Trends in the Epidemiology of Brucellosis in a Highly Afflicted Region in Egypt: A 16 Year Experience (1997-2012)

Abstract

Background: Brucellosis is a serious re-emerging zoonosis which vastly afflicts human health and animal productivity. The reported incidence may under-represent the real burden of the disease that has drastically evolved during the past decade. Incomplete epidemiological data particularly from developing countries and remote areas reflects partly the lack of accurate disease diagnosis and under reporting. This necessitates the comprehensive review of past experiences and disease trends over time to tailor proper intervention and control strategies. Aim: This hospital based study is an attempt to explain reasons beyond the evolution and alteration of brucellosis epidemiology in a highly burdened rural region in Egypt over 16 years (1997-2012). Methods: All cases of human brucellosis admitted to Damanhour fever hospital from 1997 to 2012 were analyzed. During 2007, the study was complemented by a detailed patient evaluation and disease description. Data about animal brucellosis were reviewed from records in the veterinary sector. Results: A total of 4371 [2609 (59.7%) males and 1762 (40.3%) females, median of age=31 years] brucellosis cases were reviewed during the study period. The annual occurrence among human has increased early in the decade and showed two peaks of incidence in 2002 and 2005-2006. On the other hand, animal brucellosis showed significant decline across decades thanks to enforcement of control measures. The disease was frequently presented by nonspecific constitutional symptoms and reticuloendothelial system involvement, yet sever complications were less encountered. All patients were treated according to the standard therapeutic guidelines and showed clinical improvement before discharge. Conclusion: These results indicate that human and livestock brucellosis persisted in Northern Egypt across the study period albeit with a fluctuating incidence. The current situation necessitates more appropriate disease surveillance and improving the control and containment strategies in order to alleviate disease burden on both human and animal populations.