A Foodborne Outbreak of Brucellosis at a Police Station Cafeteria, Lima, Peru

Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, California.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 02/2013; 88(3). DOI: 10.4269/ajtmh.12-0606
Source: PubMed


Brucella melitensis is highly infectious for humans and can be transmitted to humans in a number of epidemiological contexts. Within the context of an ongoing brucellosis surveillance project, an outbreak at a Peruvian police officer cafeteria was discovered, which led to active surveillance (serology, blood culture) for additional cases among 49 police officers who had also eaten there. The cohort was followed up to 18 months regardless of treatment or symptoms. Active surveillance estimated the attack rate at 26.5% (13 of 49). Blood cultures from four cases were positive; these isolates were indistinguishable using multiple locus variable number tandem repeat analysis. This investigation indicates the importance of case tracking and active surveillance for brucellosis in the context of potential common source exposure. These results provide rationale for public health investigations of brucellosis index cases including the bioterrorism-related dissemination of Brucella.

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Available from: Joseph M Vinetz, Aug 17, 2015
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    • "As in other infectious disease, lower genetic diversity and crowded effect may favor transmission and select for faster replicating organisms with major zoonotic potential (McDaniel et al., 2013). Examples of these were observed in the early days of brucellosis in Malta (Wyatt, 2005, 2009a), and more recently in foodborne outbreaks in Peru (Román et al., 2013) and massive outbreaks in Inner Mongolia, threatening hundreds of thousands of people. "
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    ABSTRACT: Members of the genus Brucella are pathogenic bacteria exceedingly well adapted to their hosts. The bacterium is transmitted by direct contact within the same host species or accidentally to secondary hosts, such as humans. Human brucellosis is strongly linked to the management of domesticated animals and ingestion of their products. Since the domestication of ungulates and dogs in the Fertile Crescent and Asia in 12000 and 33000 ya, respectively, a steady supply of well adapted emergent Brucella pathogens causing zoonotic disease has been provided. Likewise, anthropogenic modification of wild life may have also impacted host susceptibility and Brucella selection. Domestication and human influence on wild life animals are not neutral phenomena. Consequently, Brucella organisms have followed their hosts' fate and have been selected under conditions that favor high transmission rate. The "arm race" between Brucella and their preferred hosts has been driven by genetic adaptation of the bacterium confronted with the evolving immune defenses of the host. Management conditions, such as clustering, selection, culling, and vaccination of Brucella preferred hosts have profound influences in the outcome of brucellosis and in the selection of Brucella organisms. Countries that have controlled brucellosis systematically used reliable smooth live vaccines, consistent immunization protocols, adequate diagnostic tests, broad vaccination coverage and sustained removal of the infected animals. To ignore and misuse tools and strategies already available for the control of brucellosis may promote the emergence of new Brucella variants. The unrestricted use of low-efficacy vaccines may promote a "false sense of security" and works towards selection of Brucella with higher virulence and transmission potential.
    Full-text · Article · May 2014 · Frontiers in Microbiology
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    ABSTRACT: Neglected Infectious Diseases (NID) affect more than one billion people worldwide, and are associated with poverty, geographic isolation of populations, social stigma, lack of precise data on estimates on both the global and local burden of disease (underreporting of the diseases), inadequate financial and political resources to effective control measures, lack of lobbying on behalf of the most vulnerable population, as well as scarce drug and diagnostic methods development. In this article we describe the relationship between NID, poverty and inequality, we propose a new concept of disease in the tropics, expanding the list of diseases that share characteristics with NID in the Peruvian context, discuss the limited availability of drugs and diagnostic tests to properly deal with these diseases, as well as highlight the contributions by the Peruvian National Institute of Health, and as final thoughts, we state that the solution for the prevention and control of NID must include an integrated approach, including the social determinants of health in the context of the fight against poverty and inequality.
    No preview · Article · Jun 2014 · Revista peruana de medicina experimental y salud publica
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    ABSTRACT: Background: The first case of human brucellosis was reported in 2002 in South Korea, and followed by the incidence, it has been nationally increasing. However, bovine brucellosis, through the management of Animal and Plant Quarantine Agency, has not been discovered from 2003 to date on Jeju Island. Despite Jeju Island previously considered a clean area for bovine brucellosis, we experienced an outbreak of human brucellosis between 2012 and 2013. Methods: We detected patients with human brucellosis between 2012 and 2013 on Jeju Island. The epidemiological, clinical, and microbiological data were collected. We tested for specimens in tissue from wound and blood using nested polymerase chain reaction (PCR) amplification of 16S ribosomal RNA (rRNA) and omp2. Serologic screening with standard tube agglutination (STA) test was performed on those who had a history of a contact with cattles. Results: Between January 2012 and September 2013, 5 cases were identified on Jeju Island. Herein, the cases with Brucella abortus infection after ingested raw fetal materials of cattle at a folk restaurant are reported. All patients were male and immunocompetent. They were infected with brucella by a folk remedy that a raw fetal material would restore general conditions. Four cases were confirmed the isolation of brucella from blood. We investigated folk restaurants and detected a illegal distribution channel of raw fetal materials of cattle. Conclusion: Because all patients developed zoonosis by a wrong folk remedy, we emphasize to enhance an educational program for awareness of zoonosis, active surveillance, detection and a control of illegal distribution channel for brucella infected animals in other areas.
    No preview · Conference Paper · Oct 2014
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