Incidence Of Human Brucellosis Research Articles

The incidence and clinical manifestations of human brucellosis in a referral hospital in Southern Saudi Arabia between 2015 and 2019.

We determined the incidence and clinical manifestations of human brucellosis from patients who attended a referral hospital in South of Saudi Arabia. A record-based retrospective study was conducted from January 2015 to December 2019 at King Abdulla Hospital, Bisha, Saudi Arabia. Information on patients' demographic characteristics, detailed records of signs and symptoms, and the laboratory findings were reviewed. Of 6,586 patients included, 15.8% (n = 1,041) were infected with brucellosis. The age of infected individuals ranged from five to 95 years, with an average of 35.1 ± 21.2 years. Most infected patients were male (72.3%). Young adults (26-44 years) were the most common age group with the disease (34.1%). The annual rate of infection significantly decreased (P < 0.0001) from 33.2% in 2015 to 12.5% in 2019. An escalating number of brucellosis cases was seen in the spring and peaked during the summer. Fever (35.3%), joint pain (25.5%), generalized body ache (10.7%), and neurological symptoms (10.0%) were the most frequent clinical manifestation associated with brucellosis. Joint pain was commonly found among children (44.4%). Neurological findings were more frequent among adult patients. The study concluded that brucellosis is endemic in Southern Saudi Arabia and needs local health authority to implement preventive and educational program measures. Infected patients may present with diverse, nonspecific clinical manifestations that require intuition from clinicians to detect the disease.

Spatial prediction of human brucellosis (HB) using a GIS-based adaptive neuro-fuzzy inference system (ANFIS)

ObjectiveThis study pursues three main objectives: 1) exploring the spatial distribution patterns of human brucellosis (HB); 2) identifying parameters affecting the disease spread; and 3) modeling and predicting the spatial distribution of HB cases in 2012–2016 and 2017–2018, respectively, in rural districts of Mazandaran province, Iran. MethodsWe collected data on the disease incidence, demography, ecology, climate, topography, and vegetation. Using the Global Moran’s I statistic, we measured spatial autocorrelation between log (number of HB cases). We applied the Getis-Ord Gi* statistic to identify areas with high and low risk of the disease. To investigate the relationships between the factors affecting the incidence of HB as input variables together and the factors with the log (number of HB cases) as an output variable, we used the statistical linear regression model and the Pearson correlation coefficient. Then, we implemented a GIS-based adaptive neuro-fuzzy inference system (ANFIS) with two subtractive clustering and fuzzy c-means (FCM) clustering methods to model and predict the spatial distribution of HB. ResultsGlobal Moran's I spatial autocorrelation analysis indicated that the type of HB distribution is clustered in all years except 2014 and 2017, which are random. According to the Getis-Ord Gi* analysis, the location of the hot spots varied during 2012–2018. In 2012 and 2013, most of the hot spots were seen in the west of the province. While in 2018, they were mostly concentrated in the eastern regions of the province. The linear regression model indicated that the parameters affecting the incidence of HB are independent of each other and can explain only 25.3% of the total changes in the log (number of HB cases). The results of the Pearson correlation coefficient showed that there were positive relationships between vegetation, log (population), and the number of sheep and cattle (p-value < 0.05). The above-mentioned factors had the strongest positive correlation with the log (number of HB cases) (p-value < 0.01). These results may be due to the fact that vegetation regions are suitable for livestock grazing, attracting large crowds of people. Therefore, this will increase HB cases. We compared the results of subtractive clustering and FCM clustering methods by evaluation criteria (e.g., linear correlation coefficient (LCC) and mean absolute error (MAE)) in two phases of development and assessment of the ANFIS model. In the assessment phase, we predicted the spatial distribution of log (number of HB cases) in 2017 and 2018 by subtractive clustering (R2 = 0.699, LCC or R = 0.692, MAE = 0.509, MSE = 0.455) and by FCM clustering (R2 = 0.704, LCC or R = 0.697, MAE = 0.512, MSE = 0.448) that showed FCM clustering outperformed the subtractive clustering. ConclusionThe findings may have important implications for public health. The emergence of the hot spots in the east of the province can be a warning to the health system. Health authorities can use the findings of this study to predict the spread of HB and perform HB prevention programs. They can also investigate the factors affecting the prevalence of the disease, identify high-risk areas, and ultimately allocate resources to high-risk regions.

Research on the predictive effect of a combined model of ARIMA and neural networks on human brucellosis in Shanxi Province, China: a time series predictive analysis

BackgroundBrucellosis is a major public health problem that seriously affects developing countries and could cause significant economic losses to the livestock industry and great harm to human health. Reasonable prediction of the incidence is of great significance in controlling brucellosis and taking preventive measures.MethodsOur human brucellosis incidence data were extracted from Shanxi Provincial Center for Disease Control and Prevention. We used seasonal-trend decomposition using Loess (STL) and monthplot to analyse the seasonal characteristics of human brucellosis in Shanxi Province from 2007 to 2017. The autoregressive integrated moving average (ARIMA) model, a combined model of ARIMA and the back propagation neural network (ARIMA-BPNN), and a combined model of ARIMA and the Elman recurrent neural network (ARIMA-ERNN) were established separately to make predictions and identify the best model. Additionally, the mean squared error (MAE), mean absolute error (MSE) and mean absolute percentage error (MAPE) were used to evaluate the performance of the model.ResultsWe observed that the time series of human brucellosis in Shanxi Province increased from 2007 to 2014 but decreased from 2015 to 2017. It had obvious seasonal characteristics, with the peak lasting from March to July every year. The best fitting and prediction effect was the ARIMA-ERNN model. Compared with those of the ARIMA model, the MAE, MSE and MAPE of the ARIMA-ERNN model decreased by 18.65, 31.48 and 64.35%, respectively, in fitting performance; in terms of prediction performance, the MAE, MSE and MAPE decreased by 60.19, 75.30 and 64.35%, respectively. Second, compared with those of ARIMA-BPNN, the MAE, MSE and MAPE of ARIMA-ERNN decreased by 9.60, 15.73 and 11.58%, respectively, in fitting performance; in terms of prediction performance, the MAE, MSE and MAPE decreased by 31.63, 45.79 and 29.59%, respectively.ConclusionsThe time series of human brucellosis in Shanxi Province from 2007 to 2017 showed obvious seasonal characteristics. The fitting and prediction performances of the ARIMA-ERNN model were better than those of the ARIMA-BPNN and ARIMA models. This will provide some theoretical support for the prediction of infectious diseases and will be beneficial to public health decision making.

High incidence of human brucellosis in a rural Pastoralist community in Kenya, 2015.

BackgroundBrucellosis occurs globally with highly variable incidence in humans from very low in North America and Western Europe to high in the Middle East and Asia. There are few data in Sub-Saharan Africa. This study estimated the incidence of human brucellosis in a pastoralist community in Kenya.MethodsBetween February 2015 and January 2016, we enrolled persons living in randomly selected households in Kajiado County. Free health care was offered at three facilities in the study area. Those who met the study clinical case definition completed a standardized questionnaire on demographics, clinical history and presentation. A blood sample was collected and tested by Rose Bengal test (RBT), then later tested at the Kenya Medical Research Institute laboratory for Brucella IgG and IgM by ELISA. Those who tested positive by both RBT and ELISA (IgG or IgM antibodies) were classified as confirmed while those that only tested positive for IgG or IgM antibodies were classified as probable. Further, sera were tested by polymerase chain reaction using a TaqMan Array Card (TAC) for a panel of pathogens causing AFI including Brucella spp. Annual incidence of brucellosis was calculated as the number of confirmed cases in one year/total number in the study population.ResultsWe enrolled a cohort of 4746 persons in 804 households. Over half (52.3%) were males and the median age was 18 years (Interquartile range (IQR) 9 months– 32 years). A total of 236 patients were enrolled at three health facilities; 64% were females and the median age was 40.5 years (IQR 28–53 years). Thirty-nine (16.5%) were positive for Brucella antibodies by IgG ELISA, 5/236 (2.1%) by IgM ELISA and 4/236 (1.7%) by RBT. Ten percent (22/217) were positive by TAC. We confirmed four (1.7%) brucellosis cases giving an annual incidence of 84/100,000 persons/year (95% CI 82, 87). The incidence did not significantly vary by gender, age and location of residence.ConclusionWe report a high incidence of brucellosis in humans among members of this pastoralist community. Brucellosis was the most common cause of febrile illness in this community.

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...

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.

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.

Analysis of the Epidemic and Epizootic Situation on Brucellosis around the World in 2019 and the Forecast for the Russian Federation for 2020

The paper presents the data on brucellosis incidence in a number of countries around the world. An assessment of the epizootic and epidemic situation of brucellosis in the Russian Federation in 2019 is performed. In 2019, Russia maintains the presence of an unfavorable epizootic situation for brucellosis. An increase in the number of brucellosis infected cattle by 14 % and primary foci of small cattle infection by 52 % was established. Epizootics of bovine brucellosis were mainly recorded in the North Caucasus (63.5 %), Southern (19.9 %) and Volga federal districts (7.4 %). The main number of points unfavorable for brucellosis of small cattle, and sick sheep and goats were detected in two federal districts – North-Caucasian (36.8 %) and Southern (26.3 %). The epidemic manifestations of brucellosis in the Russian Federation are closely related to the activity of the epizootic process among the main epidemiologically significant species of farm animals. In 2019, Russia registered 397 human brucellosis cases (0.27 0 / 0000 including 23 (0.08 0 / 0000 among minors. The number of cases of brucellosis and the value of the incidence rate in 2019 are comparable with long-term average data over the past 10 years. The largest number of human brucellosis cases, as in previous years, was established in the North-Western Federal District (278 cases, 70.4 % of the total number of cases) and the Southern Federal District (59 cases, 14.9 %). There is an increase in the relative long-term incidence of brucellosis in the Republic of Dagestan, Voronezh, Penza Regions and the Republic of Kalmykia. In the territories of these subjects in 2019, atense epizootic situation regarding brucellosis among cattle and small cattle was noted. Taking into account the current epizootic and epidemic situation and the long-term dynamics of brucellosis situation development in the Russian Federation, in 2020 it is possible to predict human brucellosis incidence at the level of 0.23–0.27 0 / 0000 .

Spatial-temporal distribution of human brucellosis and its correlation with the number of livestock in Ningxia Hui Autonomous Region, 2012-2018

Objective: To analyze the spatial-temporal distribution characteristics of human brucellosis (HB) in Ningxia Hui Autonomous Region (Ningxia) from 2012 to 2018 and the correlation between HB and the number of livestock stocks, so as to provide reference for the development of preventive measures. Methods: Data on the incidence of HB was collected from the Infectious Disease Report Information Management System of Ningxia, 2012 to 2018. Data related to HB incidence in Ningxia from 2012 to 2018 was then analyzed by global spatial autocorrelation and local spatial autocorrelation analysis methods through the geographic information system (GIS). SPSS (23.0) Spearman correlation was used to analyze the correlation between the incidence of HB and the number of cattle, sheep and pigs. Results: From 2012 to 2018, the incidence of HB showed an overall increase in Ningxia, with an annual growth in 2012-2015 but declined between 2015 and 2018. Results from the global autocorrelation analysis showed that the distribution of HB in the counties and districts of Ningxia appeared non-randomly, with Moran's I value as positive in 2012, 2013 and 2016 indicating the distribution was positive in space. Through local autocorrelation analysis, results showed that "H-H" concentration area was mainly concentrated in central while the "L-L" concentration area was mainly in the northern part of Ningxia. As for the results from correlation analysis between HB and animal husbandry, it showed that the incidence of HB was positively correlated with the number of sheep in stock (r=0.692, P=0.000). Conclusions: The epidemic situation of HB expressed different degrees of aggregation. Areas with high incidence were mostly concentrated in central Ningxia, and with certain degree of correlation with the number of sheep in stock. Corresponding measures should be taken to control the different aggregation situation. Programs on quarantine and immunization for sheep should also be strengthened.

Investigation of human brucellosis cases in newly affected counties in Sichuan province, 2015-2017

Objective: To understand the discovery of human brucellosis cases in new affected counties in Sichuan province, 2015-2017, and provide evidences for prevention and control of human brucellosis. Methods: The incidence data and outbreak data of human brucellosis in Sichuan were collected from Chinese Infectious Disease Surveillance Reporting System, and face to face interview, telephone interview and on-line survey were conducted to collect the case information, such as epidemiological characteristics, medical care seeking. Results: The incidence of human brucellosis in Sichuan has increased obviously since 2013, and 103 counties reported human brucellosis cases for the first time. A total of 23 cases of human brucellosis were investigated, and the common symptoms of the cases was fever, accounting for 91.30% (21/23). The cases mainly sought medical care in hospitals under county-level for the first time, accounting for 73.91% (17/23), and the misdiagnosis rate was 91.30% at the first diagnosis (21/23). The median interval between onset and diagnosis was 52 days, and the longest one was 142 days. Only 4.35% (1/23) cases knew human brucellosis, and when they contacted with suspected livestock, the use rate of protective clothing was 30.43% (7/23), the use rate of gloves was 8.70% (2/23), the use rate of mask was 4.35% (1/23), and the rate of washing hands with disinfectant after contact with livestock was 4.35% (1/23). Goat was suspected to be the infection source of all the cases, and 34.75% (8/23) of the cases were from Gansu, Qinghai and other provinces. The overall awareness rate of human brucellosis in the doctors was 34.58% (102/295), and the training rate was 58.31% (172/295). Only 33.33% (11/33) of the hospitals could perform laboratory diagnosis of human brucellosis and 34.78% (8/23) of county CDCs could carry out laboratory test of human brucellosis. Conclusions: The prevention and control of human brucellosis is facing challenge in Sichuan. The misdiagnosis rate was very high in newly affected counties, and the diagnosis were delayed obviously. The awareness of human brucellosis was low in the cases, and their awareness of self-protection was poor. The awareness rate about human brucellosis in doctors was low and they need more training; the capacity of brucellosis laboratory diagnosis in hospitals and CDCs at county-level should be improved.

An estimate of the incidence and quantitative risk assessment of human brucellosis in mainland China.

Two epidemiological models were applied to simulate whether animals with latent infections were contagious and calculate the outcomes of people that contracting brucellosis by all possible transmission routes under control measures implemented by the Chinese government. The health and economic burden of brucellosis overall presented an increasing trend from 2004 to 2017. Scenarios from epidemiological models showed that a larger scale of vaccine coverage would contribute to fewer infections in livestock and humans. S2 vaccine, the disinfection of the environment and the protection of the susceptible animals and humans could effectively reverse the trend of increasing brucellosis and reduce the incidence rates of brucellosis in humans to curb the epidemic of brucellosis in China.

Epidemiological trends of notified human brucellosis in Germany, 2006–2018

ObjectiveWe describe epidemiological trends of human brucellosis in Germany over a 13 year period based on national surveillance data. MethodsWe analyzed demographic, clinical, laboratory and exposure information of symptomatic laboratory-confirmed brucellosis cases notified 2006–18. Using official population data, we calculated incidences and risk ratios (RR). ResultsFrom 2006 to 2018, 408 brucellosis cases were notified in Germany (mean annual incidence: 0.38/1,000,000 population), of which 75% were travel-associated. Yearly notifications peaked in 2014 (n = 47) and remained elevated compared to 2006–2013 (mean: n = 25). Asylum seekers (AS) arriving in Germany accounted for 9/44 (2015) and 15/36 (2016) cases, respectively. RR AS/non-AS 2015–2016: 28, 95% CI: 17–45. Unpasteurized milk products were most frequently notified as source of infection. Imported food and occupational exposure played a role in autochthonous cases. ConclusionsThe incidence of human brucellosis has markedly increased in recent years. Most of the observed rise in notifications can be explained by infections in AS. Exposure still predominantly occurs abroad. Risk factors for autochthonous infections need to be investigated further, though imported dairy products seem to play a role. Physicians should consider brucellosis as differential diagnosis in AS and people with travel to endemic regions with compatible symptoms.

Analysis of the Epidemiological, Clinical Characteristics, Treatment and Prognosis of Human Brucellosis During 2014-2018 in Huludao, China.

PurposeTo describe the incidence trend, demographic and clinical characteristics, treatment and prognosis, epidemiological history and risk factors of human brucellosis in Huludao, China.Patients and MethodsA total of 1887 brucellosis patients were reported in Huludao, China from January, 2014 to December, 2018 and the case questionnaires from 1149 patients were collected from Huludao Municipal Center for Disease Control and Prevention. Demographic characteristics of the patients and the information relating to the patients’ clinical manifestations, diagnosis, treatment and prognosis were collected and analyzed.ResultsThe number of annually reported brucellosis patients has dropped from 711 to 187 during the study period, with the incidence decreased from 27.31/100,000 in 2014 to 7.15/100,000 in 2018. A total of 1149 individual data were collected, with a mean age of 49.59±13.14 years and 75.7% were male. Patients aged more than 60 years were more likely to have arthralgia/myalgia than the other age groups, and patients who had an enlarged spleen in male were more than female (P<0.05). There were more acute brucellosis cases, less sub-acute and chronic brucellosis cases in the ethnic minority (83.6%, 5.5% and 11.0%, respectively) than that in the Han nationality (64.7%, 22.2% and 13.0%, respectively, P<0.05). For antibiotic therapy, “Doxycycline plus rifampicin or streptomycin” was the most commonly used drug combination. Sheep/goat was the main contacted animal and feeding/grazing was the most frequent transmission route; no personal protective measures were the major risk factor.ConclusionThe incidence of human brucellosis is still high in Huludao, China, and this is mostly associated with contacting with domestic animals and barely taking protective measures. The most common clinical manifestations of brucellosis patients in Huludao were fatigue, hyperhidrosis, fever, and arthralgia/myalgia, the most common route of exposure was feeding and grazing, and the major species of livestock was sheep/goat. The most commonly adopted treatment option was antibiotic therapy, and most patients responded well to treatment. The integrality and accuracy of the notifiable epidemiological case questionnaire needs to be improved in order to provide more factual and objective information for both the physicians and policy-makers.

Spatial-temporal distribution of human brucellosis in mainland China from 2004 to 2017 and an analysis of social and environmental factors

BackgroundThis study aimed to describe the changing distribution of human brucellosis between 2004 and 2017 in mainland China and seek scientific evidence of the relationship between socio-economic, environmental, and ecological factors and human brucellosis incidence.MethodsThe annual numbers of brucellosis cases and incidence rates from 31 provinces in mainland China between 2004 and 2017 were obtained from the Data-Center for China Public Health Science. The number of monthly brucellosis cases in 2018 was obtained from the Chinese Center for Disease Control and Prevention. The electronic map of the People’s Republic of China was downloaded from the National Earth System Science Data Sharing Platform. Human population density, gross domestic product (GDP), and an inventory of cattle and sheep at the end of each year from 2004 to 2017 were obtained from the National Bureau of Statistics of China. Annual rainfall data from 31 provinces in the People’s Republic of China from 2004 to 2017 were collected from the China Meteorological Data Service Center. The risk distribution and changing trends of human brucellosis were mapped with ArcGIS. A cluster analysis was employed to identify geographical areas and periods with statistically significant incidence rates. Multivariate linear regression was used to determine possible factors that were significantly correlated with the presence of human brucellosis cases.ResultsHuman brucellosis cases have spread throughout the whole country. Human brucellosis cases occurred mostly from March to August and were concentrated from April to July. The inventory of sheep, GDP, and climate were significantly correlated with the presence of brucellosis cases in mainland China.ConclusionsThe geographical expansion of human brucellosis in mainland China was observed, so did the high-incidence clusters between 2004 and 2017. Most of the cases were reported during the early spring to early summer (February–August). Results from the multivariate linear regression suggested that the inventory of sheep, GDP, and climate were significantly associated with the incidence of human brucellosis in mainland China.

A primary investigation of the relation between the incidence of brucellosis and climatic factors in Iran

Brucella spp. are Gram-negative coccobacilli that may grow in different media and environmental conditions for extended periods of time. The survivals of these bacteria in the environment have an important impact on the epidemiology of brucellosis worldwide. The effect of climate on the incidence of certain zoonotic infectious diseases, (recently referred to as climate-sensitive zoonosis) is now well established. The aim of this study was to evaluate the relation between the incidence of brucellosis and climatic parameters in Iran, an important endemic region for brucellosis with diverse climate. The information on the incidence of human brucellosis in different Iranian provinces for 2016 has been provided by the Ministry of Health and Medical Education, Iran. Annual meteorological data collected between 2015 and 2016 were obtained from the Iranian Meteorological organization (IMO). A regression analysis of the incidence of brucellosis was performed via STATA 14.0 and the heterogeneity among observations was determined via Cochrane's Q-test and I2 statistic. If I2 index was higher than 50%, heterogeneity was considered as considerable. The results of regression analyses revealed a negative significant association between mean ambient air temperature and brucellosis incidence (C = - 0.022, P value = 0.004). Likewise, a positive significant association was found between number of frosty days and brucellosis incidence (C = 0.002, p value = 0.003). Other metrological parameters showed no significant effect on the human brucellosis incidence. Although our results suggest a high degree of temperature sensitivity in regards to the brucellosis incidence in Iran, this study opens up prospects for further investigations regarding environmental conditions and climatic changes influencing the spatial distributions and seasonal/annual cycle of this zoonotic pathogen worldwide.

Potential Effects of Climatic Parameters on Human Brucellosis in Fars Province, Iran, during 2009-2015.

Background:Human brucellosis is widespread in Fars province. The present study aimed to investigate the effect of climate on its incidence and determine the areas prone to the infection. Methods:Monthly meteorological data and the incidence rate of human brucellosis during 2009-2015 were collected and their correlation was studied using Pearson’s correlation coefficient. Additionally, the multiple regression method and multi-layer perceptron neural network model were used to predict the incidence of human brucellosis. In order to analyze the data SPSS software (version 16.0), MATLAB software (version 8.1), and GIS software (version 10.4) were used. Results: Pearson’s regression analysis, on a monthly basis, showed a significant indirect correlation between the incidence of human brucellosis (with a time lag of up to 5 months) and climatic parameters (minimum temperature: -0.72 and evaporation: -0.73) in Abadeh (Fars, Iran). Moreover, there was a significant direct correlation (P<0.001) between the incidence of human brucellosis and the maximum relative humidity (+0.67) and rainfall (+0.48). The incidence of human brucellosis in Abadeh was predicted by using artificial neural network models (4 layers, 4 neurons in each layer), the Levenberg-Marquardt training algorithm, and Sigmoid transfer function. It was determined that a correlation rate of 0.89 in the training level and 0.8 in the test level (with the lowest error rate) were the best values in multi-layer perceptron modeling. Conclusion: Climatic parameters are important factors in determining the incidence rate of human brucellosis in Fars province. Climate conditions provide a favorable environment for the spread of human brucellosis in this area.

An exploratory study of factors associated with human brucellosis in mainland China based on time-series-cross-section data from 2005 to 2016.

ObjectiveMany studies focused on reasons behind the increasing incidence and the spread of human brucellosis in mainland China, yet most of them lacked comprehensive consideration with quantitative evidence. Hence, this study aimed to further investigate the epidemic mechanism and associated factors of human brucellosis so as to provide thoughts for future countermeasures in China and the rest of the world.MethodsData of human brucellosis incidence and some associated factors in economy, animal husbandry, transportation as well as health and hygiene were collected at provincial level from 2005–2016. Time series plots were first used to visualize the annual incidence and annual rate of change of human brucellosis for each province, then cluster analysis categorized all the 31 provinces of mainland China based on their incidence time series during the study period. In addition, according to the characteristics of data, the dynamic panel data model in combination with supervised principal component analysis was proposed to explore effects of associated factors on human brucellosis.Results1. The incidence rate of human brucellosis in mainland China increased three-fold from 1.41 per 100,000 people in 2005 to 4.22 per 100,000 people in 2014, though it went down a little in 2015 and 2016. Incidence rates in the north have always been higher than those in the south, but the latter also experienced an upward trend especially between 2012 and 2016. 2. The 31 provinces of mainland China were categorized into three clusters, and each cluster had its own characteristics of incidence time series. 3. The impact of health and hygiene situations on the prevention and control work of human brucellosis was still very limited and trivial (regression coefficient = -0.02). Therefore, it was plausible to presume that improving the personal average number of medical institutes and the proportion of rural medical expenditure might be helpful in preventing and controlling human brucellosis.ConclusionsThe epidemic status of human brucellosis has changed in both spatial and temporal dimensions in recent years in mainland China. Apart from traditional control measures, more attention should be paid to the improvement of medical healthcare especially in rural areas in the hope of enhancing the control effect.

The use of CaSO4 drug delivery system in transforaminal lumbar interbody fusion for spinal brucellosis

ObjectivesThe incidence of human brucellosis has risen dramatically in China with few reports regarding the operation on spinal brucellosis. In this retrospective study we introduced CaSO4drug delivery system into the TLIF surgical procedure and evaluated its clinical effectiveness and feasibility. Patients and Methods36 patients with lumbar brucellosis were enrolled and treated by posterior transforaminal decompression, instrumentation and fusion. Prepared CaSO4 beads carrying doxycycline were placed into the disc space and around pedicle screws. The activity of infection and pain-related function scales were recorded. Neurologic and functional recovery was evaluated using ASIA and Kirkaldy-Willis scale. Segmental and overall lordotic angles were measured and fusion status was assessed at final follow up. ResultsThe average follow-up period was 15.6 ± 3.73 months. The level of ESR and CRP returned to normal at 3 months post-op. 14 patients with ASIA grade D pre-op returned ASIA grade E with 3 months. The improvement of VAS and ODI was 82% and 85.8% at 3 months post-op. The corrections of segmental and overall lordotic angle were 5.98 ± 3.54° and 6.24 ± 7.93°. 69% of patients reached definitive union at 12 months after surgery. The satisfactory rate on Kirkaldy-Willis functional outcome criteria was 88.9%. ConclusionThe use of CaSO4 drug delivery system during single-stage TLIF for spinal brucellosis was safe and showed no negative impacts on fusion status and neurological function recovery. Our results are promising and the drug delivery system may be considered as a choice for future treatment in spinal brucellosis or other spondylodiscitis.

Spatio-temporal cluster and distribution of human brucellosis in Shanxi Province of China between 2011 and 2016

In recent years, the incidence of human brucellosis (HB) in the Shanxi province has ranked to be the top five among the 31 China provinces. HB data in Shanxi province between 2011 and 2016 were collected from the Centers for Disease Control and Prevention. Spatial and temporal distribution of HB was evaluated using spatial autocorrelation analysis and space-time scan analysis. The global Moran’s I index ranged from 0.37 to 0.50 between 2011 and 2016 (all P < 0.05), and the “high-high” clusters of HB were located at the northern Shanxi, while the “low-low” clusters in the central and southeastern Shanxi. The high-incidence time interval was between March and July with a 2-fold higher risk of HB compared to the other months in the same year. One most likely cluster and three secondary clusters were identified. The radius of the most likely cluster region was 158.03 km containing 10,051 HB cases. Compared to the remaining regions, people dwelling in the most likely region were reported 4.50-fold ascended risk of incident HB. HB cases during the high-risk time interval of each year were more likely to be younger, to be males or to be farmers or herdsman than that during the low-risk time interval. The HB incidence had a significantly high correlation with the number of the cattle or sheep especially in the northern Shanxi. HB in Shanxi showed unique spatio-temporal clustering. Public health concern for HB in Shanxi should give priority to the northern region especially between the late spring and early summer.

A study to identify the practices of the buffalo keepers which inadvertently lead to the spread of brucellosis in Delhi

BackgroundIndia has the largest Buffalo population in the world, with every household in rural India owning buffaloes depending upon daily milk requirement – dairy farmers can own between 10 to 70 buffaloes. The health of Indian buffaloes is of economic importance since India is one of the largest buffalo meat exporters in the world, and Indian Buffalo semen is sold in the USA for breeding purposes. However, National Control Program on brucellosis is only active in South India and in Panjab (a North Indian state with high human brucellosis incidence). Our aim was to assess the knowledge and practices of the buffalo keepers of Delhi that make them susceptible to brucellosis.ResultsAmongst all the 11 districts of Delhi, there was 0% awareness about brucellosis and also about the S19 vaccine as the buffalo keepers had never heard of S19 vaccine which is available at minimal cost from Indian Veterinary Research Institute, Bareilly, India. Majority of the respondents drink raw milk, sleep in cattle sheds, do not isolate sick cattle, do not test buffaloes blood for any disease before purchasing them, apply intrauterine medication with bare hands to buffalo after abortion of foetus, never clean their cattle sheds with a disinfectant and believe that they can only acquire skin infections from cattle. All of these habits make them prone to brucellosis. While about 20 to 27% of respondents reported a history of abortions and retained placenta, disposed of the placenta with bare hands, and applied raw milk on cracked lips. It was surprising to note that majority of them never reared small ruminants like sheep and goat with buffaloes or Bos species as they were aware of the rapid spread of disease from small to big ruminants.ConclusionsWe found that buffalo keepers were ignorant of brucellosis, its causative agent, relevant vaccines and that they also involved in high-risk activities. As such, our findings highlight a need for buffalo keepers to be better educated via several awareness camps to minimize human exposure to Brucella in Delhi.