The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis

Vered, Oded; Simon‐Tuval, Tzahit; Yagupsky, Pablo; Malul, Miki; Cicurel, Assi; Davidovitch, Nadav

doi:10.1371/journal.pone.0145086

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…They are most frequently associated with the conflicting needs of wildlife and agriculture and the risk of human disease (42). This confirmed the widespread existence and natural epidemic origin of brucellosis in countries along the Silk Road (43,44), which poses severe challenges to the prevention and surveillance of brucellosis in these countries.…”

Section: Discussionmentioning

confidence: 71%

Investigation of Genetic Relatedness of Brucella Strains in Countries Along the Silk Road

et al. 2021

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In this study, MLVA (multiple-locus variable-number tandem repeat analysis) genotype data of Brucella strains from 11 countries along the Silk Road were downloaded from the MLVAbank. MLVA data of strains were applied to the constructed Minimum Spanning Tree to explore the species/biovars distribution, geographic origins, and genetic relationships of the strains analyzed. Moreover, whole-genome sequencing–single-nucleotide polymorphism (WGS-SNP) phylogenetic analysis of the genome of Brucella melitensis strains from GenBank was performed to discriminate the relatedness of strains further and investigate the transmission pattern of B. melitensis brucellosis. A total of 1,503 Brucella strains were analyzed in this study: 431 Brucella abortus strains (29.8%), 1,009 B. melitensis strains (65.7%), and 63 Brucella suis strains (4.5%). B. melitensis biovar 3 was the dominant species and was shown to be widespread in all of the examined regions, suggesting that the prevention and surveillance of the B. melitensis population are a main challenge in these countries. A wide host spectrum was observed for this Brucella population; many animal reservoirs are a potential reason for the continuous brucellosis circulation in these countries. Although the B. abortus strains from the examined regions had common geographic origins, only a few shared genotypes were observed in different countries. These data revealed that the majority of B. abortus strains were spreading within the national borders. However, the B. melitensis strains from Italy originated from a Western Mediterranean lineage; strains from the other 10 countries originated from Eastern Mediterranean lineage, and this lineage was shared by strains from three to nine different countries, suggesting that the introduction and reintroduction of the disease in the 10 countries might have occurred in the past. Furthermore, the most shared MLVA-16 genotypes were formed in the B. melitensis strains from China, Kazakhstan, and Turkey, suggesting that the introduction and trade in sheep and goats have occurred frequently in these countries. WGS-SNP analysis showed that the B. melitensis in this study originated from the Malta (Italy) region. According to their territorial affiliation between four clade strains from these countries in genotype B, the absence of a clear differentiation suggests that strains continuously expand and spread in countries along with Silk Road. Active exchange and trade of animals (sheep and goats) among these countries are reasonable explanations. B. suis strains from different nations showed unique geographic origins and epidemiological characteristics. Therefore, there is an urgent need for the control of transfer and trade of infected sheep (goats) in countries along the Silk Road, namely, the strengthening of the entry–exit quarantine of sheep and goats and improvements in the diagnosis of animal brucellosis.

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Section: Discussionmentioning

confidence: 71%

Investigation of Genetic Relatedness of Brucella Strains in Countries Along the Silk Road

et al. 2021

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“…Depending on the existing healthcare system where the patient lives, the responsibility for paying these costs can fall on the patient, patient’s family, insurer, hospital, taxpayers, or government. Human brucellosis is a disease that results in significantly higher healthcare costs compared to the average patient seeking medical care [ 38 ]. A study conducted in southern Israel revealed that healthcare utilization costs for brucellosis patients was USD $57 ( p < 0.05 ) greater before diagnosis and USD $947 ( p < 0.001 ) greater one year post diagnosis when compared to non-brucellosis cases that were matched by age, sex, hospital, and primary care physician [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Human brucellosis is a disease that results in significantly higher healthcare costs compared to the average patient seeking medical care [ 38 ]. A study conducted in southern Israel revealed that healthcare utilization costs for brucellosis patients was USD $57 ( p < 0.05 ) greater before diagnosis and USD $947 ( p < 0.001 ) greater one year post diagnosis when compared to non-brucellosis cases that were matched by age, sex, hospital, and primary care physician [ 38 ]. The higher costs of patients post diagnosis stem from higher utilization of medications, spinal/skeletal diagnostic procedures, emergency room visits, and laboratory tests [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Brucellosis remains a neglected disease in the developing world: a call for interdisciplinary action

et al. 2018

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BackgroundBrucellosis is an endemic zoonotic disease in most of the developing world that causes devastating losses to the livestock industry and small-scale livestock holders. Infected animals exhibit clinical signs that are of economic significance to stakeholders and include reduced fertility, abortion, poor weight gain, lost draught power, and a substantial decline in milk production. In humans, brucellosis typically manifests as a variety of non-specific clinical signs. Chronicity and recurring febrile conditions, as well as devastating complications in pregnant women are common sequelae.DiscussionIn regions where the disease is endemic, brucellosis has far-reaching and deleterious effects on humans and animals alike. Deeply entrenched social misconceptions and fear of government intervention contribute to this disease continuing to smolder unchecked in most of the developing world, thereby limiting economic growth and inhibiting access to international markets. The losses in livestock productivity compromise food security and lead to shifts in the cognitive competency of the working generation, influence the propagation of gender inequality, and cause profound emotional suffering in farmers whose herds are affected. The acute and chronic symptoms of the disease in humans can result in a significant loss of workdays and a decline in the socioeconomic status of infected persons and their families from the associated loss of income. The burden of the disease to society includes significant human healthcare costs for diagnosis and treatment, and non-healthcare costs such as public education efforts to reduce disease transmission.ConclusionBrucellosis places significant burdens on the human healthcare system and limits the economic growth of individuals, communities, and nations where such development is especially important to diminish the prevalence of poverty. The implementation of public policy focused on mitigating the socioeconomic effects of brucellosis in human and animal populations is desperately needed. When developing a plan to mitigate the associated consequences, it is vital to consider both the abstract and quantifiable effects. This requires an interdisciplinary and collaborative, or One Health, approach that consists of public education, the development of an infrastructure for disease surveillance and reporting in both veterinary and medical fields, and campaigns for control in livestock and wildlife species.

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“…These results are especially important to public health, since B. melitensis is one of the most pathogenic and the most prevalent species of Brucella spp. for humans [88], and the disease may progress to the development of debilitating symptoms, with severe involvement of multiple organs and systems, and high cost of hospitalization due to the prolonged therapy recommended [89]. The close contact of rural workers with small ruminants, preferred hosts for B. melitensis, was identified as the main form of acquisition of the disease among these individuals (Table 1), which has been confirmed by the identification of a high genetic similarity between B. melitensis strains isolated from occupationally infected workers and from goat milk samples [38].…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

Occupational exposure to Brucella spp.: A systematic review and meta-analysis

et al. 2020

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Brucellosis is a neglected zoonotic disease of remarkable importance worldwide. The focus of this systematic review was to investigate occupational brucellosis and to identify the main infection risks for each group exposed to the pathogen. Seven databases were used to identify papers related to occupational brucellosis: CABI, Cochrane, Pubmed, Scielo, Science Direct, Scopus and Web of Science. The search resulted in 6123 studies, of which 63 were selected using the quality assessment tools guided from National Institutes of Health (NIH) and Case Report Guidelines (CARE). Five different job-related groups were considered greatly exposed to the disease: rural workers, abattoir workers, veterinarians and veterinary assistants, laboratory workers and hunters. The main risk factors and exposure sources involved in the occupational infection observed from the analysis of the articles were direct contact with animal fluids, failure to comply with the use of personal protective equipment, accidental exposure to live attenuated anti-brucellosis vaccines and non-compliance with biosafety standards. Brucella species frequently isolated from job-related infection were Brucella melitensis, Brucella abortus, Brucella suis and Brucella canis. In addition, a metaanalysis was performed using the case-control studies and demonstrated that animal breeders, laboratory workers and abattoir workers have 3.47 [95% confidence interval (CI); 1.47-8.19] times more chance to become infected with Brucella spp. than others individuals that have no contact with the possible sources of infection. This systematic review improved the understanding of the epidemiology of brucellosis as an occupational disease. Rural workers, abattoir workers, veterinarians, laboratory workers and hunters were the groups more exposed to occupational Brucella spp. infection. Moreover, it was observed that the lack of knowledge about brucellosis among frequently exposed professionals, in addition to some behaviors, such as negligence in the use of individual and collective protective measures, increases the probability of infection.

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The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis

Cited by 12 publications

References 15 publications

Investigation of Genetic Relatedness of Brucella Strains in Countries Along the Silk Road

Investigation of Genetic Relatedness of Brucella Strains in Countries Along the Silk Road

Brucellosis remains a neglected disease in the developing world: a call for interdisciplinary action

Occupational exposure to Brucella spp.: A systematic review and meta-analysis

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