Food safety and better animal care needed to prevent Brucellosis in Egypt

Egyptian scientists have linked a bacterial disease affecting humans and animals to unsafe animal handling and food preparation. They said that when people don't pasteurise milk or improperly dispose of aborted animal foetuses, their risk of contracting Brucellosis increases.

They further recommended that the government should implement better measures to control the disease, educate people on food safety and how to keep their animals clean and healthy.

Brucellosis, which can be passed from animals to humans, causes symptoms like fever, weakness, and weight loss in humans. In farm animals like cattle and goats, the disease can cause animals to abort their young and produce less milk.

In Egypt, the government has implemented a national programme to control the disease, but the rate of animal infection is still very high. Many people also still contract Brucellosis, making it important for scientists to understand how and why the disease is being transmitted.

In this study, the researchers therefore wanted to find out how much people know about the disease, and whether they take the appropriate precautions when working with animals that might carry it. They were also interested in learning how different factors, like improper food preparation and animal care techniques, affect the chance of someone contracting the disease.

Over a period of two years, the researchers interviewed 217 people who were in hospital with a diagnosis of Brucellosis. They also interviewed another 434 “controls”, or people who did not have Brucellosis, but were at the hospital for other reasons. This type of study, called a case-control study, allows researchers to pinpoint factors that might affect the chances of someone contracting the disease.

The people being interviewed were asked about their knowledge of the disease, whether they had regular contact with animals, their knowledge of proper animal care practices, and which dairy products they usually consumed.

What the researchers found was that many of the people interviewed did not know anything about the disease, even though 40% of them owned susceptible animals. The people with Brucellosis also knew less about how to safely handle animals, and how to make dairy products safe for consumption through pasteurisation, than people in the control group.

One particular issue the researchers noticed, was that the majority of people who kept animals didn’t know how to properly dispose of aborted animal foetuses, and weren’t aware that they should contact the authorities to report these incidents. The researchers say people may therefore unintentionally spread the disease by disposing of foetuses improperly, and that they themselves are at much higher risk because of these practices.

They also found that people in the control group were more likely to take additional protective measures, like having animals vaccinated and keeping their enclosures clean, than people who had the disease.

The researchers say that their study will help the Egyptian government to plan better control interventions in the future. Their study also highlights the importance of proper education for people who keep animals, particularly regarding Brucellosis risks and prevention strategies.

They add that future work should focus on the economic impacts of the disease in Egypt, which together with their study will form the basis for designing a more effective Brucellosis control strategy.

The study provides new information on a disease that is often overlooked in developing countries despite economic and public health effects, and was a collaboration between scientists from Egypt, Australia and the United Kingdom. 

Abstract

Background

Brucellosis is a highly contagious zoonosis affecting human and almost all domestic species. It is a multi-burdens disease leading to severe economic losses due to disability in humans in addition to abortion, infertility and reduced milk production in animals. An Important element for effective prevention and control of brucellosis is to improve knowledge, attitude and practices of the community.

 Objective(s)

This study aimed to assess the knowledge, attitudes and practices (KAP) related to brucellosis at human-animal interface and to determine the risk factors for human infection in the Nile Delta, Egypt.

 Methods

A matched case-control study was conducted at the main fever hospitals located in 6 governorates in the Nile Delta, Egypt between June 2014 and June 2016. Face-to-face interviews with cases and controls was done using a structured questionnaire. Differences in proportions of KAP variables among the cases and controls were evaluated by Pearson’s Chi square test and a p value <0.05 was set as a level of significance. A multivariate conditional logistic regression analysis was built to determine the risk factors for Brucella spp. infection among study participants.

Results

A total of 217 cases and 434 controls matched for age, gender and sociodemographic characteristics were enrolled and interviewed. In total, 40.7% of the participants owned animals in their households and lived in shared accommodation with animals [48.8% of cases vs 36.9% of controls; (p= 0.003)]. The majority (78.1%) used to accommodate cows and buffaloes with sheep and goats. Human brucellosis cases experienced more animal abortions comparing to the controls [(23.5% vs 9.7%, respectively), (p= 0.0003)]. The majority of the participants (82.4%) did not notify authorities in case that abortion occurs in their owned animals. Apparently, 67.4% of the participants [(70.0% of the cases vs 66.1% of the controls) (p = 0.315)] had not ever heard about brucellosis. The overall mean practice score regarding animal husbandry, processing and consumption of milk and dairy products was significantly lower among cases comparing to controls (−12.7±18.1 vs 0.68±14.2 respectively; p<0.0001). Perceived barrier for notification of animal infection and/or abortion was significantly higher among cases (p= 0.034) and positively correlated with participants’ education. Results of univariate analysis showed that participants who have animals’ especially small ruminates were at a higher risk of getting Brucella spp. infection than others. In the proposed multivariate conditional logistic regression model, the predictors of having brucellosis infection were consumption of unpasteurized milk, having consumed dairy products in the last 3 months before the study, consumption of yoghurt or home-made cheeses and involvement in contact with animals [OR (95% CI) = 4.12 (1.62 - 10.75); 2.71 (1.06 – 6.93); 2.51 (1.21 – 5.24); 1.96 (1.17- 3.30), p<0.05; and 4.97 (2.84 - 8.72)], respectively. Participants who take more protective measures against infection were at a significant lower risk of being diseased with brucellosis; [OR (95% CI) = 0.23 (0.10 - 0.58); p<0.001], respectively. A model predicting risk factors for brucellosis among those who own animal showed that frequent abortions per animal increased the chance for brucellosis infection among human cases by 49.33 fold [(95% CI)= (8.79 – 276.91); p= 0.001] whereas the practice protective measures with animals was protective for humans as well [OR (95% CI)= 0.11 (0.03-0.45); p= 0.002].

Conclusion

Consumption of dairy products stands side by side with the contact with infected animals particularly aborted ones as the major risk factors for Brucella spp. infection among humans in Egypt. On the other hand, there is a poor knowledge, negative attitudes and risky behaviors among villagers which increase the magnitude of the risk of brucellosis transmission at the human-animal interface. This supports the need for integrating health education in the national brucellosis control programs in Egypt with a special emphasis on hygienic animal husbandry, disease notification and benefits of animal vaccination.

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