Strengthening capacity in brucellosis surveillance, diagnosis, and control in Iraq and Jordan.
Brucellosis is a zoonotic disease of worldwide distribution affecting both animals and humans. Brucellosis is transmitted to humans by eating undercooked meat or consuming unpasteurized/raw dairy products, breathing in the bacteria that cause brucellosis and bacteria entering the body through skin wounds or mucous membranes. The disease burden is more pronounced in the developing countries due to inadequacy of surveillance and control measures, domestic and imported animal based control programs, and diagnostic services. A prolonged incubation period and wide range of symptoms, such as fever, sweating, fatigue, weight loss, headache, and joint pain persisting for weeks to months, present challenges to prompt diagnoses. In addition to causing a severely debilitating and disabling illness in humans, the disease causes livestock production losses resulting in a major economic impact on affected countries. Currently the majority of human brucellosis cases are diagnosed with a simple agglutination test without confirmation utilizing any additional diagnostics. The recommended treatment course of brucellosis is six weeks with at least two antibiotics, so accurately identifying confirmed cases is critical for treatment of the individual and for targeted public health interventions.
Furthermore, Brucella species are easily aerosolized and have a small infectious dose, and are thus being recognized as a potential biological weapon. Both the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) have designated Brucella as a “select agent,” with the potential to pose a severe threat to both human and animal health.
In the Eastern Mediterranean Region (EMR), the population incidence of brucellosis ranges from 1 per 100,000 to 20 per 100,000, although the actual figure is estimated at 20 to 25 times greater due to poor surveillance systems. Both Iraq and Jordan have a high disease burden from brucellosis cases. The government of Iraq reports over 6000 cases of human brucellosis annually. Even though Jordan has made great strides in the fight against brucellosis over the past decade, there has been a recent eruption in the number of human brucellosis cases with an average of about 145 cases reported per year, concentrated especially in the Karak and Mafraq governorates. However, seroprevalence data is out of date, and current surveillance measures are inadequate. The Ministries of Health in both Iraq (I-MOH) and Jordan (J-MOH) have requested assistance from the U.S. Centers for Disease Control and Prevention (CDC) in combating human brucellosis.
With support and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC), EMPHNET is conducting surveillance studies on brucellosis cases in Iraq and Jordan. The Ministry of Health (MOH) will lead and be the primary implementer of these projects in their respective countries.
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