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The Role of Sheep, Goats and Springbok (Antidorcus Marsupialis) As Sources of Human Infections in Namibia

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The Role of Sheep, Goats and Springbok (Antidorcus Marsupialis) As Sources of Human Infections in Namibia Article — Artikel Brucellae through the food chain: the role of sheep, goats and springbok (Antidorcus marsupialis) as sources of human infections in Namibia K Magwederea,c*, A Bishia, G Tjipura-Zaireb, G Eberleb, Y Hembergera, L C Hoffmanc and F Dzivad dead-end hosts of Brucella infections, ABSTRACT while some wildlife species can act as A confirmed case of human brucellosis motivated an investigation into the potential source potential reservoir hosts15,17,19. The patho- of infection in Namibia. Since domestic animals are principal sources of Brucella infection in genic species are B. melitensis, which pre- humans, 1692 serum samples were screened from sheep, goats and cattle from 4 presum- dominantly infects goats and sheep; ably at-risk farms and 900 springbok (Antidorcas marsupialis) serum samples from 29 mixed farming units for Brucella antibodies by the Rose-Bengal test (RBT) and positive cases B. abortus, which principally affects cattle; confirmed by complement fixation test (CFT). To assess the prevalence of human B. suis that infects swine and B. canis that 5,11,21,52,53 brucellosis, 137 abattoir employees were tested for Brucella antibodies using the standard infects dogs . Although any of tube agglutination test (STAT) and by enzyme linked immunosorbent assay (ELISA). Cattle 4 species of Brucella can cause systemic and sheep from all 4 farms were negative by RBT and CFT but 2 of the 4 farms (Ba and C) disease in humans, B. melitensis has the had 26/42 and 12/285 seropositive goats, respectively. Post mortem examination of seroposi- lowest infective dose, requiring as few as tive goats revealed no gross pathological lesions typical of brucellosis except enlarged 10 organisms to cause infection2,9,25. mesenteric and iliac lymph nodes seen in a single buck. Culture for brucellae from organs of Human brucellosis, commonly referred seropositive animals was negative. None of the wildlife sera tested positive by either RBT to as undulant fever or Malta fever, often or CFT.Interviews revealed that besides the case that prompted the investigation, a family coincides with livestock infection4,35. and another person from other farms with confirmed brucellosis shared a common history of consumption of unpasteurised goat milk, home-made goat cheese and coffee with raw The disease in humans presents as a milk and prior contact with goats, suggesting goats as the likely source of infection. All multi-systemic, acute to chronic disease 137 abattoir employees tested negative by STAT,but 3 were positive by ELISA. The 3 abattoir characterised by non-specific signs such workers were clinically normal and lacked historical connections with clinical cases. Al- as fever, headache, joint pains, musculo- though goats are often associated with B. melitensis, these studies could not explicitly impli- skeletal pains, sweating, malaise, myal- cate this species owing to cross-reactivity with B. abortus, which can also infect goats. gia, abdominal pain, lymphadenopathy, Nevertheless, these data reinforce the need for a better National Control Programme for skin rash, pneumonitis, back-ache and brucellosis in Namibia. body wasting9,21,25,36. The non-specific na- Keywords: abattoir, brucellosis, goats, Namibia, serology. ture often presents a tremendous chal- Magwedere K, Bishi A,Tjipura-Zaire G, Eberle G, Hemberger Y, Hoffman L C, Dziva F lenge in clinical diagnosis of brucellosis Brucellae through the food chain: the role of sheep, goats and springbok (Antidorcus since these signs can also occur in com- marsupialis) as sources of human infections in Namibia. Journal of the South African mon diseases or conditions like malaria, Veterinary Association (2011) 82(4): 205–212 (En.). Division of Veterinary Public Health and typhoid, rheumatic fever and pyrexia of Epidemiology, Directorate of Veterinary Services, Hospital Street, Mariental, Namibia. unknown origin21. Unlike in Tanzania25,45, the disease’s status in Namibia is not pre- cisely known as most health centres do INTRODUCTION Trade Organization (WTO) to develop not routinely test for brucellosis. Sporadic The emergence or re-emergence of minimum scientific or evidence-based cases and even small clusters are often dif- zoonotic diseases is complex and multi- international standards, guidelines and ficult to identify owing to an extremely factorial, often driven by evolving ecol- recommendations to facilitate safe trade variable incubation period (weeks to ogy, microbial adaptation, human demo- in animals and their products51.Inthe months) and a lack of pathognomonic graphics and behaviour, international case of zoonotic diseases such as brucel- clinical features or manifestations27,44. travel and trade, agricultural practices, losis, it is believed that protection of Of the zoonotic species, B. melitensis technology and industry49. The World human health can be achieved through contributes up to 70 % of human brucel- Organization for Animal Health (OIE) is control of the disease in the animal popu- losis cases worldwide14,32 with sheep, mandated under the Sanitary and Phyto- lation. The OIE/FAO (Food and Agricul- goats and camels being the main sources sanitary Agreement (SPS) of the World ture Organization)/WHO (World Health of infection9,24. The difficulty in clinically Organization) Global Early Warning diagnosing brucellosis, coupled with the aDivision of Veterinary Public Health and Epidemiology, System (GLEWS) provides for rapid noti- weakness of human health services in Directorate of Veterinary Services, Hospital Street, Mariental, Namibia. fication of major animal diseases, includ- developing countries, often contribute to bCentral Veterinary Laboratory, Ministry of Agriculture, ing zoonoses, of which B. melitensis infec- human brucellosis being inadequately Water and Forestry, Private Bag 13187, Windhoek, tion is a priority disease51. treated34. Bacteria gain entry into the Namibia. Brucellae are small, non-motile, Gram- body by ingestion, inhalation, penetra- cDepartment of Animal Sciences, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602 South negative coccobacilli that are responsible tion through skin abrasions as well as Africa. for one of the most widespread zoonotic through conjunctival mucosa41. Once in dDivision of Microbiology, Institute for Animal Health, Compton, Berkshire RG20 7NN, United Kingdom. infections of medical significance world- the body, Brucella spp. survive and multi- 28,44 *Author for correspondence wide . Humans are accidentally in- ply within cells of the reticuloendothelial E-mail: [email protected] fected through direct or indirect contact system. Notably, human neutrophils Received: February 2011. Accepted: October 2011. with infected material and are invariably exhibit variable antiphagocytic activity 0038-2809 Jl S.Afr.vet.Ass. (2011) 82(4): 205–212 205 towards some Brucella strains but are vir- region triggered an investigation into the Sampling techniques tually ineffective against B. melitensis52,53. potential source of infection in this The sample size for farmed wildlife was However, once excreted, brucellae rarely area and 3 other surrounding regions in determined by the formula: n =log ~ survive for long periods in tropical envi- the foot-and-mouth disease-free zone, { )/log(1 – pmax × sensitivity), where n = ronmental conditions. Risk factors for namely Karas, Omaheke and Khomas the required sample size, p = the preva- infection in humans include handling of (Fig. 1). The main farming activities in lence (based on livestock data), ~ = the infected dead or live animals, ingestion of these regions include extensive sheep, probability (confidence level) of missing a contaminated animal products espe- goat and game rearing. These regions are diseased animal at a prevalence of up-to cially unpasteurised dairy products, poor home to 88.3 % of the 2.7 million sheep in pmax in a large population. The population handling of Rev 1 vaccine and cultures of Namibia. A single abattoir caters for size refers to the total number of spring- 2 Brucella spp . The Rev 1 vaccine is poten- animals from these 4 regions and has an bok in the 3 regions exercising commer- tially harmful to humans. Vaccinated ani- annual turnover of 219 929 sheep and cial harvesting. The sampling protocol mals should not be slaughtered for 6251 springbok (Antidorcas marsupialis). was designed to detect at least 1 positive human consumption within 3 months of Relevant background data in the study animal in the flock at a 95 % confidence vaccination. Although it is believed that regions were collected via a questionnaire limit, that is, if the disease was present at a with ordinary handling this vaccine is that included the following main catego- prevalence (p)of5%inharvested spring- harmless to man , care should neverthe- ries: i) vaccination with Rev 1, ii) animal bok when the test sensitivity is 95 % and less be taken not to accidentally inject it trace-back and trace-forward movements animals are randomly selected. In this into humans and contamination of to and from the suspected farms within a particular study on farmed wildlife, the human eyes with this vaccine should be year, iii) farms and other places visited 3 regions were defined as an epidemio- avoided. By virtue of increased contact by family members within a year, and logical unit. A total of 900 adult springbok with animals and their products, abattoir iv) sources and type of animal products from farmed flocks in 3 regions were workers are at a greater risk of brucellosis consumed. Farms presumed
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