Date Published: February 11, 2018
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Shama Cash-Goldwasser, Michael J. Maze, Matthew P. Rubach, Holly M. Biggs, Robyn A. Stoddard, Katrina J. Sharples, Jo E. B. Halliday, Sarah Cleaveland, Michael C. Shand, Blandina T. Mmbaga, Charles Muiruri, Wilbrod Saganda, Bingileki F. Lwezaula, Rudovick R. Kazwala, Venance P. Maro, John A. Crump.
Little is known about the epidemiology of human brucellosis in sub-Saharan Africa. This hampers prevention and control efforts at the individual and population levels. To evaluate risk factors for brucellosis in northern Tanzania, we conducted a study of patients presenting with fever to two hospitals in Moshi, Tanzania. Serum taken at enrollment and at 4–6 week follow-up was tested by Brucella microagglutination test. Among participants with a clinically compatible illness, confirmed brucellosis cases were defined as having a ≥ 4-fold rise in agglutination titer between paired sera or a blood culture positive for Brucella spp., and probable brucellosis cases were defined as having a single reciprocal titer ≥ 160. Controls had reciprocal titers < 20 in paired sera. We collected demographic and clinical information and administered a risk factor questionnaire. Of 562 participants in the analysis, 50 (8.9%) had confirmed or probable brucellosis. Multivariable analysis showed that risk factors for brucellosis included assisting goat or sheep births (Odds ratio [OR] 5.9, 95% confidence interval [CI] 1.4, 24.6) and having contact with cattle (OR 1.2, 95% CI 1.0, 1.4). Consuming boiled or pasteurized dairy products was protective against brucellosis (OR 0.12, 95% CI 0.02, 0.93). No participants received a clinical diagnosis of brucellosis from their healthcare providers. The under-recognition of brucellosis by healthcare workers could be addressed with clinician education and better access to brucellosis diagnostic tests. Interventions focused on protecting livestock keepers, especially those who assist goat or sheep births, are needed.
Human brucellosis is a major zoonosis worldwide.1,2 It presents as an acute febrile illness3,4 and sometimes progresses to chronic debilitating disease.5 In addition to direct impacts on human health, brucellosis is associated with reproductive failure in domestic animals, resulting in economic losses for communities that rely on livestock for their livelihoods.6,7
Our results point to multiple potential transmission pathways involving several livestock species in the epidemiology of human brucellosis in northern Tanzania. We showed that assisting goat or sheep births and contact with cattle were risk factors for brucellosis. We found that consuming boiled or pasteurized dairy products was protective. We also confirmed that brucellosis remains underdiagnosed by healthcare workers.