Seroepidemiological Study of Q Fever, Brucellosis and Tularemia In
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Comparative Immunology, Microbiology and Infectious Diseases 66 (2019) 101322 Contents lists available at ScienceDirect Comparative Immunology, Microbiology and Infectious Diseases journal homepage: www.elsevier.com/locate/cimid Seroepidemiological study of Q fever, brucellosis and tularemia in butchers T and slaughterhouses workers in Lorestan, western of Iran Saber Esmaeilia, Fahimeh Bagheri Amirib, Hamid Mokhayeric, Mohammad Hassan Kayedid, ⁎ Max Maurine,f, Mahdi Rohania,g, Ehsan Mostafavia,h, a National Reference Laboratory of Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar-Ahang, Hamadan, Iran b Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran c Department of Communicable Diseases Control and Prevention, Health Center, Lorestan University of Medical Sciences, Khorramabad, Iran d Department of Parasitology, School of Medicine, Lorestan University of Medical, Sciences, Khorramabad, Iran e Université Grenoble Alpes, Centre National de la Recherche Scientifique, TIMC-IMAG, Grenoble, France f Centre National de Référence Francisella tularensis, Laboratoire de Bactériologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France g Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran h Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran ARTICLE INFO ABSTRACT Keywords: Most zoonoses are occupational diseases. Q fever, brucellosis and tularemia are major zoonotic diseases for Q fever butchers and slaughterhouse workers. However, little information is available about these infectious diseases in Tularemia such professional populations in western of Iran. The aim of this study was to investigate the seroprevalence and Brucelloses risk factors associated with these three zoonoses among butchers and slaughterhouse workers in the Lorestan Zoonoses province of Iran. In 2017, 289 individuals (144 butchers or slaughterhouse workers, and 145 people from the Seroprevalence general population) were enrolled in 11 different counties of this province. Collected serum samples were tested Lorestan province Iran by ELISA for detection of IgG antibodies against Coxiella burnetii, Brucella spp. or Francisella tularensis antigens. The seroprevalence of Q fever, brucellosis and tularemia among all participants were 23.5%, 31.8% and 3.8%, respectively. The seroprevalence of brucellosis and Q fever among butchers and slaughterhouse workers (43.7% and 29.8%, respectively) were significantly higher (p < 0.05) than those of the general population (20%and 17.2%, respectively). A contact history with small ruminants (sheep and goats) was associated with a higher risk of positive serology for all three studied zoonoses. The high seroprevalence for Q fever and brucellosis we found among butchers and slaughterhouse workers suggests that both diseases are common in these populations of the Lorestan province. Since these two infectious diseases are clinically unspecific, they must be systematically included in the etiological diagnosis of infectious diseases occurring in these at-risk populations. In addition, we recommend specific training programs as well as the use of personal protective equipment in these occupational groups to reduce the occurrence of these zoonotic diseases. 1. Introduction need for frequent contact with either domestic or wildlife animals, and their tissues or carcasses, and the level of knowledge of at-risk situa- Emerging and reemerging infectious diseases represent significant tions of the exposed individuals and their use of personal protection health threats and challenges worldwide, more than half of them being equipment [2]. zoonoses [1]. Most zoonoses are occupational diseases often trans- Brucellosis is a worldwide zoonosis caused by bacteria of the genus mitted to workers through direct contact with animals and their car- Brucella [3]. It remains one of the most frequent zoonoses, affecting casses. The risk of transmission of zoonotic pathogens from animals to wildlife animals, livestock and humans. The major risk factors for humans during occupational activities depends on several factors, in- human brucellosis include contact with infected animals (mainly live- cluding the animal health situation, the type of work performed, the stock) or their tissues and body fluids (blood, urine, vaginal discharge), ⁎ Corresponding author at: National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar-Ahang, Hamadan, Iran. E-mail address: [email protected] (E. Mostafavi). https://doi.org/10.1016/j.cimid.2019.06.003 Received 12 April 2019; Received in revised form 8 June 2019; Accepted 10 June 2019 0147-9571/ © 2019 Published by Elsevier Ltd. S. Esmaeili, et al. Comparative Immunology, Microbiology and Infectious Diseases 66 (2019) 101322 and consumption of unpasteurized dairy products. Thus, brucellosis is each of the two groups. usually more common in slaughterhouse workers, animal farmers, and After obtaining informed consent from the participants, 6 ml of veterinarians compared to the general population [4]. The annual in- blood was collected form each person. Sera were extracted and kept at cidence of brucellosis in Iran is estimated at 0.001% [5]. However, the −20 C until they were transferred to the Pasteur Institute of Iran for prevalence of this disease varies between different regions of Iran de- serological testing. pending on the climatic conditions, the raised livestock species and The following information was collected for each participant: em- their health situation, and the access or not to pasteurized dairy pro- ployment history; level of job satisfaction; contact with livestock spe- ducts [6]. cies; perceived level of risk of exposure to zoonoses; observance of in- Q fever is a widespread zoonosis caused by the bacterium Coxiella dividual protection measures against zoonotic diseases; and level of burnetii. Human infections may correspond to acute or chronic diseases, knowledge concerning tularemia, brucellosis, and Q fever. The level of the most severe form being endocarditis [7]. Like in other Middle East personal protective measures was assessed based on criteria such as countries, Q fever is endemic in Iran [8]. This disease was first reported wearing gloves and boots, and performing practices such as disinfecting in this country in 1951. Subsequently, C. burnetii infection was detected hands and tools after work. In the statistical analysis, the borderline by culture or serology in humans, sheep, cattle, goats, camels, equines, serological results for the three diseases evaluated (i.e. suspected cases) rodents, birds, ticks, and even eggs. Q fever infection is mainly asso- were considered negative. ciated with contact with livestock, but also exposure to contaminated This research was approved by the Ethics Committee of Lorestan environments where C. burnetii can survive for months. Dairy products University of Medical Sciences (IR.LUMS.REC.1397.008). may be contaminated with C. burnetii but are rarely involved in human transmission [9]. 2.3. Serology Tularemia is caused by Francisella tularensis. The infectious dose of this bacterium is considered very low since 10–50 bacteria are enough For detection of IgG antibodies against F. tularensis, serum samples to cause infection in humans and animals [10]. F. tularensis can infect a were tested using the Tularemia ELISA kit (Virion\Serion GmbH, significant number of wildlife species as well as domestic livestock. This Germany) according to the manufacturer's instructions. Sera were pathogen may be transmitted to humans in many ways, including tested with the commercial Q fever ELISA kit (Virion\Serion GmbH, through direct contact with contaminated animals or their tissues, Germany) for detection Phase II IgG antibodies against C. burnetii. For consumption of undercooked contaminated meat or contaminated detection of IgG antibodies against Brucella, sera were tested with the drinking water, bites or scratches from animals, arthropod bites, and commercial Brucellosis ELISA kit (IBL, Germany). For all three diseases, environmental exposures such as breathing aerosols from contaminated the results were classified into positive, borderline (suspected cases), or dust [11]. In Iran, human cases of tularemia were firstly reported in negative categories according to the ODs results, and based on manu- 1980, although positive serological tests were reported in livestock facturer's instructions. several years earlier (1973) [12]. Then, various studies have shown the persistence of F. tularensis circulation in different parts of Iran 2.4. Statistical analysis [1,11–15]. Slaughterhouse workers and butchers are at high risk of developing Statistical analyses were performed using SPSS software version 23. these three diseases through direct contact with infected animals and Descriptive analysis was performed for quantitative variables such as their tissues. Our study aimed at evaluating the seroprevalence of mean, standard deviation, median, and qualitative data such as fre- brucellosis, Q fever and tularemia among these occupational groups in quency and percent. For inferential analysis, chi-square, Fisher’s exact, the Lorestan province of Iran. Given that specific antibodies directed and logistic regression