Summary During 2013, cutaneous lesions developed in two men in the country of Georgia after they were exposed to ill cows. The men had never received vaccination against smallpox. Tests of lesion material with the use of a quantitative real-time polymerase-chain-reaction assay for non–variola virus orthopoxviruses were positive, and DNA sequence analysis implicated a novel orthopoxvirus species. During the ensuing epidemiologic investigation, no additional human cases were identified. However, serologic evidence of exposure to an orthopoxvirus was detected in cows in the patients’ herd and in captured rodents and shrews. A third case of human infection that occurred in 2010 was diagnosed retrospectively during testing of archived specimens that were originally submitted for tests to detect anthrax. Orthopoxvirus infection should be considered in persons in whom cutaneous lesions develop after contact with animals.

Human brucellosis occurs when humans ingest or contact Brucella spp. from shedding animals or contaminated environments and food. In Georgia animal and human brucellosis is endemic, but the epidemiology has not been fully characterized. A case-control study was conducted in 2010 to identify risk factors for human brucellosis. Using multivariable logistic regression, the following risk factors were identified: animal-related work [odds ratio (OR) 77·8, 90% confidence interval (CI) 4·7-1278], non-animal-related work (OR 12·7, 90% CI 1·1-149), being unemployed or a pensioner (OR 13·1, 90% CI 1·7, 101), sheep ownership (OR 19·3, 90% CI 5·1-72·6), making dairy products (OR 12·4, 90% CI 1·4-113), living in eastern Georgia (Kakheti) (OR 278·1, 90% CI 9·5-8100), and being aged >44 years (OR 9·3, 90% CI 1·02-84·4). Education of at-risk groups about risk factors and control of disease in sheep may reduce the human disease risk. This is the first study of its kind in Georgia since the collapse of the Soviet Union.

Human anthrax cases reported in the country of Georgia increased 75% from 2011 (n = 81) to 2012 (n = 142). This increase prompted a case-control investigation using 67 culture- or PCR-confirmed cases and 134 controls matched by residence and gender to investigate risk factor(s) for infection during the month before case onset. Independent predictors most strongly associated with disease in the multivariable modelling were slaughtering animals [odds ratio (OR) 7·3, 95% confidence interval (CI) 2·9-18·1, P 1 km; 15 (12%) of 125 had sick livestock; and 11 (9%) of 128 respondents reported finding dead livestock. We recommend joint public health and veterinary anthrax case investigations to identify areas of increased risk for livestock anthrax outbreaks, annual anthrax vaccination of livestock in those areas, and public awareness education.

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Tularemia has sustained seroprevalence in Eurasia, with estimates as high as 15% in endemic regions. The purpose of this report is to characterise the current epidemiology of Francisella tularensis subspecies holarctica in Georgia. Three surveillance activities are summarised: (1) acute infections captured in Georgia's notifiable disease surveillance system, (2) infectious disease seroprevalence study of military volunteers, and (3) a study of seroprevalence and risk factors in endemic regions. Descriptive analyses of demographic, exposure and clinical factors were conducted for the surveillance studies; bivariate analyses were computed to identify risk factors of seropositivity using likelihood ratio χ2 tests or Fisher's exact tests. Of the 19 incident cases reported between 2014 and August 2017, 10 were confirmed and nine met the presumptive definition; the estimated annual incidence was 0.12/100 000. The first cases of tularemia in Western Georgia were reported. Seroprevalences of antibodies for F. tularensis were 2.0% for military volunteers and 5.0% for residents in endemic regions. Exposures correlated with seropositivity included work with hay and contact with multiple types of animals. Seroprevalence studies conducted periodically may enhance our understanding of tularemia in countries with dramatically underestimated incidence rates.

Background: Cutaneous anthrax is an endemic disease in Georgia with approximately 50 human cases reported each year. In 2011 the number of reported cases increased to 78. We conducted a retrospective investigation to determine the reasons for the increased incidence in 2011. Methods: We reviewed all existing records for human and animal anthrax cases for the years 2002-2011. We reviewed laboratory records from 75 cases in 2011 that included 69 ulcer aspirates, 14 ulcer swabs, 29 blood samples, 1 stool, and 8 samples from soil and animal body parts. We reviewed all laboratory testing protocols and results. Results: Of the 78 human cutaneous anthrax cases reported in 2011, 55 (70.5%) were laboratory confirmed and 23(29.5%) were reported as probable. One case resulted in death. Human Incidence rate of 1.75 per 100,000 in 2011 was 2.2 times higher than the average for the years 2002-2010 (0.78/100,000). In 2011, 57 blood and tissue samples were submitted from cattle which represented an increase of 3.4 times over the numbers for the previous 5 years for which records are available. 42% of these samples were positive representing a rise of 4.7 times over the 2010 rate (9% positive). Human cases age ranged from 10 to 75 years with a median of 42 years. 71 (91%) cases were in males, 37 cases (47.4%) were from Kvemo Kartli region. We detected 10 outbreaks with 28 cases. 8 outbreaks (with 23 cases) were from Kvemo Kartli region. 69 (88.5%) patients took part in slaughtering infected animals. 61 human cases were PCR positive, 34 were culture positive and PCR positive, 26 were PCR positive and culture negative, 15 were culture negative and PCR negative. Conclusion: Slaughtering sick animals is the major mechanism for human infections and outbreaks in Georgia. The increased incidence in human cases in 2011 may be related to contact with a larger number of sick or infected cattle. We recommend stronger veterinary control measures for animal slaughtering especially in the Kvemo Kartli region.