Molecular epidemiology and antibiotic susceptibility of livestock Brucella melitensis isolates from Naryn Oblast, Kyrgyzstan.

The incidence of human brucellosis in Kyrgyzstan has been increasing in the last years and was identified as a priority disease needing most urgent control measures in the livestock population. The latest species identification of Brucella isolates in Kyrgyzstan was carried out in the 1960s and investigated the circulation of Brucella abortus, B. melitensis, B. ovis, and B. suis. However, supporting data and documentation of that experience are lacking. Therefore, typing of Brucella spp. and identification of the most important host species are necessary for the understanding of the main transmission routes and to adopt an effective brucellosis control policy in Kyrgyzstan. Overall, 17 B. melitensis strains from aborted fetuses of sheep and cattle isolated in the province of Naryn were studied. All strains were susceptible to trimethoprim-sulfamethoxazole, gentamicin, rifampin, ofloxacin, streptomycin, doxycycline, and ciprofloxacin. Multilocus variable number tandem repeat analysis showed low genetic diversity. Kyrgyz strains seem to be genetically associated with the Eastern Mediterranean group of the Brucella global phylogeny. We identified and confirmed transmission of B. melitensis to cattle and a close genetic relationship between B. melitensis strains isolated from sheep sharing the same pasture.

Representative seroprevalences of brucellosis in humans and livestock in Kyrgyzstan.

Kyrgyzstan reported 77.5 new human brucellosis cases per 100,000 people in 2007, which is one of the highest incidences worldwide. In Kyrgyzstan, the currently used diagnostic tests in humans and animals are the Rose Bengal Test and the Huddleson test. A national representative cross-sectional study using cluster sampling proportional to size in humans, cattle, sheep, and goats was undertaken to assess the apparent seroprevalence in humans and animals. A total of 4,936 livestock sera and 1,774 human sera were tested in Naryn, Chuy, and Osh Oblasts. The overall apparent seroprevalences of brucellosis were 8.8% in humans (95% CI 4.5-16.5), 2.8% (95% CI 1.6-4.9%) in cattle, 3.3% (95% CI 1.5-6.9%) in sheep, and 2.5% (95% CI 1.4-4.5%) in goats. Naryn Oblast had the highest seroprevalences in humans and sheep. More men than women were seropositive (OR = 1.96; P < 0.001). Human seroprevalence was significantly associated with small ruminant seroprevalence but not with cattle seroprevalence. Annual incidence of human brucellosis exposure, measured by serological tests, was more than ten times higher than the annual incidence of reported clinical brucellosis cases. This indicates an under-reporting of human brucellosis cases, even if only a fraction of seropositive people have clinical symptoms. In conclusion, this study confirms the high seroprevalence of brucellosis in Kyrgyzstan and warrants rapid effective intervention, among others, by mass vaccination of sheep and goats but also of cattle.

Towards a 'One Health' research and application tool box.

The 'One Medicine' concept by Calvin Schwabe has seen an unprecedented revival in the last decade and has evolved towards 'One Health' conceptual thinking, emphasising epidemiology and public health. Pathologists rightly recall the contribution of their discipline by close genomic relationship of animals and humans e.g. in cancer genetics. We need to change our 'us versus them' perspective towards a perspective of 'shared risk' between humans and animals. Professional organisations have declared their adhesion, governments have created joint public and animal health working groups and numerous research and surveillance programmes have been incepted as demonstrated on the 'One Health Initiative' website. Above all these beneficial developments, we should not forget however, that there remains a huge divide between human and veterinary medicine borne from unprecedented (over) specialisation of disciplines and increasingly reductionist approaches to scientific inquiry. What is required now is a radical paradigm shift in our approach to global public health with practical approaches and 'hands-on' examples to facilitate its application and accelerating necessary leverage of 'One Health'. We propose elements of an open 'tool box' translating the 'One Health' concept into practical methods in the fields of integrated disease surveillance, joint animal-human epidemiological studies and health services development, which we hope might serve as a discussion basis for mutually agreed practical cooperation between human and animal health with special emphasis on developing countries.