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Seroepidemiological Survey of Brucellosis and Q Fever Among High-Risk Occupations in Northeast of Iran for First Time

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Seroepidemiological Survey of Brucellosis and Q Fever Among High-Risk Occupations in Northeast of Iran for First Time Volume 13 Number 3 (June 2021) 325-336 Seroepidemiological survey of brucellosis and Q fever among high-risk occupations in northeast of Iran for first time TICLE R A 1,2* 1 3 Sadaf Sabzevari , Hamidreza Shoraka , Mohammad Seyyedin 1Vector-Borne Disease Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran 2 ORIGINAL Preclinical Core Facility, Infection Preclinical Imaging Group, Tehran University of Medical Sciences, Tehran, Iran 3Department of Quality Control, Razi Vaccine and Serum Research Institute, Agricultural Research Education And Extention Organization, Mashhad Branch, Mashhad, Iran Received: January 2021, Accepted: April 2021 ABSTRACT Background and Objectives: Brucellosis and Q fever are considered as occupational hazards to people in contact with domestic animals or their carcasses. The present cross-sectional study was carried out to determine the seroprevalence of brucellosis and Q fever among professions at risk in the North Khorasan Province, northeastern Iran during 2020. Materials and Methods: In this study, 185 sera samples were collected from butchers, slaughterhouse workers, farmers, and veterinarians in different counties of the province. The collected sera were tested by ELISA test for the detection of IgG antibodies against Coxiella burnetii and Brucella spp. A questionnaire was filled for each participant to investigate demo- graphic characteristics information (i.e., age, gender, educational status, occupation, years of occupational experience, and location), and any exposure to risk factors (animals Keeping, consumption of unpasteurized dairy products, exposure to ill or dead animals, tick bite, splashing animal fluids, travel history, and use of personal protective equipment) that could be associated with these infections. Results: The seroprevalence of antibodies against C. burnetii and Brucella spp. were 17.2% and 19.4%, respectively. Twelve participants also had Q fever and brucellosis co-infection, with a prevalence of 6.4%. Conclusion: Based on the results, it is concluded that brucellosis and Q fever occur among the high-risk populations in this area and it needs more surveillance to control the diseases by public health and veterinary authorities. Keywords: Coxiella burnetii; Brucella spp.; High-risk population; Seroprevalence; Enzyme-linked immunosorbent assay; Iran INTRODUCTION imals or their carcasses (1, 2). Brucellosis and Q fe- ver have been established as occupational zoonosis, Many zoonoses are occupational diseases which globally. These diseases affect many groups, espe- appear out of close contact between human and an- cially who mainly deal with infected livestock such as veterinarians, abattoir workers, and dairy farmer *Corresponding author: Sadaf Sabzevari, Ph.D, Vec- without the use of personal and environmental pro- tor-Borne Disease Research Center, North Khorasan Uni- tection measures (3, 4). versity of Medical Sciences, Bojnurd, Iran; Preclinical Core Q fever, a worldwide-distributed zoonotic disease Facility, Infection Preclinical Imaging Group, Tehran Uni- caused by C. burnetii, is considered a significant versity of Medical Sciences, Tehran, Iran. public health problem in many countries except for Telefax: +98-5832297182 New Zealand and Antarctica (5, 6). Human Infec- Email: [email protected] tions most commonly occur through contaminated Copyright © 2021 The Authors. Published by Tehran University of Medical Sciences. This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Noncommercial uses of the work are permitted, provided the original work is properly cited. 325 SADAF SABZEVARI ET AL. aerosols generated by ruminants particularly during The overall seroprevalence of IgG phase I and II parturition (5, 7), however, the infection can also be antibodies of Q fever in Iran were 19.80% and 32.86% acquired via the ingestion of raw milk and unpasteur- respectively, furthermore, seroprevalence of anti- ized dairy products, bites of ticks, and person-to-per- bodies against brucellosis was 15.4% overall (6, 14). son contact (5, 6). Q fever should be considered Positive findings for Q fever and brucellosis are a disease of an occupational hazard for farmers, based on common serological tests including rap- slaughterhouse workers, veterinarians, and butch- id tube agglutination, standard tube agglutination ers who have regular exposure to livestock or their (STA), immunofluorescence assay (IFA), Rose Ben- products (3, 4, 8). In livestock and animals, Q fever gal, Coombs-Wright, 2-mercaptoethanol (2-ME), is mostly asymptomatic (6) but in humans, C. bur- and ELISA for both immunoglobulin M (IgM) and netii infection can present as asymptomatic, acute, immunoglobulin (IgG) antibodies (4, 9). or chronic forms (5, 6). Approximately less than half As mentioned before veterinarians, slaughterhouse (40%) of infected people will manifest clinical signs workers, and butchers are at risk of contracting Q fe- of acute Q fever. The most common clinical symp- ver and brucellosis. Due to the endemicity of brucel- toms consisting of a flu-like illness, atypical pneumo- losis and to a lesser extent Q fever in Iran and since nia, and hepatitis (5, 6). In the patients with chronic the shortage of recent epidemiologic data regarding Q fever form (with a rate of about 5%), endocarditis, the distribution of them in North Khorasan Province, vascular infection, nonspecific fatigue, fever, weight the current study thus intended to prepare a seroepi- loss, night sweats, hepatosplenomegaly as well as demiological survey for these two important zoonotic premature birth and spontaneous abortion have been diseases in this province by ELISA method. The ob- reported. Moreover, the majority of patients infect- jective of this study was to determine the seropreva- ed with Q fever (roughly 60%) remain asymptom- lence of brucellosis and Q fever among veterinarians, atic (4-6, 9). High phases II antibody titer suggests slaughterhouse workers, farmers, and butchers with acute infection whereas both phases I and II anti- exposure to work hazards. The most common haz- bodies are identified in chronic Q fever (4, 5, 9). En- ards for these groups similar to previous studies that demic to the Middle East, Q fever has been reported have been done in Iran (9, 11, 17) were considered from different parts of Iran (5, 6, 10). (animals keeping, consumption of unpasteurized Brucellosis is the most common zoonotic dis- dairy products, exposure to ill or dead animals, tick ease in humans around the world that is caused by bite, splashing animal fluids, travel history, and use Gram-negative bacteria, Brucella spp. (11, 12). Hu- of personal protective equipment). This, to our best man brucellosis is endemic in many developing knowledge, has never been investigated before. countries especially in the Mediterranean, Central and South America, Asia North and East Africa, and the Middle- East; especially in Syria, Iraq, Egypt, MATERIALS AND METHODS Turkey, and Iran (11, 13-15). More than 500 million new cases of brucellosis per year globally are intro- Study area. This cross-sectional study was carried duced according to the World Health Organization out in North Khorasan Province in the northeast of (WHO) reports (13, 16). Transmission to humans Iran in 2020. North Khorasan is one of the three prov- occurs mainly via the consumption of unpasteurized inces that were created after the division of Khorasan dairy products from infected animals. Also, direct or in 2004. This province has a total area of about 28434 indirect contact with infected animals or exposure to km2 and is located in northeastern Iran. The climate tissues such as the placenta and birth can contaminate is mountainous and moderate with cold winters. human (4, 13, 15). Brucellosis is an occupational dis- North Khorasan shares a long border with Turkmen- ease in veterinarians, slaughterhouse workers, butch- istan in the north. Bojnurd city is the capital of the ers, and farmers through close contact with livestock province. The counties of North Khorasan Province or their products (3, 4, 17). In humans, brucellosis are Shirvan County, Esfarayen County, Maneh and causes a wide range of symptoms including weakness, Samalqan County, Raz and Jargalan County, Jajarm undulant fever, headaches, myalgia, night sweats, County, Faruj County, and Garmeh County (Fig. 1). arthritis, splenomegaly, hepatomegaly, pulmonary, cutaneous, and ocular involvement (4, 13, 18). Samples collection. The blood samples were col- 326 IRAN. J. MICROBIOL. Volume 13 Number 3 (June 2021) 325-336 http://ijm.tums.ac.ir BRUCELLOSIS AND Q FEVER IN NORTHEAST OF IRAN Fig. 1. Map of North Khorasan Province of Iran lected from at-risk groups in all cities around the Ethics approval and consent to participate. The province. Four groups including butchers (33 sub- present study was approved by the Medical Ethics jects), slaughterhouse workers (30 subjects), farmers Committee of the North Khorasan University of Med- (70 subjects), and veterinarians (52 subjects) were ical Sciences. (Ethic ID: IR.NKUMS.REC.1396.78). tested in our study. A questionnaire including some All participants' subjects submitted an informed writ- demographic details was completed for each volun- ten consent. teer. 10 mL of blood samples in venouject tubes were taken from each individual. The blood tubes were transported to the laboratory under cool conditions. RESULTS The blood clots were centrifuged for 5-10
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