epidemic characteristic of human brucellosis in this province, more than 38.6% (51/132) outbreaks were also found in the Shaan northern area and Guanzhong areas. The 47 shared MLVA-16 GTs were observed in strains (n = 71) from this study and strains (n = 337) from 19 other provinces of China. These data suggest that strains from the northern provinces are a potential source of human brucellosis cases in Shaanxi Province. It is urgent to strengthen the surveillance and control of the trade and transfer of infected sheep among regions.

Changes in the epidemiological characteristics of human brucellosis in Shaanxi Province from 2008 to 2020

In the present study, surveys of case numbers, constituent ratios, conventional biotyping, and multilocus sequence typing (MLST) were applied to characterize the incidence rate and epidemiological characteristics of human brucellosis in Shaanxi Province, China. A total of 12,215 human brucellosis cases were reported during 2008–2020, for an annual average incidence rate of 2.48/100,000. The most significant change was that the county numbers of reported cases increased from 36 in 2008 to 84 in 2020, with a geographic expansion trend from northern Shaanxi to Guanzhong, and southern Shaanxi regions; the incidence rate declined in previous epidemic northern Shaanxi regions while increasing each year in Guanzhong and southern Shaanxi regions such as Hancheng and Xianyang. The increased incidence was closely related to the development of large-scale small ruminants (goats and sheep) farms in Guanzhong and some southern Shaanxi regions. Another significant feature was that student cases (n = 261) were ranked second among all occupations, accounting for 2.14% of the total number of cases, with the majority due to drinking unsterilized goat milk. Three Brucella species were detected (B. melitensis (bv. 1, 2, 3 and variant), B. abortus bv. 3/6, and B. suis bv. 1) and were mainly distributed in the northern Shaanxi and Guanzhong regions. Three known STs (ST8, ST2, and ST14) were identified based on MLST analysis. The characteristics that had not changed were that B. melitensis strains belonging to the ST8 population were the dominant species and were observed in all nine regions during the examined periods. Strengthened human and animal brucellosis surveillance and restriction of the transfer of infected sheep (goats) as well as students avoiding drinking raw milk are suggested as optimal control strategies.

Epizootiological and Epidemiological Situation on Brucellosis around the World in 2011–2020 and Forecast for the Russian Federation for 2021

Analysis of the incidence of human brucellosis in the world in 2011–2020 is presented in the paper. An assessment of the epizootiological-epidemiological situation on brucellosis in the Russian Federation in 2020 is performed. It is outlined that the epidemiological situation on brucellosis in Russia over the past decade was characterized as unfavorable with downward trend in the incidence rate against the background of persistent epizootiological insecurity among cattle and small ruminants. Between 2011 and 2020, 3507 first identified human cases of brucellosis were registered. The long-term average number of cases is 350 per year, including 28 cases among children under 17 years old. The average long-term intensive morbidity rate per 100 000 people was 0.24, among children under 17 – 0.1. In 2020, 119 human cases of brucellosis were detected in Russia (0.08), which indicates that the trend towards an improvement in the epidemiological situation on brucellosis continues. The largest number of brucellosis cases among people was registered in the North-Caucasian (77.1 % of the total incidence across Russia) and the Southern Federal District (13.5 %). In the period of 2010–2020 (9 months), 4610 areas potentially hazardous as regards bovine brucellosis and 422 – as regards brucellosis in sheep and goats were registered in the Russian Federation. Analysis of the development of brucellosis situation in Russia indicates that in the medium term, with the current trend maintained, there is a real risk of widespread brucellosis distribution among farm animals in the constituent entities of the Central, Volga, Far Eastern and Siberian Federal Districts, as well as the persistence of epizootiological insecurity in the North Caucasus and Southern Federal Districts. Taking into account the current epizootiological-epidemiological situation and the long-term dynamics of the development in the Russian Federation, one can predict the incidence of brucellosis in people at a level below the longterm average values – 0.13–0.18 per 100000 of the population in 2021.

Predictive analysis of the number of human brucellosis cases in Xinjiang, China

Brucellosis is one of the major public health problems in China, and human brucellosis represents a serious public health concern in Xinjiang and requires a prediction analysis to help making early planning and putting forward science preventive and control countermeasures. According to the characteristics of the time series of monthly reported cases of human brucellosis in Xinjiang from January 2008 to June 2020, we used seasonal autoregressive integrated moving average (SARIMA) method and nonlinear autoregressive regression neural network (NARNN) method, which are widely prevalent and have high prediction accuracy, to construct prediction models and make prediction analysis. Finally, we established the SARIMA((1,4,5,7),0,0)(0,1,2)12 model and the NARNN model with a time lag of 5 and a hidden layer neuron of 10. Both models have high fitting performance. After comparing the accuracies of two established models, we found that the SARIMA((1,4,5,7),0,0)(0,1,2)12 model was better than the NARNN model. We used the SARIMA((1,4,5,7),0,0)(0,1,2)12 model to predict the number of monthly reported cases of human brucellosis in Xinjiang from July 2020 to December 2021, and the results showed that the fluctuation of the time series from July 2020 to December 2021 was similar to that of the last year and a half while maintaining the current prevention and control ability. The methodology applied here and its prediction values of this study could be useful to give a scientific reference for prevention and control human brucellosis.

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 45-54years, 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 3months 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.

Human brucellosis epidemiology in the pastoral area of Hulun Buir city, Inner Mongolia autonomous region, China, between 2003 and 2018.

Human brucellosis represents a serious public health concern in Hulun Buir and requires a comprehensive epidemiologic analysis to define adapted control measures. The present study describes the case numbers, constituent ratios and incidence rate of human brucellosis. Conventional biotyping, that is abortus, melitensis, ovis and suis (AMOS)-PCR and multi-locus variable-number tandem repeat analysis (MLVA) were used to characterize the Brucella strains. Between 2003 and 2018, a total of 23,897 human brucellosis cases were reported, with an incidence rate of 56.03/100,000, which is 20 times higher than the country's average incidence. This incidence rate increased year after year, culminating in 2005 and decreased between 2011 and 2018. Because Hulun Buir relies on a nomadic livestock rearing system, brucellosis spreads easily among different animal species and humans. In Xin Barag Left Banner and Xin Barag Right Banner, the incidence rates were, respectively, 226.54/100,000 and 199.10/100,000, exceeding those observed in other areas. Most of the cases occurred in the 25- to 45-year-old group, accounting for 65.74% of the cases (15,709/23,897), and among farmers, accounting for 66.71% (15,942/23,897). The male to female incidence ratio was 2.67:1. The higher incidence in younger people and the large gender ratio reflected the unique traditional production and lifestyle of nomads. Most reported cases were observed from April to June, indicating that more than 40% of the cases were related to the delivery of domestic livestock. The biotyping showed that the 44 isolated strains were all B.melitensis, including 12 Brucella melitensis biovar (bv) 1 and 32 B.melitensis bv. 3. The strains displayed a genetic similarity of 80%-100%. Our hypothesis is that human brucellosis outbreak in this region may be originating from a limited source of infection, so further investigation is necessary. The epidemic situation of human brucellosis in Hulun Buir is extremely serious, strengthened surveillance and control in animals' brucellosis should be priority.

Identification of a small-scale pig farm infected with Brucella suis linked to a clinical case of human brucellosis in Buenos Aires province, Argentina

Here we report a case of human brucellosis due to Brucella suis in a person who worked in a small-scale pig farm. The farm had no history of clinical brucellosis, and signs of the disease were not observed upon clinical examination of the animals. Serum from all the 3 boars, 16/22 sows and 9/25 gilts was obtained for serological examination by Buffered Plate Agglutination Test (BPAT), Rose Bengal Test (RBT) and Fluorescent Polarization Assay (FPA). Bacteriological culture and Direct Fluorescence Antibody Test (DFAT) were performed in tissue samples from a seropositive boar and a sow. Specific antibodies were detected in 53 % (10/19) adult pigs, while all sampled gilts were seronegative. B. suis biovar 1 was isolated from one boar. In contrast, while the bacterium was not isolated from any tissue from a seropositive sow, it was detected by DFAT. From the bacteriological and serological evidence of B. suis endemic infection in the pig farm and the lack of preventive measures and biosecurity practices, it is concluded that the person most likely acquired the disease from the infected animals or by contact with contaminated environment in the farm.

Tracking the Origin of Austrian Human Brucellosis Cases Using Whole Genome Sequencing.

Brucellosis is a zoonotic disease caused by Brucella spp. and a major concern for livestock. Most human cases are caused by B. melitensis and clinical presentation is usually a mild febrile illness. However, treatment failure is frequent and more severe complications can occur. In Austria, every human brucellosis is investigated to determine whether it was imported from endemic areas or is the sign of an undetected autochthonous transmission. For this study, 21 B. melitensis strains isolated in Austria between 2005 and 2019 were collected, 17 strains from 15 different patients and four strains from cattle. Whole genome sequencing combined with core-genome MLST analysis was used to characterize these strains. A cluster of seven isolates from 2018 (three human and four cattle isolates) was identified, with fewer than two allelic differences. They corresponded to the only Austrian B. melitensis outbreak that happened over the past 15 years. The other 12 Austrian brucellosis cases were single cases, and geographical origins were available for 8/12. Genomic data was used to locate probable geographical origins and compared with the results of the epidemiological investigations. Austrian strains were compared with 67 published B. melitensis sequences available on NCBI. The result of genomic analysis matched for 7/8 cases with documented conclusion of the epidemiological investigation. Genome analysis also pointed to the geographical origin for three of the four cases with missing epidemiological data. Strains from six cases were grouped together (<40 allelic differences) with 4/6 cases imported from the Balkans. Additional B. melitensis isolates from Serbian animals were analyzed and grouped with this branch, suggesting frequent importation from Balkan countries to Austria. Overall, this study highlights the specificities of human brucellosis in Austria. It also underlines the value of whole genome sequencing as a tool to investigate brucellosis cases, allowing to identify and investigate outbreaks but also to support epidemiological investigation of imported cases. However, the reliability of such methods depends on the number of strains for comparison, which can be challenging in low incidence countries. Increasing the availability of published sequences with documented geographical origins would help establishing genomic-based methods for investigating brucellosis cases.

Epidemiological Characteristics of Human Brucellosis - China, 2016-2019.

IntroductionBrucellosis is an important zoonotic infectious disease with its main mode of transmission from livestock to humans. The study analyzed epidemiological characteristics of human brucellosis from 2016 to 2019 in China, aiming to understand progress of the National Program of Brucellosis Prevention and Control. MethodsThe research obtained data on human brucellosis cases reported through China’s National Notifiable Disease Reporting System (NNDRS) from January 1, 2016 to December 31, 2019 and described brucellosis epidemiological patterns by region, seasonality, age, sex, and occupation. ResultsThe number of cases reported nationwide in China decreased from 47,139 (3.4/100,000) in 2016 to 37,947 (2.7/100,000) in 2018, and then increased to 44,036 (3.2/100,000) in 2019, with an average annual incidence of 3.0/100,000 during the four study years. Brucellosis in Xinjiang declined from 35.6/100,000 in 2016 to 16.3/100,000 in 2019 — an average annual decrease of 22.9%. Brucellosis in Inner Mongolia increased from 23.8/100,000 in 2016 to 54.4/100,000 in 2019 — an average increase of 31.8% per year and accounting for 22% of all reported cases. Northern China reported 95.2% of cases during this period and still had an incidence of 7.2/100,000 and 87.0% of counties being affected by brucellosis in 2019. In this region in 2019, males aged 45-64 years old had an incidence of over 15.9/100,000, compared with over 7.0/100,000 among females aged 45-64 years old. Conclusionslthough there was progress in prevention and control of human brucellosis in some provincial-level administrative divisions (PLADs) in 2016 through 2019, progress was limited nationwide and there was an overall resurgence of brucellosis in 2019. The resurgence was primarily in Inner Mongolia. An One Health approach should be strengthened to ensure successful and sustainable brucellosis prevention and control in China.

A retrospective survey of Brucella melitensis human infection in Hainan Province, China

In China, brucellosis has spread from the northern provinces to the southern coastal area, and Brucella melitensis has become the overwhelmingly dominant species nationwide. Although human Brucellosis cases have been reported in many parts of Hainan Province, investigations into the source of infection have been rare. In this case, we have used the techniques of bacteriology, genome sequencing, and WGS-SNP to investigate the source of infection on a patient with a traveling history between Hainan and Inner Mongolia autonomous regions. We collected a 5mL blood sample under sterile conditions from this suspected case of Brucellosis infection and incubated it in a culture bottle. A week later, Brucella colonies were purified and identified under the standard bacteriology procedures to show that the strain appeared as B. melitensis bv. 3. Subsequently, a draft genome sequencing of this strain was obtained. A WGS-SNP comparison analysis of Chinese B. melitensis selected (n = 36) from GenBank revealed that the strain in this study was more similar to the strains isolated from China's northern parts, especially those from the Inner Mongolia Autonomous Region. These data indicated that the source of infection of the patient was in the Inner Mongolia Autonomous Region, but the actual location where this patient became infected was unclear. We suggest that travelers from the southern part of China be cautious when visiting the traditional endemic areas of Brucellosis.

Epidemiological Survey of First Human Brucellosis Outbreak Caused by the Sika Deer (Cervus nippon) - Guizhou Province, China, 2019.

What is already known on this topic? Brucellosis is a zoonotic infectious disease caused by Brucella spp. The main source of infection in human brucellosis is sick animals, mainly including sheep, goat, and cattle, but sika deer (Cervus nippon) can also cause human brucellosis. The first human brucellosis case in Guizhou Province was reported in 2009, and no brucellosis outbreak was reported caused by sika deer ever before. What is added by this report? This is the first reported outbreak of human brucellosis caused by sika deer in Guizhou Province. Inappropriate regulation of animal movement may be the main driver of introducing and spreading brucellosis in southern areas. The ability to diagnose brucellosis in both humans and animals was weak in the county where the outbreak took place. What are the implications for public health practice? It was suggested to prioritize occupational protection and health education for sika deer breeders. The inspection of the movement of animals and the reimbursement policy need to be improved.

Comparison of ARIMA model and XGBoost model for prediction of human brucellosis in mainland China: a time-series study

ObjectivesHuman brucellosis is a public health problem endangering health and property in China. Predicting the trend and the seasonality of human brucellosis is of great significance for its prevention. In...

Epidemiological and molecular characteristics of human brucellosis in Qinghai province, 2005-2019

Objective: To analyze the epidemiological and molecular characteristics of human brucellosis in Qinghai province from 2005 to 2019 and provide basic data for brucellosis prevention and control. Method: The data about human brucellosis in Qinghai from 2005 to 2019 were collected from the information system of China CDC to describe the spatial, population and time distributions of human brucellosis cases in Qinghai. The isolated strains were identified and typed with traditional methods, BCSP31-PCR, AMOS-PCR and multi-locus variablenumber tandem repeat (MLVA-16). Results: A total of 577 human brucellosis cases were reported in Qinghai from 2005 to 2019, the average prevalence rate was 0.07 per 100 000 person, there were statistic differences among different years. The disease occurred all the year around, but mainly during March-October. The 577 cases were distributed in 31 counties (cities/districts) from 6 autonomous prefectures (cities). The prevalence rats of five counties were high, i.e. Menyuan Hui autonomous county (22.88%, 132/577), Tianjun county (10.57%, 61/577)、Xining city (10.57%, 61/577), Henan Mongol Autonomous County (10.51%, 58/577) and Haiyan county (9.53%, 55/577). Age of the cases ranged from 8 years to 82 years, and the male to female ratio of the cases was 1.8∶1 (374/203). The prevalence rate in herdsman (47.83%, 276/577) was highest among different occupational populations. Ten isolates were all Brucella melitensis strains, belonging to biovar 3, and clustering analysis indicated that the 10 strains had 5 genotypes, in which 2 were distinct, the remaining 3 were same. MLVA-16 analysis indicated that the 10 strains had close relationship with 26 B. melitensis strains isolated in Qinghai previously. Conclusions: The prevalence of brucellosis increased in Qinghai in recent years, we should strengthen the population based brucellosis surveillance and reporting. MLVA-16 indicated the gene diversity of the Brucella strains, suggesting that MLVA-16 can be used for genetic diversity analysis and molecular epidemiology survey to improve brucellosis surveillance.

Spatiotemporal expansion of human brucellosis in Shaanxi Province, Northwestern China and model for risk prediction.

BackgroundHuman brucellosis imposes a heavy burden on the health and economy of endemic regions. Since 2011, China has reported at least 35,000 human brucellosis cases annually, with more than 90% of these cases reported in the northern. Given the alarmingly high incidence and variation in the geographical distribution of human brucellosis cases, there is an urgent need to decipher the causes of such variation in geographical distribution.MethodWe conducted a retrospective epidemiological study in Shaanxi Province from January 1, 2005 to December 31, 2018 to investigate the association between meteorological factors and transmission of human brucellosis according to differences in geographical distribution and seasonal fluctuation in northwestern China for the first time.ResultsHuman brucellosis cases were mainly distributed in the Shaanbei upland plateau before 2008 and then slowly extended towards the southern region with significant seasonal fluctuation. The results of quasi-Poisson generalized additive mixed model (GAMM) indicated that air temperature, sunshine duration, rainfall, relative humidity, and evaporation with maximum lag time within 7 months played crucial roles in the transmission of human brucellosis with seasonal fluctuation. Compared with the Shaanbei upland plateau, Guanzhong basin had more obvious fluctuations in the occurrence of human brucellosis due to changes in meteorological factors. Additionally, the established GAMM model showed high accuracy in predicting the occurrence of human brucellosis based on the meteorological factors.ConclusionThese findings may be used to predict the seasonal fluctuations of human brucellosis and to develop reliable and cost-effective prevention strategies in Shaanxi Province and other areas with similar environmental conditions.

Human distribution and spatial-temporal clustering analysis of human brucellosis in China from 2012 to 2016

BackgroundBrucellosis is a major public health issue in China, while its temporal and spatial distribution have not been studied in depth. This study aims to better understand the epidemiology of brucellosis in the mainland of China, by investigating the human, temporal and spatial distribution and clustering characteristics of the disease.MethodsHuman brucellosis data from the mainland of China between 2012 and 2016 were obtained from the China Information System for Disease Control and Prevention. The spatial autocorrelation analysis of ArcGIS10.6 and the spatial-temporal scanning analysis of SaTScan software were used to identify potential changes in the spatial and temporal distribution of human brucellosis in the mainland of China during the study period.ResultsA total of 244 348 human brucellosis cases were reported during the study period of 2012–2016. The average incidence of human brucellosis was higher in the 40–65 age group. The temporal clustering analysis showed that the high incidence of brucellosis occurred between March and July. The spatial clustering analysis showed that the location of brucellosis clustering in the mainland of China remained relatively fixed, mainly concentrated in most parts of northern China. The results of the spatial-temporal clustering analysis showed that Heilongjiang represents a primary clustering area, and the Tibet, Shanxi and Hubei provinces represent three secondary clustering areas.ConclusionsHuman brucellosis remains a widespread challenge, particularly in northern China. The clustering analysis highlights potential high-risk human groups, time frames and areas, which may require special plans and resources to monitor and control the disease.

Human Brucellosis as an Epidemic Zoonosis in Zenica-Doboj Canton (Bosnia and Herzegovina) During 2008-2018

Background:Brucellosis is associated with people living in close proximity to their animals, where conditions for disease onset and spread exist. An epidemic of brucellosis in Bosnia and Herzegovina (B&amp;H) has persisted since 2004. Zenica-Doboj Canton is one of the most affected areas.Objective:To investigate the epidemiological characteristics of human brucellosis from the year 2008 to2018.Methods:Data collected from paper-based patients/cases reported to the Epidemiology Department were analyzed.Results:After 2008, the annual number of patients diagnosed with brucellosis was decreasing, except in 2017 and 2018 with 20 and 35 cases, respectively. Within the 2008-2018 period, a total of 263 human brucellosis cases were recorded, decreasing from 102 (incidence of 44.7/100,000) cases in 2008 to three cases in 2012, but increased to 35 cases in 2018. Males were predominant, with a total of 205 (77.9%) cases. The mean age of the affected patients was 39.2 years; but the most affected age group was the 25-49 years age group with 117 (44.5%) cases. Most cases (151 cases, 66%) were reported during the period of March-July, and 242 (92%) cases were from the rural areas.Conclusion:With the implementation of the small ruminant vaccination program in 2009, the number of infected humans had declined, while brucellosis still remains.

How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time.

OBJECTIVESSpatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis.METHODSAn exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas.RESULTSThe spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables.CONCLUSIONSThe cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.

Epidemiology of human brucellosis in Nahavand county, Hamadan Province, western Iran: an 8-year (2010-2017) registry-based analysis.

Brucellosis is an infectious zoonosis, which greatly afflicts human health and animal productivity. To describe the trends and epidemiological characteristics of human brucellosis in Nahavand county, Hamadan Province, western Iran over 8 years (2010-2017). In this registry-based longitudinal study, we analyzed all reported cases of human brucellosis, including 1,130 patients from 2010 to 2017. A checklist including demographic and clinical characteristics of patients with reported cases of brucellosis had been used to gather data. We calculated annual percent changes (APCs) and average annual percent changes (AAPCs) using Joinpoint software to determine the trend of brucellosis using a segmented regression model. Among the patients, 60.9% were male and 87.3% lived in rural areas. The mean age of the patients was 35.9 ± 18.34 years. Compared with male patients, female patients were more affected when they were elderly (15.6% men vs. 24.2% women for those aged ≥55 years) (P = 0.001). Of patients with brucellosis, 65.2% had consumed unpasteurized dairy products and 82.3% had a history of contact with animals. The incidence of human brucellosis in Nahavand county increased between 2010 and 2014, then decreased in 2015, and thereafter remained steady. Per 100,000 population, the AAPC pertaining to the incidence was 17.4 in the male population (95% CI: 4.4, 31.9), 13.8 in the female population (95% CI: 0.2, 29.3), and 16.1 in rural dwellers (95% CI: 2.2, 31.8) indicating an increasing trend from 2010 to 2017 (P < 0.05). The incidence of brucellosis in the western part of Iran is high and remains a challenging health problem. In the present study, age, job, sex, and seasonal changes are important risk factors for human brucellosis.