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21/1/2008Dr. Salwa Tayel (Brucellosis)1 21/1/2008Dr. Salwa Tayel (Brucellosis)2 Associate Professor Family and Community Medicine Department King Saud.

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Presentation on theme: "21/1/2008Dr. Salwa Tayel (Brucellosis)1 21/1/2008Dr. Salwa Tayel (Brucellosis)2 Associate Professor Family and Community Medicine Department King Saud."— Presentation transcript:

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2 21/1/2008Dr. Salwa Tayel (Brucellosis)1

3 21/1/2008Dr. Salwa Tayel (Brucellosis)2 Associate Professor Family and Community Medicine Department King Saud University By Brucellosis Dr. Salwa Tayel

4 21/1/2008Dr. Salwa Tayel (Brucellosis) 3

5 21/1/2008Dr. Salwa Tayel (Brucellosis) 4 Brucellosis is primarily a disease affecting animals. It can be transmitted to humans.Brucellosis is primarily a disease affecting animals. It can be transmitted to humans. Brucellosis is a major health and economic problem in many parts of the world.Brucellosis is a major health and economic problem in many parts of the world. It is an old disease, Sir David Bruce, isolated the causative agent from a soldier in Malta in 1886It is an old disease, Sir David Bruce, isolated the causative agent from a soldier in Malta in 1886 It remains the commonest zoonotic disease worldwide.It remains the commonest zoonotic disease worldwide.

6 21/1/2008Dr. Salwa Tayel (Brucellosis) 5 Magnitude of the problem Globally: More than new human cases of brucellosis annuallyMore than new human cases of brucellosis annually Associated with substantial residual disabilityAssociated with substantial residual disability An important cause of travel-associated morbidity.An important cause of travel-associated morbidity.

7 21/1/2008Dr. Salwa Tayel (Brucellosis) 6 Bioterrorism CDC has declared Brucella as one of three major bioterrorist agents (anthrax, tularemia, brucella) –the epidemic potential –the absence of a human vaccine –the drawbacks of current vaccine strains in animals –the efficiency of aerosol infection –the expense required for the treatment of human brucellosis patients –the financial impact of brucellosis in society.

8 21/1/2008Dr. Salwa Tayel (Brucellosis) 7 Human disease Other animal species affected Natural host Species Less severe Wild animals, water buffalo, camels CattleBrucella abortus Severe Wild ruminant cattle Sheep and Goat & camel Brucella melitensis Severe ( except biovar 2) Various wild species SwineBrucella suis BenignNoneDogBrucella canis Etiologic Agent: Brucella species

9 21/1/2008Dr. Salwa Tayel (Brucellosis) 8 Resistance of brucella Heating at 60ºCFor 10 minutes Phenol 1%For 15 minutes Direct sunlightIn a few hours MilkFor several days Milk(till the milk turns sour) Fresh cheeseFor 3 months Tap-waterFor 57 days Human urineFor 1 week DustFor 6 weeks Damp soilFor 10 weeks Animal fecesFor 100 days

10 21/1/2008Dr. Salwa Tayel (Brucellosis) 9 The new global map of human brucellosis 2006

11 21/1/2008Dr. Salwa Tayel (Brucellosis) 10 The global epidemiology of human brucellosis has drastically changed over the past decade. –because of various sanitary, –Socioeconomic, –political reasons –the evolution of international travel. The new global map of human brucellosis

12 21/1/2008Dr. Salwa Tayel (Brucellosis) 11 Countries traditionally considered to be endemic -e.g. France, Israel, and most of Latin America,Countries traditionally considered to be endemic -e.g. France, Israel, and most of Latin America, Now, they achieved control of the disease.Now, they achieved control of the disease. New foci of human brucellosis have emerged, particularly in central AsiaNew foci of human brucellosis have emerged, particularly in central Asia The new global map of human brucellosis

13 21/1/2008Dr. Salwa Tayel (Brucellosis) 12 Middle East & Asia The situation in central and western Asia is dramatic: Syria has the highest annual incidence worldwide reaching an alarming 1603 cases per million per yearSyria has the highest annual incidence worldwide reaching an alarming 1603 cases per million per year Mongolia, is ranked second (605·9 cases per million)Mongolia, is ranked second (605·9 cases per million) ***In USA the annual incidence of 0·48 cases per million for last ten years (only cases annually)

14 21/1/2008Dr. Salwa Tayel (Brucellosis) 13 Incidence (annual cases per million population) Syria 1,603·4 Iraq 278·4 Turkey262·2 Iran238·6 Saudi Arabia 214·4

15 21/1/2008Dr. Salwa Tayel (Brucellosis) 14 Situation in Saudi Arabia: Distribution: Central & Eastern regions & Asir Regional endemicity varies in Saudi Arabia Due to climatic factors: –rainy season---- increased grass growth.

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17 21/1/2008Dr. Salwa Tayel (Brucellosis) 16 Situation in Saudi Arabia: Between 1956 and 1982Between 1956 and 1982 –only Sporadic human cases of brucellosis. During early 1980s:During early 1980s: –brucellosis emerged as a major public health problem.

18 21/1/2008Dr. Salwa Tayel (Brucellosis) 17 Reasons of the surge in incidence of brucellosis: Intensive sheep/cattle breeding projectsIntensive sheep/cattle breeding projects –minimal veterinary resources Uncontrolled importation of live animals both for Hajj periods and for commercial reasons.Uncontrolled importation of live animals both for Hajj periods and for commercial reasons. –They were poorly screened for infection In addition to, prevailing local custom of drinking raw and warm milk of sheep, goats, and camels, among the population of nomadic background.In addition to, prevailing local custom of drinking raw and warm milk of sheep, goats, and camels, among the population of nomadic background.

19 21/1/2008Dr. Salwa Tayel (Brucellosis) 18 Voting Miss Goat Universe ملكة جمال الماعز

20 21/1/2008Dr. Salwa Tayel (Brucellosis) 19

21 21/1/2008Dr. Salwa Tayel (Brucellosis) 20 Transmission

22 21/1/2008Dr. Salwa Tayel (Brucellosis) 21 The most important route of animal to human transmission of Brucella

23 21/1/2008Dr. Salwa Tayel (Brucellosis) 22 1.Ingestion Consumption of potentially infected milk, milk products, or meat.Consumption of potentially infected unpasteurized milk, milk products, or meat. Unpasteurized cheese, called "village cheese," from endemic areas is a particular risk for touristsUnpasteurized cheese, called "village cheese," from endemic areas is a particular risk for tourists.

24 21/1/2008Dr. Salwa Tayel (Brucellosis) 23 2.Direct contact with infected animals, aborted fetus, the placenta and the discharge from vagina. Accidental self inoculation of vaccines.Accidental self inoculation of vaccines. High Risk Groups slaughter-house workers, meat inspectors, animal handlers and veterinarians.

25 21/1/2008Dr. Salwa Tayel (Brucellosis) 24 3.Inhalation of aerosols containing the bacteria –aerosol contamination of the conjunctiva In the lab, transmission is via aerosolizationIn the lab, transmission is via aerosolization High Risk Groups Laboratory workers.Laboratory workers.

26 21/1/2008Dr. Salwa Tayel (Brucellosis) 25 Other Modes of transmission!!

27 21/1/2008Dr. Salwa Tayel (Brucellosis) 26 Can brucellosis be spread from person to person? Human-to-human transmission is rare. –Bone marrow transplantation from infected donors –Blood transfusion –Sexual intercourse –Neonatal infection; trans-placentally or during delivery – Or probably through breast milk.

28 21/1/2008Dr. Salwa Tayel (Brucellosis) 27 Summary In the Middle East and Africa ingestion of contaminated dairy products is an important route of infection.In the Middle East and Africa ingestion of contaminated dairy products is an important route of infection. In USA, Human brucellosis is primarily an occupational hazard (Lab, Vet)In USA, Human brucellosis is primarily an occupational hazard (Lab, Vet) Whether human beings can become infected via person-to-person spread is rare or uncertain.Whether human beings can become infected via person-to-person spread is rare or uncertain.

29 21/1/2008Dr. Salwa Tayel (Brucellosis) 28 Prevention 1. Eradication of brucellosis in animals is the key to prevention in humans. surveillance, serologic testing, quarantine and massive immunization of animals in areas with high infection ratessurveillance, serologic testing, quarantine and massive immunization of animals in areas with high infection rates legislation to control marketing and movement of animals.legislation to control marketing and movement of animals.

30 21/1/2008Dr. Salwa Tayel (Brucellosis) Brucellosis acquired from milk is preventable Legislation to pasteurization of milk and dairy products.Legislation to pasteurization of milk and dairy products. Public health education to avoid drinking untreated milk and dairy products.Public health education to avoid drinking untreated milk and dairy products. 3. Health education for those occupationally at risk (Use of Safety measures). 4. For other modes of transmission……. Prevention

31 21/1/2008Dr. Salwa Tayel (Brucellosis) 30 Vaccination?! A human Brucella vaccine does not exist.A human Brucella vaccine does not exist. For animals: all are live-attenuated.For animals: all are live-attenuated. Currently, B. abortus RB51 is used to immunize cattleCurrently, B. abortus RB51 is used to immunize cattle B. melitensis REV.1 is used to immunize goats and sheep.B. melitensis REV.1 is used to immunize goats and sheep.

32 21/1/2008Dr. Salwa Tayel (Brucellosis) 31 Thank you Bibliotheca Alexandrina

33 21/1/2008Dr. Salwa Tayel (Brucellosis) 32

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35 21/1/2008Dr. Salwa Tayel (Brucellosis) 34 Brucellosis Clinical description An illness characterized by –acute or insidious onset of fever, –night sweats, –undue fatigue, –anorexia, –weight loss, –headache, and –arthralgia CDC Case Definition

36 21/1/2008Dr. Salwa Tayel (Brucellosis) 35 Laboratory criteria for diagnosis Isolation of Brucella sp. from a clinical specimen, or Fourfold or greater rise in Brucella agglutination titer between acute- and convalescent-phase serum specimens obtained greater than or equal to 2 weeks apart and studied at the same laboratory, or Demonstration by immunofluorescence of Brucella sp. in a clinical specimen CDC Case Definition

37 21/1/2008Dr. Salwa Tayel (Brucellosis) 36 Probable:Probable: a clinically compatible case that is epidemiologically linked to a confirmed case or that has supportive serology (Brucella agglutination titer of greater than or equal to 160 in one or more serum specimens obtained after onset of symptoms) Confirmed:Confirmed: a clinically compatible case that is laboratory confirmed CDC Case classification


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