EC 1 th SELECTED ZOONOTIC DISEASES SYMPOSIUM May 30-31 2011 NICOSIA Brucellosis in Italy:...
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Transcript of EC 1 th SELECTED ZOONOTIC DISEASES SYMPOSIUM May 30-31 2011 NICOSIA Brucellosis in Italy:...
EC 1 th SELECTED ZOONOTIC DISEASES SYMPOSIUMMay 30-31 2011
NICOSIA
Brucellosis in Italy: Epidemiology, Control and Eradication
Paolo PasqualiPaolo Pasquali
Department of Veterinary Public Health and Food Safety,Department of Veterinary Public Health and Food Safety,
Istituto Superiore di Sanità, Rome, Italy Istituto Superiore di Sanità, Rome, Italy
Caprine and ovine brucellosis is usually caused by Brucella melitensis
Bovine brucellosis is usually caused by Brucella abortus, less frequently by B. melitensis,
Clinically, the disease is characterised by one or more of the following signs:
• abortion,
• retained placenta,
• orchitis, epididymitis and, rarely, arthritis,
with excretion of the organisms in uterine discharges and in milk
There is a need to control brucellosis?
Why?
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EMERGING DISEASES, 1996-2004 (WHO source)
1. Cryptosporidium North America
2. Lyme borreliosis North America
3. Brucellosis worldwide
4. E.coli O157 North Europa
5. Salmonella (MDR) Northern Europe
6. Ebola Africa
7. Influenza Asia
8. BSE Europe
9. SARS Asia
10. EE Africa, America, Europe
11. Hendra/Nipah South East Asia, Australia
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0
10
20
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Pe
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2005
Perception of importance of zoonosisFAO 2005
rabiesbrucellosistuberculosis influenza
salmonellosiscysticercosishydatidosisleptospirosisprion diseases
anthraxtoxoplasmosiscampylobacteriosistrichinosisleishmaniosis
Source: FAO 2005. Survey based on 165 veterinary public health Source: FAO 2005. Survey based on 165 veterinary public health professionalsprofessionals
4/28
Pappas G. et al. , Lancet Infect Dis 2006; 6: 91–99
more than 500 000 new cases annually
WHO/FAO COLLABORATING CENTRE FOR RESEARCH AND TRAINING IN VETERINARY PUBLIC HEALTH
Pappas G. et al. , Lancet Infect Dis 2006; 6: 91–99
Brucellosis, indeed, is a major problem with costs related to:
•Human population (disease)
•Animals (disease and production):
• (direct) abortion, milking
• (indirect) trade limitations
The disease in humans• intermittent or remittent fever accompanied by malaise, anorexia and prostration,
• may persist for weeks or months.
• typically, few objective signs are apparent.
• The acute phase may progress to a chronic one with relapse, development of persistent localized infection or a non-specific syndrome resembling the “chronic fatigue syndrome”.
how much the disease is acute?
Case study No.1
Majority was not simptomatic
Can you control the system? NO
Yes
Prevalence < 2% (true!) test and slaughter
> 2% vaccination and/or test and slaughter
• which animals?
• when?
• with what?
vaccination
Heat treatment of milk
• Mass vaccination• Vaccination of replacements• Vaccination of replacements and test and slaughter• Test and slaughter
Vaccination
Can induce abortion
•Adult not pregnant•Yungs after weaning (3-6 months of age)
1. Strain 19
PROS
• Strong efficacy against B.abortus
• High stability
CONS
• S19 induces antibodies detectable by using standard serological test, preventing differentiation of vaccinated versus infected animals.
• Although highly attenuated S19 is able to induce abortion in 1-2.5% of pregnant immunised cows
• S19 can be shed through milk
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2. B. melitensis Rev.1
Rev.1 vaccine is a live, smooth attenuated B. melitensis strain derived from a virulent B.melitensis isolate which became dependent on streptomycin for its growth, but lost this characteristic, although remaining streptomycin resistant, upon further subculture
It stimulates protection against infection with B. melitensis in sheep and goats and also protects rams against infection with B.ovis. This vaccine is attenuated when compared with field strains but retains some virulence.
PROS
• Strong efficacy against B.melitensis and B.abortus
• High stability
CONS
• REV 1 induces antibodies detectable by using standard serological test, preventing differentiation of vaccinated versus infected animals.
• Still able to induce abortion of pregnant immunised animals
• REV 1 can be shed through milk
3. B.abortus RB51
Rough strain devoid of the O-chain. Its roughness is very stable after multiple passages in vitro and in vivo through various species of animals
Strain RB51 is attenuated as indicated by studies carried out in mice, guinea pigs, goats and cattle, from all of which it is cleared in a relatively short time.
Two studies carried out in sheep suggests that strain RB51 does not induce protection versus B.melitensis
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Prevention of human brucellosis
As the ultimate source of human brucellosis is direct or indirect exposure to infected animals or their products, prevention must be based on elimination of such contact.
BRUCELLOSIS IS A “SYSTEM PROBLEMSYSTEM PROBLEM”
1.1. Awareness of farmers and population. Awareness of farmers and population. Risk factors Risk factors are milk and lamb delivery. are milk and lamb delivery.
2.2. PhysiciansPhysicians informed and trained informed and trained
3.3. LaboratoryLaboratory support to make diagnosis support to make diagnosis
4.4. ControlControl of animals (cattle and sheep) (trade and animal identification)
5. Vaccination… or or Elimination of infected animals
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Year 2008: Sheep and goat population (herds)
Total number of herdsYear 2008
10.001 - 20.000 (2)5.001 - 10.000 (8)2.001 - 5.000 (8) 500 - 2.000 (2)
Region Total number of herds
Total 117.519
Sardegna 15.377Lombardia 11.641Piemonte 9.617Sicilia 9.161Lazio 8.478Campania 8.313Calabria 7.970Toscana 7.111Basilicata 6.612Abruzzo 5.735Puglia 4.013Marche 3.918Bolzano 3.602Emilia Romagna 3.391Umbria 3.017Liguria 2.553Molise 2.364Veneto 2.310Trento 1.043Valle d'Aosta 768Friuli Venezia Giulia 525
Year 2008: Sheep and goat population (animals)
Total number of animalsYear 2008
500.001 - 4.000.000(4)
200.001 - 500.000 (4)
80.001 - 200.000 (7)
10.000 - 80.000 (5)
Region Total number of animals
Total 8.634.838
Sardegna 3.530.931Sicilia 946.368Lazio 818.767Toscana 525.243Calabria 463.932Puglia 411.672Basilicata 410.616Campania 303.109Lombardia 189.496Piemonte 185.062Abruzzo 183.479Marche 175.181Umbria 136.788Emilia Romagna 88.874Bolzano 69.043Veneto 58.063Molise 55.309Trento 31.059Liguria 26.088Friuli Venezia Giulia 15.439Valle d'Aosta 10.319
Sheep and goat herds tested in Italy
0,0%10,0%20,0%30,0%40,0%50,0%60,0%70,0%80,0%90,0%
100,0%
Perc
en
t o
f te
ste
d h
erd
s
2003 2004 2005 2006 2007 2008 2009Year
Percent of tested herds
Percentage of infected flocks in 2009
Positive herds on controlled (%)Year 2009
2,50- 15,00 (2)
0,20 - 2,49 (2)0,0 - 0,19 (17)
Region
Total
Region Percentage infected flocks
Total 1,55%
Prevalence decreased in Calabria, Pugliaand Basilicata
Sicilia 13,19%
Calabria 2,81%
Puglia 1,87%
Campania 0,92%
Basilicata 0,19%
Emilia Romagna 0,08%
Abruzzo 0,04%
Lazio 0,03%
Lombardia 0,02%
Sardegna 0,01%
Bolzano 0,00%
Friuli Venezia Giulia 0,00%
Liguria 0,00%
Marche 0,00%
Molise 0,00%
Piemonte 0,00%
Toscana 0,00%
Trento 0,00%
Umbria 0,00%
Valle d'Aosta 0,00%
Veneto 0,00%
VACCINATION IN SICILYYEAR 2004 - 2009
Total number of holdings
eligible for vaccination
Total number of holdings vaccinated
Total number of young animals
vaccinated
Number of doses of vaccine used
2004 3.914 372.623 2.307 0 0 0
2005 9.162 1.060.611 3.389 1.177 46.277 46.277
2006 9.266 822.906 2.237 1.424 60.702 60.702
2007 9.241 1.010.667 2.475 1.316 60.247 60.247
2008 9.161 946.368 2.051 893 37.927 37.927
2009 9.009 1.015.103 4.847 388 14.138 14.138
YEARTotal number
of holdingsTotal number
of animals
Information on young animals subjected to the programme of vaccination
Take home message
1.Brucellosis is an insidious disease with high costs
2.Is very common in mediterranean Countries
3.The control strategy has to be tailored according to critical parameters (costs, epidemiology, needs, capability and so on ..)
4.There is not a perfect vaccine, so far
Thank you