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Epidemiology, Cost and Surveillance of Brucellosis in People and Livestock of Kyrgyzstan

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Epidemiology, Cost and Surveillance of Brucellosis in People and Livestock of Kyrgyzstan Epidemiology, cost and surveillance of brucellosis in people and livestock of Kyrgyzstan Inauguraldissertation zur Erlangung der eines Doktor der Philosophie Vorgelegt der Philosophisch-Naturwissenschaftlichen Fakultät der Universität Basel von Joldoshbek Kasymbekov Aus Yssyk-Köl, Kyrgyzstan Basel, 2016 Originaldokument gespeichert auf dem Dokumentenserver der Universität Basel edoc.unibas.ch Genehmigt von der Philosophisch-Naturwissenschaftlichen Fakultät auf Antrag von Prof. Dr. Jakob Zinsstag und Prof. Dr. Gertraud Irene Schüpbach-Regula Basel, den 25. März 2014 Prof. Dr. Jörg Schibler Dekan ii Table of Contents Table of Contents .......................................................................................................................... iii List of figures ................................................................................................................................ vii List of tables ................................................................................................................................ viii List of abbreviations ....................................................................................................................... ix 1. Acknowledgement ................................................................................................... 10 2. Summary ................................................................................................................. 12 3. Кириш сѳз ............................................................................................................... 15 4. Резюме ................................................................................................................... 18 5. Introduction ............................................................................................................. 21 5.1 Infection and disease .......................................................................................................... 21 5.2 Burden and epidemiology of brucellosis in Kyrgyzstan .................................................... 23 5.3 Previous work on brucellosis in Kyrgyzstan ...................................................................... 25 5.4 Institutional collaboration ................................................................................................... 26 6. Research rationale .................................................................................................. 27 6.1 Goal .................................................................................................................................... 27 6.2 Specific objectives .............................................................................................................. 28 7. Methods .................................................................................................................. 29 7.1 Literature review ................................................................................................................. 29 7.2 Analyses of existing quantitative data ................................................................................ 30 7.3 Interviews with key livestock experts in Kyrgyzstan ......................................................... 30 7.4 Structure of thesis ............................................................................................................... 31 8. Effect of political, cultural and economic issues on brucellosis epidemiology and control in Kyrgyzstan ............................................................................................... 32 8.1 Introduction ........................................................................................................................ 33 8.2 Materials and methods ........................................................................................................ 34 8.2.1 Data collection ....................................................................................................... 34 8.2.2 Analyses of existing data ....................................................................................... 35 8.2.3 Interviews with key brucellosis experts in Kyrgyzstan ......................................... 35 8.3 Investigation outcomes ....................................................................................................... 35 8.3.1 Pre-Soviet time in Kyrgyzstan and role of animals in human livelihood .............. 35 8.3.2 Political change and livestock production systems ................................................ 36 8.3.3 Brucellosis intervention in Kyrgyzstan .................................................................. 37 8.3.4 The spread of infection .......................................................................................... 39 8.3.5 Vaccine quality ...................................................................................................... 40 8.3.6 Causes of disease prevalence ................................................................................. 41 8.3.7 Serological test ....................................................................................................... 42 8.3.8 Brucella characterization ....................................................................................... 43 8.3.9 Political change and public health systems ............................................................ 44 iii 8.3.10 Epidemiology of brucellosis in animals and humans before, during and after the political transition................................................................................................... 44 8.4 Discussion ........................................................................................................................... 46 8.4.1 Analysis of the effects of past and current policies and interventions ................... 46 8.5 Recommendations for brucellosis control policy and interventions in Kyrgyzstan and Central Asia ........................................................................................................................ 47 9. Representative seroprevalences of brucellosis in humans and livestock in Kyrgyzstan .............................................................................................................. 48 9.1 Introduction ......................................................................................................................... 49 9.2 Materials and methods ........................................................................................................ 50 9.2.1 Partnership between public health and the veterinary sector ................................. 50 9.2.2 Study design ........................................................................................................... 50 9.2.3 Human and livestock sample collection ................................................................. 52 9.2.4 Diagnostic tests ...................................................................................................... 52 9.2.5 Data analysis .......................................................................................................... 53 9.2.6 Analyses of human sera ......................................................................................... 53 9.2.7 Correlation between human and livestock seropositivity ...................................... 53 9.2.8 Estimation of incidence of apparent brucellosis seropositivity in humans ............ 54 9.3 Results ................................................................................................................................. 54 9.3.1 Representative apparent seroprevalences and human incidences .......................... 55 9.3.2 Analysis of human sera for risk factors of brucellosis seropositivity .................... 55 9.3.3 Correlation between human and livestock seropositivity ...................................... 56 9.4 Discussion ........................................................................................................................... 57 9.5 Conclusion .......................................................................................................................... 59 9.6 Acknowledgments .............................................................................................................. 59 9.7 Open access......................................................................................................................... 59 10. Molecular epidemiology and antibiotic susceptibility of livestock Brucella melitensis isolates from Naryn oblast, Kyrgyzstan ................................................................... 60 10.1 Abstract ............................................................................................................................... 61 10.2 Introduction ......................................................................................................................... 61 10.3 Material and methods.......................................................................................................... 62 10.3.1 Sampling sites and survey ...................................................................................... 62 10.3.2 Cultures .................................................................................................................. 63 10.3.3 Antibiotic resistance testing ................................................................................... 63 10.3.4 DNA extraction and genotyping ...........................................................................
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