Risk factors for acute human brucellosis in Ijara, north-eastern Kenya
Risk factors for acute human brucellosis in Ijara, north-eastern Kenya
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DOI：
10.1371/journal.pntd.0008108
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发表时间：
2020-04-01
影响因子：
3.8
通讯作者：
de Glanville, William A.
中科院分区：
文献类型：
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作者：
Kiambi, Stella G.;Fevre, Eric M.;de Glanville, William A.
布鲁氏菌病是全球一种重要的人畜共患疾病，在畜牧环境中负担特别高。虽然布鲁氏菌的人畜共患传播途径是众所周知的，但动物接触、食品处理和消费做法的相对重要性可能有所不同。了解人类布鲁氏菌病的当地流行病学对于指导兽医和公共卫生干预以及为临床诊断决策提供信息非常重要。我们在肯尼亚东北部的伊贾拉区医院进行了一项横断面研究。2011年共招募了386名寻求治疗并报告发热性疾病症状的人。使用实时聚合酶链反应（RT-PCR）检测样本是否存在布鲁氏菌，并将结果与Ijara区医院使用的布鲁氏菌病检测结果，即发热布鲁氏菌平板凝集试验（FBAT）进行比较。对所有参与者进行问卷调查，并使用信息论（IT）方法和最小绝对收缩和选择（LASSO）的逻辑回归确定布鲁氏菌病的危险因素。60人RT-PCR阳性，导致可能的布鲁氏菌病患病率为15.4% （95% CI 12.0-19.5）。IT和LASSO方法都认为，饮用购买的牛奶与风险增加密切相关，而在饮用前煮牛奶与风险降低密切相关。没有证据表明饲养牲畜的人患布鲁氏菌病的风险与不饲养牲畜的人不同。与RT-PCR相比，FBAT的诊断性能较差，估计敏感性为36.6% (95% CI 24.6-50.1)，特异性为69.3% （95% CI 64.0-74.3）。布鲁氏菌病是肯尼亚东北部发热性疾病的一个重要病因。在销售链中推广对牛奶进行巴氏消毒，并发出健康信息，鼓励在消费前将生奶煮沸，预计可大大减少伊哈拉的布鲁氏菌病发病率。这项研究支持了越来越多的证据，即FBAT在布鲁氏菌病的诊断方面表现非常差。
Brucellosis is an important zoonotic disease globally, with particularly high burdens in pastoral settings. While the zoonotic transmission routes for Brucella spp. are well known, the relative importance of animal contact, food-handling and consumption practices can vary. Understanding the local epidemiology of human brucellosis is important for directing veterinary and public health interventions, as well as for informing clinical diagnostic decision making. We conducted a cross-sectional study in Ijara District Hospital, north-eastern Kenya. A total of 386 individuals seeking care and reporting symptoms of febrile illness were recruited in 2011. Samples were tested for the presence of Brucella spp. using a real-time PCR (RT-PCR) and results compared to those from the test for brucellosis used at Ijara District Hospital, the febrile Brucella plate agglutination test (FBAT). A questionnaire was administered to all participants and risk factors for brucellosis identified using logistic regression with an information theoretic (IT) approach and least absolute shrinkage and selection (LASSO). Sixty individuals were RT-PCR positive, resulting in a prevalence of probable brucellosis of 15.4% (95% CI 12.0-19.5). The IT and LASSO approaches both identified consuming purchased milk as strongly associated with elevated risk and boiling milk before consumption strongly associated with reduced risk. There was no evidence that livestock keepers were at different risk of brucellosis than non-livestock keepers. The FBAT had poor diagnostic performance when compared to RT-PCR, with an estimated sensitivity of 36.6% (95% CI 24.6-50.1) and specificity of 69.3% (95% CI 64.0-74.3). Brucellosis is an important cause of febrile illness in north-eastern Kenya. Promotion of pasteurisation of milk in the marketing chain and health messages encouraging the boiling of raw milk before consumption could be expected to lead to large reductions in the incidence of brucellosis in Ijara. This study supports the growing evidence that the FBAT performs very poorly in the diagnosis of brucellosis.