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Abstract
Aim:
To evaluate the current practices in laboratory disease detection, biosafety and biosecurity measures and information-sharing systems available to the public health systems in R. Macedonia and the Balkan region.
Methods:
Epidemiological studies were reviewed from the region to examine the high incidence of localized forms of human brucellosis.
Results:
There is clearly a need for the development of a South Eastern European regional network for sharing information aimed at disease surveillance, early reporting and efficient containment of human brucellosis. Given the zoonotic nature of the disease's onset and progression, public health strategies aimed at containing and eventually eliminating human brucellosis require a broader national and regional bioengagement framework that involves human and veterinary diseases detection systems, deployment of medical countermeasures, epidemiology and a supportive laboratory infrastructure, strategic stockpiles and information sharing.
Conclusions:
A systems-centric framework for a national and regional strategy to combat human brucellosis is essential, and should be comprised of: a) a disease threat and surveillance framework at the national and broader regional level, b) laboratory performance evaluation metrics, c) best practices for information-sharing and regional coordination, and d) a coordinated regional strategy to improve biosafety and biosecurity.
... A big number of participants from the SEE and other countries, invited key-note speakers and representatives from FAO and European Commission, in their presentations and discussion at the Conference, and afterwards in the papers prepared for publication in the scientific journal thematic issues, expressed their views and experiences in control and eradication of brucellosis and pointed out that B. melitensis infection in sheep and goats and brucellosis in humans in many SEE and Mediterranean countries has re-emerged or situation has worsen over the last more than 10 years. Brucellosis, from low prevalence became an important endemic disease, especially in the Balkans, with high prevalence in sheep and goats, as well as in humans [5][6][7][10][11][12][13]. In part, this has been the result of political changes, conflicts and wars in the new countries established in early 1990s after the breaking apart of the former Yugoslavia [8,11,14]. ...
... continuous surveillance and reporting are necessary for animal/herd identification and risk analysis, to monitor the presence/absence of brucellosis in herds/ flocks, to monitor the efficacy of the control programs, and to ensure early warning against spread of disease/infection to new areas. The surveillance and reporting systems should include domestic animals and wildlife disease control methods, including the use of vaccination under certain circumstances, with a relevant corresponding human continuum [5,10,18,[25][26][27][28]. ...
... 7. Besides general and occupational hygiene measures from veterinarians and cattlemen, awareness programs and health education, especially for the rural populations by utilizing a wide variety of media technologies, and education of all personnel involved are essential [8,10,29]. ...
Aim. To present main outputs of the International Scientific Conference on Brucellosis in South Eastern Europe (SEE) and Mediterranean Region, held in Struga, Republic of Macedonia, Nov. 12-14, 2009, and to summarize the weak points and constraints for implementation of the current brucellosis control programs in the SEE countries, as well as main components and directions for perspective developments of brucellosis prevention, control and eradication strategies at national and regional levels. Methods. Retrospective study based on the presentations and discussions recorded at the conference, selected published papers from participants in the scientific journal thematic issues on brucellosis, and a review of the relevant literature. Results. Networking and exchange of knowledge and experiences among the participants at the conference, together with the adopted declaration for intersectoral and regional collaboration and prepared thematic issues on brucellosis in three scientific journals will have important influence for the future control and eradication of brucellosis in SEE countries. Re-emergence or worsening the situation with brucellosis in many SEE countries indicates weaknesses in the control programs and insufficient organization and collaboration in their implementation. Vaccination and test and slaughter of infected animals need to be accompanied with appropriate herd management, public awareness and health education programs. Conclusion. Brucellosis is a serious concern in many SEE countries which needs comprehensive approach and investments in long-term, with sound strategies and programs for control and eradication, strengthening intersectoral and regional collaboration between all countries in the SEE region, with technical and financial support from European Commission and relevant international organizations.
... Identification and reporting of sick animals is necessary for risk analysis and monitoring of control programs. The surveillance and reporting system should include both domestic and wild animals [77]. ...
The buffalo (Bubalus bubalis) is one of the most important livestock having great promise and potential as an economically important animal and is usually referred to as "black gold of South Asia". It plays an important role in the economy by contributing milk, meat, hide and draft power for various agricultural maneuvers. However, buffaloes are regarded as poor breeders in general because of a long postpartum anestrus; late attainment of puberty and maturity, which may further be complicated by abortions. Abortion is the most important condition that limits the dam's ability to produce a calf and considerably harms profit of the dairy industry. It is defined as fetal death and expulsion between 42-300 days of gestation in buffalo. Actually, 42 day is the estimated time for attachment and 300 day is the age at which a fetus is capable of surviving outside the uterus. This condition does not include fetal maceration and mummification. The greatest risk of fetal loss is during the first trimester of gestation which then progressively decreases as gestation advances with a slight increase in the risk toward the last month of gestation. Abortion rate of 3 to 5 abortions per 100 pregnancies per year on an animal farm is often considered normal but if fetal loss is more than 3%-5% per year then it becomes a matter of concern for owner as well as veterinarians. Loss of any pregnancy can represent a significant loss of income to the producer and appropriate action should therefore be taken to prevent abortions and to investigate the cause of abortions. On the basis of nature of abortifacient agents, abortion can be considered as non-infectious or infectious. But, abortions of infectious nature are more important as they largely result into abortion storms (>10% abortion per year) or abortion outbreaks and require specific control measures for their management. Non-infectious causes may also be responsible for outbreaks of abortion (e.g. feed mycotoxin), making identification of abortifacient agent a critical part of any abortion investigation. This chapter describes the important infective abortifacient agents that have so far been recognized for causing abortion in buffaloes. A wide variety of infectious agents have been found associated with abortion in buffaloes which include viruses, bacteria, and protozoa. Determining the cause of an abortion is very complex process and attempts to arrive at a diagnosis are frequently frustrating and unproductive. Effective control measures in cases of infectious abortion require accurate diagnosis, specific treatment and vaccination.
Objective: Anthrax is a notifiable disease in many countries including Turkey. Spatial statistics and spatial analysis methods those are included in Geographical Information Systems (GIS) software’s modules, began to receive increasing attention. GIS have had a place in public health and epidemiologic investigations. Therefore, we aimed to explore presence of regional clustering of anthrax in Turkey, using explorative spatial analyses.
Material and Methods: The recorded anthrax cases (1989-2006) by Turkish Ministry of Health (totally 7145), and demographic data from Turkish Statistical Institute were used for analyses. Empirical Bayes smoothing is used to remove background noise from the raw disease rates because of the sparsely populated cities and the ones with small number of cases. To detect global variations and trends in the values of smoothed rates over the neighboring provinces, spatial rate smoothing based on spatial moving areas technique is performed. Spatial analyses, including local and global spatial autocorrelation methods were performed to the anthrax cases (1996-2006), to detect any trend or cluster for any particular provinces.
Results: There has been a decrease in the number of anthrax cases after the year 2001 according to the records. Spatial analyses of 4543 anthrax cases showed a trend towards to the eastern region of Turkey. Spatial analyses of the anthrax showed that the cases are not spatially random the eastern region of Turkey. Global spatial autocorrelation indices indicated significant clustering of Anthrax in the eastern region of Turkey (Moran’s I: 0.08 p<0.01, Geary’s C: 0.77 p<0.01).
Conclusion: This study shows that Anthrax is a serious public health concern in the especially eastern region of Turkey, and that region should have a priority to implement precautionary measures. It also shows that spatial analyses and statistics can contribute to understanding epidemiology of diseases, and identifying high rate disease locations.
(0) Castillo-Chavez, Carlos Castillo-Garsow, Carlos W Yakubu, Abdul-Aziz JAMA. 2003 Dec 3;290(21):2876-7.
The aim of the study was to determine the evolution and outcome of human brucellosis in an endemic region in relation to time interval. Retrospective analysis was employed to compare demographic, epidemiological, clinical, laboratory features and the outcome of patients with brucellosis, treated at University Department of Infectious Diseases in Skopje during two different periods of time. A series of 159 patients were studied in the first (1990-1991) and 138 in the second (2003-2005) study period. Patients treated in the second period were older (34.6+/-20.9 vs. 30.0+/-17.7 years; P=0.041) and acquired brucellosis less frequently on ingestion of incriminated food (34.8% vs. 47.2%; P=0.031). Focal forms were more evident in the second period (66.7% vs. 50.3%; P=0.004), mainly due to osteoarticular localization. Post-treatment follow up was more efficient in the second group (76.1% vs. 61%; P=0.005). There was no difference according to disease outcome in spite of different therapeutic trials during the two study periods. In conclusion, the established differences showed an improvement in the understanding of the disease by the general population as well as upgrading of some aspects considering medical activities. Nevertheless, this endemic region still lacks the most important measure, i.e. development and implementation of an appropriate national program for efficient control of the disease.
Brucella has traditionally been considered a biological weapon. It was the subject of extensive offensive research in the past, and still belongs to category B pathogens on most lists. Its propensity for airborne transmission and induction of chronic debilitating disease requiring combined antibiotic regimens for treatment, its abundance around the world and its vague clinical characteristics defying rapid clinical diagnosis are some of the characteristics that apply to the pathogen's weapons potential. Yet minimal mortality, availability of treatment options, protracted inoculation period and the emergence of new, more virulent potential weapons means that its inclusion among agents of bioterrorism is nowadays mainly of historical significance. Nevertheless, in the interest of literacy and of avoiding panic, physicians and the public both should be aware of the most common zoonosis worldwide.
The aim of this study was to describe some demographic, clinical and laboratory characteristics, and to evaluate the outcome, in patients with brucellosis in an endemic area in the Balkan Peninsula, and to reveal the differences between patients with and without occupational exposure.
The study was carried out at the Clinic for Infectious Diseases in Skopje over a period of seven years. Four hundred and eighteen patients with brucellosis were enrolled and classified into two groups: patients with (251) and without (167) occupational exposure.
Two hundred and twenty-eight (54.5%) of the patients had a positive family history. The most common clinical manifestations were arthralgia (81.8%), sweating (71.5%), localized disease (67.7%) and subjective fever (68.4%), whereas elevated values of C-reactive protein (78.9%) and circulating immune complexes (75.8%) were the most frequent laboratory abnormalities. Relapses and therapeutic failure were registered in 16.2% and 10.4%, respectively. Male gender, positive family history and arthralgia were more prevalent in those with occupational exposure, while pediatric age, fever and anemia were inversely correlated with occupational exposure.
Human brucellosis is a serious problem in the Republic of Macedonia presenting with a high percentage of localized forms, relapses and therapeutic failures. The risk factor for acquiring the disease had no influence on the outcome.
New regulations on the possession, transfer and use of biological agents and toxins have provided the regulatory premise to introduce institutional-level biosecurity practices at research laboratories handling Select Agents and other infectious materials. However, clinical and public health laboratories licensed under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) that do diagnostic testing, verification, or proficiency testing are generally exempted from the regulations. Although a CLIA laboratory director is required to notify the Department of Health and Human Services immediately upon identifying specific Select Agents, a prevailing opinion is there is no reporting mechanism for diagnostic test results. CLIA Laboratories are required to adhere to established biosafety guidelines, but face fewer biosecurity-driven restrictions on their behavior, and are often more vulnerable compared to research laboratories to diversion of Select Agents and other agents of public health concern for malevolent uses. International laboratories involved in proficiency testing programs routinely receive agents of public health concern, and lack biosecurity status and reporting mechanism. This applies also to international shipping companies involving in transport of agents of public health concern under the proficiency testing programs. This paper reviews the emerging consensus on whether CLIA exemption fundamentally compromises on the biosecurity goals of the new regulations, and options for addressing biosecurity of Select Agents and other agents of public health concern for international CLIA Laboratories and shipping companies.
The objective of this paper is to give an overview of the epidemiologic and epizootic status of brucellosis in selected countries of Central and Southeast Europe (Balkan region). Based on dimension of the disease problem, there is a need to establish collaboration in the eradication and prevention of brucellosis between all countries in the region. Although there were no readily accessible data concerning epidemiology and epizootology of brucellosis in these countries, the limited official and published data were analyzed. The incidence of brucellosis caused by Brucella melitensis in sheep, goats and humans is a very significant problem in Macedonia and Greece. In Greece, cattle are also affected either by B. melitensis or B. abortus. The disease is an endemic problem in some regions of Yugoslavia and includes B. suis biovar 2 in pigs and in Croatia, B. melitensis in sheep, goats and human is found occasionally. No problem appears to exist with brucellosis in Bulgaria. Financial well-supported brucellosis control programs of the European Union that will include all countries, regardless of the magnitude of brucellosis incidence, are needed for eradication and control of brucellosis.
A hazard assessment of Venezuelan equine encephalitis (VEE) virus sub-types and vaccine candidates was performed according to standard risk assessment procedures. Data from published literature demonstrates a considerable degree of safety of V3526 when compared to TC-83 vaccine, the protective measure that has been used to protect laboratory workers for over four decades. V3526 is a new recombinant vaccine candidate that is a vastly different product with a diminished hazard to public health and the general environment. A weight-of-evidence (WOE)-based scheme was employed to assign weights for relevance, quality, and adequacy of evidence in published literature on medical pathology, epidemiology, pre-clinical investigational studies, and environmental studies. The results of this assessment indicated that V3526 has a low adverse impact on public health and the general environment. Although there are currently no human infectivity or pathogenicity data for V3526, existing evidence from published experimental animal studies reveals a diminished hazard for environmental transmission and distribution. Recently, the US Centers for Disease Control and Prevention (CDC) excluded V3526 from select agent requirements set forth under the Health and Human Services (HHS) regulations in Title 42 C.F.R. Part 73 and the US Department Agriculture (USDA) regulations set forth in Title 7 C.F.R. Part 331 and Title 9 C.F.R. Part 121. This paper summarizes the background, rationale, and hazard analysis used for assessing the environmental hazard of the VEE vaccine candidate strain V3526.
DynPort Vaccine Company (DVC) LLC, a CSC Company, is under a contract with the United States Department of Defense Joint Vaccine Acquisition Program (JVAP) to develop, test and license safe and efficacious vaccines against biowarfare agents. As part of this program DVC is conducting a comprehensive toxicological assessment of the safety of V3526, a live attenuated Venezuelan Equine Encephalitis (VEE) vaccine candidate. Our review of the published pre-clinical toxicology literature, together with the data collected from DVC-sponsored investigations indicated V3526 was comparatively safer and more efficacious than TC-83, the current VEE Investigational New Drug (IND) status vaccine. Non-clinical toxicity studies on experimental systems ranging from mouse, guinea pig, equine and non-human primates (NHP) consistently revealed the V3526 vaccine candidate superior in terms of safety and related toxicological parameters such as neurovirulence when compared with the TC-83. Our experimental investigations indicated that V3526 may conform to the key requirements of a VEE virus vaccine, in that, (a) it elicits a high level of immunogenic response in mice and hamsters, both sensitive to VEE-induced pathologies, and (b) it induces a protective response in the NHP model when challenged with either virulent IA/B or IE viruses. Additional studies are underway to further confirm these findings.
Infection with Brucella spp. continues to pose a human health risk globally despite strides in eradicating the disease from domestic animals. Brucellosis has been an emerging disease since the discovery of Brucella melitensis by Sir David Bruce in 1887. Although many countries have eradicated B. abortus from cattle, in some areas B. melitensis and B. suis have emerged as causes of this infection in cattle, leading to human infections. Currently B. melitensis remains the principal cause of human brucellosis worldwide including India. The recent isolation of distinct strains of Brucella from marine mammals as well as humans is an indicator of an emerging zoonotic disease. Brucellosis in endemic and non-endemic regions remains a diagnostic puzzle due to misleading non-specific manifestations and increasing unusual presentations. Fewer than 10% of human cases of brucellosis may be clinically recognized and treated or reported. Routine serological surveillance is not practiced even in Brucella - endemic countries and we suggest that this should be a part of laboratory testing coupled with a high index of clinical suspicion to improve the level of case detection. The screening of family members of index cases of acute brucellosis in an endemic area should be undertaken to pick up additional unrecognised cases. Rapid and reliable, sensitive and specific, easy to perform and automated detection systems for Brucella spp. are urgently needed to allow early diagnosis and adequate antibiotic therapy in time to decrease morbidity / mortality. The history of travel to endemic countries along with exposure to animals and exotic foods are usually critical to making the clinical diagnosis. Laboratory testing is indispensable for diagnosis. Therefore alertness of clinician and close collaboration with microbiologist are essential even in endemic areas to correctly diagnose and treat this protean human infection. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. In our experience, an initial combination therapy with a three drug-regimen followed by a two-drug regimen for at least six weeks and a combination of two drugs with a minimum of six weeks seems warranted to improve outcome in children and adult patients respectively with laboratory monitoring. A safe and effective vaccine in humans is not yet available. Prevention is dependent upon the control of the disease in animal hosts, effective heat treatment of dairy produce and hygienic precautions to prevent occupational exposure. This review compiles the experiences and diagnostic and treatment paradigms currently employed in fighting this disease.
Health Systems and Communicable Disease Control: Emerging Evidence and Lessons from Central and Eastern Europe In: Coker 206 Rao V. Contributions, Sec
- Ra Atun
- Rj Rj Coker
- Ra Atun
- Mckee
Atun RA., Coker RJ. (2008): Health Systems and Communicable Disease Control: Emerging Evidence and Lessons from Central and Eastern Europe. In: Coker 206 Rao V. Contributions, Sec. Biol. Med. Sci., XXXI/1 (2010), 191–207 RJ., Atun RA., McKee M., Eds. Health Systems and the Challenge of Communicable Diseases: Experiences from Europe and Latin America. ISBN 13 978 0 335 23366 3. McGraw Hill Open University Press. World Health Organization, Geneva.
The First Communicable Disease Epidemiological Report
- Amato
- A Gauci
- A Ammon
Amato-Gauci A., Ammon A. (2007): The First Communicable Disease Epidemiological Report. European Centre for Disease Prevention and Control, Stockholm, Sweeden.
Health Systems and the Challenge of Communicable Diseases: Experiences from Europe and Latin America
- Rj Atun
- Ra Mckee
RJ., Atun RA., McKee M., Eds. Health Systems and the Challenge of Communicable
Diseases: Experiences from Europe and Latin America. ISBN 13 978 0 335 23366 3.
Health Systems and Communicable Disease Control: Emerging Evidence and Lessons from Central and Eastern Europe
- Ra Atun
- Rj Coker
Atun RA., Coker RJ. (2008): Health Systems and Communicable Disease
Control: Emerging Evidence and Lessons from Central and Eastern Europe. In: Coker
Rao V.
Contributions, Sec. Biol. Med. Sci., XXXI/1 (2010), 191–207