Epidemiological Pattern and Trend of Brucellosis in Diagnosed Patients in Isfahan Province, Iran, during 2011-8 Mostafa Saberia , Nafiseh Sadeghianb , Reza Fadaei Nobaric , Javad Ramazanpourd , Maryam Nasiriane* a MSc in Epidemiology, Student Research Committee, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran b MSc in Epidemiology, Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran c Infectious Diseases Specialist, Department of Disease Prevention and Control, Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran d BSc in Public Health, Department of Disease Prevention and Control, Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran e PhD in Epidemiology, Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran *Correspondence should be addressed to Dr Maryam Nasirian, Email: [email protected] A-R-T-I-C-L-EI-N-F-O A-B-S-T-R-A-C-T Article Notes: Background & Aims of the Study: Brucellosis is a bacterial infectious disease that can be Received: 05 Dec, 2019 transmitted between humans and animals through the consumption of unpasteurized dairy Received in revised form: products or direct human contact with infected animals, placenta, or aborted fetuses. The 29 Feb, 2020 present study aimed to investigate the epidemiological pattern and trend of brucellosis in Accepted: 02 Mar, 2020 diagnosed patients in Isfahan province, Iran, during 2011-9. Available Online: 23 May, 2020 Materials and Methods: This descriptive cross-sectional study was conducted during 2011-9 in Isfahan province. Data analysis was performed in SPSS software (version 20) Keywords: using descriptive tests. Brucellosis Results: The total number of studied patients who were diagnosed with brucellosis was Cross-sectional studies 5268, including 3650 males (69.3%) and 1618 females (30.7%). The mean incidence rate of Epidemiology the disease was estimated at 14.5 per 100,000 people during the research period. The mean Iran age of the patients was 35.98±18.1 and most of the participants were within the age range Isfahan of 15-29 years. Moreover, 51.7%, 1.6%, 46.7% of the patients lived in rural, nomadic, and urban areas, respectively. Furthermore, 67.3% of the patients had a history of contact with livestock, and 17.9% of them had a family history of brucellosis. Besides, 59.2% of the infected people had a history of using unpasteurized dairy products. Conclusion: Based on the results, it can be concluded that interventions, such as the provision of appropriate training for young people, especially in rural areas, and housewives, as well as recommendations for the use of pasteurized dairy products, can be very helpful in controlling this disease. Please cite this article as: Saberi M, Sadeghian N, Fadaei Nobari R, Ramazanpour J, Nasirian M. Epidemiological Pattern and Trend of Brucellosis in Diagnosed Patients in Isfahan Province, Iran, during 2011-8. Arch Hyg Sci 2020;9(1):77-87. in animals as brucellosis (1). Brucellosis is also Background known by other names, such as undulant fever and Mediterranean fever. Moreover, it is known Brucellosis is a bacterial infectious disease as a disease with a thousand faces due to its transmitted between humans and animals. The various long-term side effects (2). This disease disease is known in humans as Malta fever and is created by a type of bacteria named Brucella ---------------------------------------------------------------------------------------------------------------------------------------- Archives of Hygiene Sciences Volume 9, Number 1, Winter 2020 © 2020 Publisher: Research Center for Environmental Pollutants, Qom University of Medical Sciences. All rights reserved. 77 whose subtypes, namely B. melitensis, B. patient four others in the society are not abortus, B. suis, and B. canis cause more than identified (10). The World Health Organization 50,000 human infections worldwide each year estimates that about 500,000 people are (3). Brucella melitensis has three serotypes and infected with this disease annually, about the first serotype is one of the most pathogenic 45,000 of whom are in the eastern Brucellas in Iran (4). Brucellosis is one of the Mediterranean countries, including Iran (2). most common zoonotic infections worldwide This disease has a high incidence rate in the (5) which can be transmitted through the Middle East region and has remained endemic consumption of unpasteurized dairy products in Iran, regarding the prevalence of animal and direct contact with infected animals, husbandry in this country. However, its placenta, or aborted fetuses (6). Moreover, the incidence rate ranges from 1-108 per 100,000 consumption of raw liver due to its high blood people in different regions of Iran (11). The volume can cause infections through the average annual incidence rate of the disease in gastrointestinal tract (4). Iran between 1990 and 2007 was estimated at This disease can also be transmitted to 43.24 per 100,000 people (12). Therefore, humans through their respiratory systems by considering the annual incidence of brucellosis infected particles existing in corrals, stables, in Isfahan province, Iran and the fact that it and laboratories. If contact with the source of causes numerous problems for the patients and the infection persists, it will be difficult to imposes an economic burden on them and the determine the timing of the infection and the healthcare system, it is necessary to study the incubation period. However, if the infection has epidemiological pattern of this disease in recent been caused by one particular contact, the years in Iran to identify high-risk groups and incubation period might be a few weeks or even use the results to plan strategies against this 6-17 months (7). There are no vaccines for the disease. prevention of this disease in humans and no significant human-to-human transmission has been observed. Therefore, it can be prevented Materials & Methods in humans by the control of animal brucellosis, milk pasteurization, and adherence to other This descriptive cross-sectional study used food hygiene standards (8). the data on the care for contagious diseases Brucellosis can cause severe disabilities and provided by the zoonotic diseases control its symptoms include fever, sweat, fatigue, department (Portal of the Deputy of Ministry of weight loss, headache, and joint pain for several Health and Medical Education) to evaluate the months. Moreover, it can cause neurological epidemiological aspects of brucellosis in complications, endocarditis, testicular swelling, Isfahan province during 8 years. The required or bone abscess. Besides, brucellosis by making data were obtained by the identification of the patients unable to perform their daily brucellosis patients in public or private activities imposes a serious financial burden on healthcare centers through the examination them. It should be noted that this disease forms and their registration in the portal of the can seriously harm dairy industries (6, 9). Ministry of Health in Isfahan province, during Brucellosis, which is a remerging disease, is 2011-9. shared between humans and animals with a One of the goals of the healthcare system is prevalence rate of about 10 per 100,000 people to assess the current situation and monitor the that has made it one of the most common human disease process. Therefore, it is necessary to and animal diseases in some countries (3). collect initial and complete data on the infected It can be said that per every identified people to obtain accurate information on this ------------------------------------------------------------------------------------------------------------------------------ Archives of Hygiene Sciences Volume 9, Number 1, Winter 2020 © 2020 Publisher: Research Center for Environmental Pollutants, Qom University of Medical Sciences. All rights reserved. 78 disease and design appropriate interventions for females (30.7%). In total, 98.6%, 1.3%, and the promotion of health. 1.1% of them were Iranian, Afghan, and Iraqi, For this reason, it is necessary to use the respectively. Furthermore, 85% of them were standardized definitions and specific criteria of recently infected, 5.1% of them had experienced the disease to achieve an accurate and standard treatment failure, and 9.9% of them had an diagnosis. Brucellosis is diagnosed by clinical unknown status. The patients were within the symptoms, epidemiological contact with age ranges of >14 (n=565, 10.7%), 15-29 infected animals or animal products, and having (n=1589, 30.2%), 30-44 (n=1421, 27%), 45-59 a Wright titer or Coombs Wright ≤ or 2ME (n=990, 18.8%), and <60 years old (n=647, 12.3%). Therefore, the most and least frequency titer of ≤ . was observed in the age ranges of 15-29 and The collected data were analyzed in SPSS >14 years old, respectively. The age of 1.1% of software (version 20) using descriptive the subjects was unknown. The mean age of the statistics, such as mean, standard deviation, patients was 35.98±18.1 while the mean age of frequency distribution, and percentage males and females was 34.1±17.57 and frequency distribution. In order to calculate the 40.5±18.7, respectively. In addition, the mean incidence rate of the disease in each city, a ages of rural, nomadic, and urban women fraction was used with the numerator were 41.3±18, 34.6±18.7, and 40.5±18.4, representing the number of diagnosed people in respectively. On the other hand, the mean ages each year and the denominator showing the of rural, nomadic, and urban men were 35±17.8, population of each city in that year. Moreover, 30.8±16.58, and 35.1±16.67 (Table 1, Figure 1). in order to calculate the mean incidence rate In total, about 51.7%, 1.6%, and 46.7% of the during the research period, the total incidence patients resided in rural, nomadic, and urban of the disease in each city was divided by the areas (Table 1). years of the research period. The geographical Based on the results, 67.3% of the patients distribution maps and GIS software (version had a history of contact with livestock in the 10.3) were used in order to manage and analyze past year.