Publications by authors named "Johanna Lindahl"

65 Publications

Risk factors of dengue fever in an urban area in Vietnam: a case-control study.

BMC Public Health 2021 Apr 7;21(1):664. Epub 2021 Apr 7.

Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.

Background: Dengue is a mosquito-borne flavivirus present in many metropolitan cities of tropical countries.

Methods: During and after the dengue season (September 2018 to January 2019), we conducted a case-control study in order to determine the risk factors for dengue fever in Hanoi city, Vietnam. 98 dengue patients and 99 patients with other acute infections, such as Hepatitis B virus infection, were recruited at Department of Infectious Disease of Bach Mai national hospital in Hanoi. Patients were interviewed using a structured questionnaire covering demographic, housing, environmental factors and knowledge, attitude, and practice on dengue prevention and control. Univariate analysis and multivariable logistic regression were used to determine the risk factors of dengue status.

Results: The mean score of knowledge items and practice items was only 7.9 out of total 19 points and 3.9 out of total 17 points, respectively. While the mean score of attitude items was 4.8 out of total 6 points. Multivariable logistic regression indicated that older patients had lesser risk of getting dengue infection as compared to younger adults aged 16-30, and patients living in peri-urban districts were less likely to suffer of dengue fever than patients living in central urban districts (OR = 0.31; 95% CI 0.13-0.75). This study could not find any association with occupation, water storage habit, knowledge, attitude, or practice on dengue prevention.

Conclusions: All patients had a relatively low level of knowledge and practice on dengue prevention and control. However, the attitude of the participants was good. We found that age group and living district were the risk factors correlated with the dengue status. Communication programs on raising dengue awareness should be repeated all year round and target particular groups of adolescents, younger adults, landlords and migrants from other provinces to improve their knowledge and encourage them to implement preventive measures against dengue fever.
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http://dx.doi.org/10.1186/s12889-021-10687-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028770PMC
April 2021

Improved Sample Selection and Preparation Methods for Sampling Plans Used to Facilitate Rapid and Reliable Estimation of Aflatoxin in Chicken Feed.

Toxins (Basel) 2021 Mar 16;13(3). Epub 2021 Mar 16.

Department of Biosciences, International Livestock Research Institute, P.O. Box 30709, Nairobi 00100, Kenya.

Aflatoxin B1 (AFB1), a toxic fungal metabolite associated with human and animal diseases, is a natural contaminant encountered in agricultural commodities, food and feed. Heterogeneity of AFB1 makes risk estimation a challenge. To overcome this, novel sample selection, preparation and extraction steps were designed for representative sampling of chicken feed. Accuracy, precision, limits of detection and quantification, linearity, robustness and ruggedness were used as performance criteria to validate this modification and Horwitz function for evaluating precision. A modified sampling protocol that ensured representativeness is documented, including sample selection, sampling tools, random procedures, minimum size of field-collected aggregate samples (primary sampling), procedures for mass reduction to 2 kg laboratory (secondary sampling), 25 g test portion (tertiary sampling) and 1.3 g analytical samples (quaternary sampling). The improved coning and quartering procedure described herein (for secondary and tertiary sampling) has acceptable precision, with a Horwitz ratio (HorRat = 0.3) suitable for splitting of 25 g feed aliquots from laboratory samples (tertiary sampling). The water slurring innovation (quaternary sampling) increased aflatoxin extraction efficiency to 95.1% through reduction of both bias (-4.95) and variability of recovery (1.2-1.4) and improved both intra-laboratory precision (HorRat = 1.2-1.5) and within-laboratory reproducibility (HorRat = 0.9-1.3). Optimal extraction conditions are documented. The improved procedure showed satisfactory performance, good field applicability and reduced sample analysis turnaround time.
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http://dx.doi.org/10.3390/toxins13030216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002447PMC
March 2021

Dogs as Sentinels for Flavivirus Exposure in Urban, Peri-Urban and Rural Hanoi, Vietnam.

Viruses 2021 Mar 19;13(3). Epub 2021 Mar 19.

International Livestock Research Institute (ILRI), Hanoi 10000, Vietnam.

Diseases caused by flaviviruses, including dengue fever and Japanese encephalitis, are major health problems in Vietnam. This cross-sectional study explored the feasibility of domestic dogs as sentinels to better understand risks of mosquito-borne diseases in Hanoi city. A total of 475 dogs serum samples from 221 households in six districts of Hanoi were analyzed by a competitive enzyme-linked immunosorbent assay (cELISA) for antibodies to the pr-E protein of West Nile virus and other flaviviruses due to cross-reactivity. The overall flavivirus seroprevalence in the dog population was 70.7% (95% CI = 66.4-74.8%). At the animal level, significant associations between seropositive dogs and district location, age, breed and keeping practice were determined. At the household level, the major risk factors were rural and peri-urban locations, presence of pigs, coil burning and households without mosquito-borne disease experience ( < 0.05). Mosquito control by using larvicides or electric traps could lower seropositivity, but other measures did not contribute to significant risk mitigation of flavivirus exposure in dogs. These results will support better control of mosquito-borne diseases in Hanoi, and they indicate that dogs can be used as sentinels for flavivirus exposure.
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http://dx.doi.org/10.3390/v13030507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003331PMC
March 2021

Live and Wet Markets: Food Access versus the Risk of Disease Emergence.

Trends Microbiol 2021 Mar 9. Epub 2021 Mar 9.

Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala SE-75237, Sweden; International Livestock Research Institute, Department of Biosciences, Nairobi 00100, Kenya; Swedish University of Agricultural Sciences, Department of Clinical Sciences, SE-750 07 Uppsala, Sweden. Electronic address:

Emerging zoonotic diseases exert a significant burden on human health and have considerable socioeconomic impact worldwide. In Asia, live animals as well as animal products are commonly sold in informal markets. The interaction of humans, live domestic animals for sale, food products, and wild and scavenging animals, creates a risk for emerging infectious diseases. Such markets have been in the spotlight as sources of zoonotic viruses, for example, avian influenza viruses and coronaviruses, Here, we bring data together on the global impact of live and wet markets on the emergence of zoonotic diseases. We discuss how benefits can be maximized and risks minimized and conclude that current regulations should be implemented or revised, to mitigate the risk of new diseases emerging in the future.
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http://dx.doi.org/10.1016/j.tim.2021.02.007DOI Listing
March 2021

Knowledge and practice on prevention of mosquito-borne diseases in livestock-keeping and non-livestock-keeping communities in Hanoi city, Vietnam: A mixed-method study.

PLoS One 2021 4;16(2):e0246032. Epub 2021 Feb 4.

Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden.

Mosquito-borne diseases (MBDs) are causing high morbidity and mortality for humans. Urban livestock keeping is still common in cities around the world. The animals may serve as reservoirs for zoonotic MBDs, which increase the risks for humans. Here we assess the knowledge and practices related to MBDs in households with livestock and without livestock and explore the perceptions of the health care sector about MBDs and livestock keeping in Hanoi city of Vietnam in a cross-sectional study. A quantitative survey was conducted including 513 households with and without livestock-keeping in six districts and complemented with qualitative surveys with four health staff from Hanoi Center of Disease Control and three district health centers. The quantitative survey indicated that the participants possessed basic knowledge on MBDs with an average score of 18.3 out of 35, of which non-livestock-keeping households had a better knowledge than households keeping livestock (p<0.05). Both household categories had low score, 3.5 out of 11, regarding preventive practices against MBDs. The negative binomial model showed that occupation and location of living were factors associated to the knowledge on MBDs. Farmers were likely to have better preventive practices as compared to office workers (p<0.05). Those who had better knowledge also had more adequate preventive practices against MBDs (p<0.001). The qualitative survey revealed that livestock keeping was determined as increasing risks of MBDs due to the increase of mosquito population. It is recommended that community campaigns to raise the awareness and change behavior on MBDs should be organized based on collaboration between the health sector and the veterinary sector for households with and without livestock living in central urban and peri-urban areas. Further studies are needed to confirm the association between urban livestock keeping and potential increasing risks of MBDs such as dengue and Japanese encephalitis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246032PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861445PMC
February 2021

Multi-Mycotoxin Occurrence in Dairy Cattle and Poultry Feeds and Feed Ingredients from Machakos Town, Kenya.

Toxins (Basel) 2020 12 3;12(12). Epub 2020 Dec 3.

Department of Veterinary Pathology, Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Nairobi. P.O. Box 29053, Nairobi 00100, Kenya.

Mycotoxins are common in grains in sub-Saharan Africa and negatively impact human and animal health and production. This study assessed occurrences of mycotoxins, some plant, and bacterial metabolites in 16 dairy and 27 poultry feeds, and 24 feed ingredients from Machakos town, Kenya, in February and August 2019. We analyzed the samples using a validated multi-toxin liquid chromatography-tandem mass spectrometry method. A total of 153 mycotoxins, plant, and bacterial toxins, were detected in the samples. All the samples were co-contaminated with 21 to 116 different mycotoxins and/or metabolites. The commonly occurring and EU regulated mycotoxins reported were; aflatoxins (AFs) (70%; range 0.2-318.5 μg/kg), deoxynivalenol (82%; range 22.2-1037 μg/kg), ergot alkaloids (70%; range 0.4-285.7 μg/kg), fumonisins (90%; range 32.4-14,346 μg/kg), HT-2 toxin (3%; range 11.9-13.8 μg/kg), ochratoxin A (24%; range 1.1-24.3 μg/kg), T-2 toxin (4%; range 2.7-5.2 μg/kg) and zearalenone (94%; range 0.3-910.4 μg/kg). Other unregulated emerging mycotoxins and metabolites including toxins, toxins, bacterial metabolites, cytochalasins, depsipeptides, metabolites, metabolites from other fungi, toxins, phytoestrogens, plant metabolites, and unspecific metabolites were also detected at varying levels. Except for total AFs, where the average contamination level was above the EU regulatory limit, all the other mycotoxins detected had average contamination levels below the limits. Ninety-six percent of all the samples were contaminated with more than one of the EU regulated mycotoxins. These co-occurrences may cause synergistic and additive health effects thereby hindering the growth of the Kenyan livestock sector.
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http://dx.doi.org/10.3390/toxins12120762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761711PMC
December 2020

Evaluating farm-level livestock interventions in low-income countries: a scoping review of what works, how, and why.

Anim Health Res Rev 2020 12 2;21(2):108-121. Epub 2020 Dec 2.

Department of Biosciences, International Livestock Research Institute, P. O. Box 30709, 00100Nairobi, Kenya.

Livestock interventions can improve nutrition, health, and economic well-being of communities. The objectives of this review were to identify and characterize livestock interventions in developing countries and to assess their effectiveness in achieving development outcomes. A scoping review, guided by a search strategy, was conducted. Papers needed to be written in English, published in peer-reviewed journals, and describe interventions in animal health and production. Out of 2739 publications systematically screened at the title, abstract, and full publication levels, 70 met our inclusion criteria and were considered in the study. Eight relatively high-quality papers were identified and added, resulting in 78 reviewed publications. Only 15 studies used randomized controlled trial designs making it possible to confidently link interventions with the resulting outcomes. Eight studies had human nutrition or health as outcomes, 11 focused on disease control, and four were on livestock production. Eight interventions were considered successful, but only four were scalable. We found good evidence that livestock-transfer programs, leveraging livestock products for nutrition, and helping farmers manage priority diseases, can improve human well-being. Our report highlights challenges in garnering evidence for livestock interventions in developing countries and provides suggestions on how to improve the quantity and quality of future evaluations.
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http://dx.doi.org/10.1017/S1466252320000146DOI Listing
December 2020

Knowledge and practices of dairy farmers relating to brucellosis in urban, peri-urban and rural areas of Assam and Bihar, India.

Infect Ecol Epidemiol 2020 May 31;10(1):1769531. Epub 2020 May 31.

Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.

Background: Brucellosis is one of the most common zoonotic diseases in the world. This study aimed at assessing farmers' knowledge about brucellosis as well as practices relevant to transmission of brucellosis and their associated determinants.

Results: Few farmers knew about brucellosis (3.4%, = 18) and its zoonotic importance (0.8%, = 4). Knowledge about brucellosis was higher for farmers with a larger herd size ( < 0.001) and fully using a stall-fed system ( < 0.001). Training on dairy cattle management ( < 0.001), training on animal disease ( < 0.01), consultation with veterinarians ( < 0.001) and farms being in urban areas ( < 0.01) were also significantly positively associated with knowledge about brucellosis. No significant association was observed between farmers' knowledge about brucellosis and state, family size, education, age or gender of the farmers. Farmers knowledge about brucellosis was significantly associated with certain practices that include use of disinfectant while cleaning farms ( < 0.05), animal movement ( < 0.01), introduction of new animals ( < 0.05) and raw milk consumption ( < 0.05). The study did not find any association between knowledge about brucellosis and method of disposal of aborted materials, personal hygiene and quarantine practices.

Conclusion: More interaction with veterinarians and training on animal management may be an important tool for generating awareness among the farming community for reducing transmission of the disease.
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http://dx.doi.org/10.1080/20008686.2020.1769531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655058PMC
May 2020

Livestock Development in Hanoi City, Vietnam-Challenges and Policies.

Front Vet Sci 2020 10;7:566. Epub 2020 Sep 10.

Department of Biosciences, International Livestock Research Institute (ILRI), Hanoi, Vietnam.

The rapid urban growth of Hanoi city requires a livestock production system that ensures both food security and the livelihoods of dwellers. This paper reviews the existing policies for livestock production of Hanoi city and the changes in livestock population between 2014 and 2018 and identifies major challenges for livestock development of the city. While a remarkable increase of the livestock population in recent years is evident, the dominance of small-scale farms, the presence of animal diseases, the slow progress of transiting farms out of urban areas, as well as the lack of analysis of climate change and gender impacts are major challenges that could affect the livestock development of Hanoi.
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http://dx.doi.org/10.3389/fvets.2020.00566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511548PMC
September 2020

A qualitative study on antibiotic use and animal health management in smallholder dairy farms of four regions of India.

Infect Ecol Epidemiol 2020 Jul 12;10(1):1792033. Epub 2020 Jul 12.

Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.

Background: Antimicrobial resistance (AMR) is a major global public health issue. In India, access to medicines is poorly regulated and therefore antibiotics in dairy cattle are commonly used by farmers without consulting with veterinarians. This study was conducted to understand practices and knowledge related to antibiotic use and AMR among dairy farmers and veterinary professionals in selected urban and peri-urban areas of India.

Methods: A total of 28 focus group discussions with farmers and 53 interviews with veterinary professionals were carried out.

Results: Mastitiswas identified as the main animal health challenge. Antibiotic consultation behavior of farmers depended on the availability of veterinarians. Except in Bangalore, farmers were found to often treat animals on their own. They were found unaware of the concept of AMR, but knew the importance of vaccination. Veterinarians included in the study had a good understanding of antibiotics, AMR, and zoonotic diseases.

Conclusion: The knowledge level and practices observed in the study related to the use/abuse of antibiotics can potentially increase the risk of development of AMR and its transfer in the community. Our findings can help support AMR - mitigation efforts in the country, including the design of better policies on antibiotic use in dairy.
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http://dx.doi.org/10.1080/20008686.2020.1792033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480485PMC
July 2020

Risk factors for spp. and infection among small ruminants in Eastern India.

Infect Ecol Epidemiol 2020 Jun 23;10(1):1783091. Epub 2020 Jun 23.

International Livestock Research Institute, Southeast Asia Regional Office, Hanoi, Vietnam.

Small ruminants are the main reservoirs for brucellosis and coxiellosis, two zoonotic diseases affecting livestock production, and posing a public health threat in India. Understanding disease prevalence and risk factors associated with small ruminant infection can help mitigate disease transmission. We report a cross-sectional survey in the states of Assam and Odisha in Eastern India. We interviewed 244 farmers to assess knowledge, attitude and practices relevant to brucellosis and coxiellosis infection. Serum samples from 411 goats and 21 sheep were analysed using enzyme-linked immunosorbent assay and Rose-Bengal agglutination plate test. Higher and seroprevalence were found in Odisha (22% and 11.5%, respectively) than Assam (9.8% and 1.6%, respectively), and certain districts in Odisha were at higher risk. No association was found between seropositive animals and clinical signs, a challenge when attempting to identify seropositive animals in the herd. None of the farmers interviewed were aware of brucellosis, its aetiology, clinical form, or zoonotic risk. This study acts as a first indication of the extent of these diseases among small ruminants in these Indian states, highlighting how farming practices are associated with increased risk of infection. More research is urgently needed to mitigate zoonoses transmission in this region.
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http://dx.doi.org/10.1080/20008686.2020.1783091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480416PMC
June 2020

High seroprevalence of SARS-CoV-2 in elderly care employees in Sweden.

Infect Ecol Epidemiol 2020 Aug 5;10(1):1789036. Epub 2020 Aug 5.

Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden.

The COVID-19 pandemic is growing and spread in the Swedish elderly care system during April 2020. The increasing number of employees on sick-leave due to COVID-19 created severe logistic problems. Some elderly care homes therefore started to screen their personnel to secure the safety of the elderly and to avoid unnecessary quarantine of potentially immune employees. Secondary data from a screening with a COVID-19 rapid test for detection of SARS-CoV-2-specific IgM and IgG of 1,005 employees in 22 elderly care homes in Stockholm, Sweden, were analyzed. Seropositive employees were found in 21 out of the 22 care homes. In total, 23% (231/1,005) of the employees tested positive for antibodies against SARS-CoV-2, and 14.3% (144/1,005) were found positive for IgM (either alone or combined with IgG), indicating recent or present infection. Of those that tested seropositive, 46.5% did not report any clinical symptoms, indicating pre- or asymptomatic infections. Reported symptoms with the highest correlation with seropositivity were fever and loss of smell and taste. These results suggest that antibody testing of employees in elderly care homes is valuable for surveillance of disease development and a crucial screening tool in the effort to decrease the death toll in this pandemic.
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http://dx.doi.org/10.1080/20008686.2020.1789036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480625PMC
August 2020

Spatio-Temporal Mutational Profile Appearances of Swedish SARS-CoV-2 during the Early Pandemic.

Viruses 2020 09 14;12(9). Epub 2020 Sep 14.

Zoonosis Science Center, Department of Medical Sciences, Uppsala University, SE-751 23 Uppsala, Sweden.

Background: During the COVID-19 pandemic, the virus evolved, and we therefore aimed to provide an insight into which genetic variants were enriched, and how they spread in Sweden.

Methods: We analyzed 348 Swedish SARS-CoV-2 sequences freely available from GISAID obtained from 7 February 2020 until 14 May 2020.

Results: We identified 14 variant sites ≥5% frequency in the population. Among those sites, the D936Y substitution in the viral Spike protein was under positive selection. The variant sites can distinguish 11 mutational profiles in Sweden. Nine of the profiles appeared in Stockholm in March 2020. Mutational profiles 3 (B.1.1) and 6 (B.1), which contain the D936Y mutation, became the predominant profiles over time, spreading from Stockholm to other Swedish regions during April and the beginning of May. Furthermore, Bayesian phylogenetic analysis indicated that SARS-CoV-2 could have emerged in Sweden on 27 December 2019, and community transmission started on February 1st with an evolutionary rate of 1.5425 × 10 substitutions per year.

Conclusions: Our study provides novel knowledge on the spatio-temporal dynamics of Swedish SARS-CoV-2 variants during the early pandemic. Characterization of these viral variants can provide precious insights on viral pathogenesis and can be valuable for diagnostic and drug development approaches.
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http://dx.doi.org/10.3390/v12091026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551444PMC
September 2020

COVID-19-a very visible pandemic.

Lancet 2020 08;396(10248):e16

Department of Medical Biochemistry and Microbiology, Zoonosis Science Centre, Uppsala University, Uppsala 751 23, Sweden.

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http://dx.doi.org/10.1016/S0140-6736(20)31674-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833711PMC
August 2020

The Extent and Structure of Peri-urban Smallholder Dairy Farming in Five Cities in India.

Front Vet Sci 2020 3;7:359. Epub 2020 Jul 3.

Public Health Foundation India, Gurgaon, India.

Livestock keeping is common in many cities in India, driven by the demand for animal-source foods, particularly perishable milk. We selected five cities from different regions of the country and conducted a census in 34 randomly selected peri-urban villages to identify and describe all smallholder dairy farms. In total 1,690 smallholder dairy farms were identified, keeping on average 2.2 milking cows and 0.7 milking buffaloes. In Bhubaneswar, the proportion of cows milking was only 50%, but in other cities it was 63-73%. In two of the five cities, more than 90% of the farmers stated that dairy production was their main source of income, while <50% in the other cities reported this. In one of the cities, only 36% of the households kept milk for themselves. Market channels varied considerably; in one city about 90% of farms sold milk to traders, in another, 90% sold to the dairy cooperative, and in another around 90% sold directly to consumers. In conclusion, peri-urban dairy systems in India are important but also varying between different cities, with only one city, Bengaluru, having a well-developed cooperative system, and the northeastern poorer region being more dependent on traders. Further studies may be needed to elucidate the importance and to design appropriate developmental interventions.
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http://dx.doi.org/10.3389/fvets.2020.00359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348999PMC
July 2020

A review of animal health and drug use practices in India, and their possible link to antimicrobial resistance.

Antimicrob Resist Infect Control 2020 07 8;9(1):103. Epub 2020 Jul 8.

International Livestock Research Institute, P. O. Box 30709, Nairobi, 00100, Kenya.

Background: Livestock production, particularly the dairy sector, is important for food and nutritional wellbeing of communities in India, it supports livelihoods of many farmers, and contributes to the economy of the country. India is a high consumer of antibiotics and antimicrobial resistant (AMR) bacteria are a major public health concern.

Objectives: Our objectives were to identify animal health and drug use practices that may contribute to emergence and spread of AMR in the country, review previous AMR- mitigation strategies, and discuss "theory of change" as an approach to informing the choice of interventions.

Methods: We undertook a desk review of literature to identify practices with potential to contribute to emergence and spread of antimicrobial resistance in India. Searches were done in PubMed, Google scholar, and Google. Data were synthesized and discussed by themes.

Results: Animal disease surveillance is less developed and infrastructure to support delivery of services is inadequate. Several groups are known to offer animal health services. The untrained "animal health workers" and para-veterinarians are more popular with farmers as they charge less for consultations (compared to veterinarians who are few and charge more). Over-the-counter access of antibiotics, without prescription, and direct marketing of drugs to farmers are common. Because of this, farmers are able to treat their animals and only consult when cases become non- responsive to treatment. Antibiotics are mostly used in management of mastitis cases. Drug withdrawal periods are rarely observed and occurrence of antibiotic- contaminated milk has been reported. Awareness on AMR is low and antimicrobial stewardship in livestock is yet to be developed. Initiatives such as the National programme for containment of AMR, National Action Plan on AMR, and the National Health policy point to government's commitment in addressing the problem of AMR in the country.

Conclusion: Several animal health and drug use practices, with potential to cause AMR, have been described, and their contribution can be discussed further by engaging stakeholders in a "theory of change" exercise. Interventions that address AMR from the animal health perspective should be promoted, and incentives to increase their adoption explored.
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http://dx.doi.org/10.1186/s13756-020-00760-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346624PMC
July 2020

Spatiotemporal and Socioeconomic Risk Factors for Dengue at the Province Level in Vietnam, 2013-2015: Clustering Analysis and Regression Model.

Trop Med Infect Dis 2020 May 19;5(2). Epub 2020 May 19.

Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.

Dengue is a serious infectious disease threat in Vietnam, but its spatiotemporal and socioeconomic risk factors are not currently well understood at the province level across the country and on a multiannual scale. We explore spatial trends, clusters and outliers in dengue case counts at the province level from 2011-2015 and use this to extract spatiotemporal variables for regression analysis of the association between dengue case counts and selected spatiotemporal and socioeconomic variables from 2013-2015. Dengue in Vietnam follows anticipated spatial trends, with a potential two-year cycle of high-high clusters in some southern provinces. Small but significant associations are observed between dengue case counts and mobility, population density, a province's dengue rates the previous year, and average dengue rates two years previous in first and second order contiguous neighbours. Significant associations were not found between dengue case counts and housing pressure, access to electricity, clinician density, province-adjusted poverty rate, percentage of children below one vaccinated, or percentage of population in urban settings. These findings challenge assumptions about socioeconomic and spatiotemporal risk factors for dengue, and support national prevention targeting in Vietnam at the province level. They may also be of wider relevance for the study of other arboviruses, including Japanese encephalitis, Zika, and Chikungunya.
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http://dx.doi.org/10.3390/tropicalmed5020081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345007PMC
May 2020

Pesticide Residues in Peri-Urban Bovine Milk from India and Risk Assessment: A Multicenter Study.

Sci Rep 2020 05 15;10(1):8054. Epub 2020 May 15.

Public Health Foundation of India, Plot 47, Sector 44, Gurugram, Haryana, India.

Pesticides residue poses serious concerns to human health. The present study was carried out to determine the pesticide residues of peri-urban bovine milk (n = 1183) from five different sites (Bangalore, Bhubaneswar, Guwahati, Ludhiana and Udaipur) in India and dietary exposure risk assessment to adults and children. Pesticide residues were estimated using gas chromatography with flame thermionic and electron capture detectors followed by confirmation on gas chromatography-mass spectrometer. The results noticed the contamination of milk with hexachlorocyclohexane (HCH), dichloro-diphenyl trichloroethane (DDT), endosulfan, cypermethrin, cyhalothrin, permethrin, chlorpyrifos, ethion and profenophos pesticides. The residue levels in some of the milk samples were observed to be higher than the respective maximum residue limits (MRLs) for pesticide. Milk samples contamination was found highest in Bhubaneswar (11.2%) followed by Bangalore (9.3%), Ludhiana (6.9%), Udaipur (6.4%) and Guwahati (6.3%). The dietary risk assessment of pesticides under two scenarios i.e. lower-bound scenario (LB) and upper-bound (UB) revealed that daily intake of pesticides was substantially below the prescribed acceptable daily intake except for fipronil in children at UB. The non-cancer risk by estimation of hazard index (HI) was found to be below the target value of one in adults at all five sites in India. However, for children at the UB level, the HI for lindane, DDT and ethion exceeded the value of one in Ludhiana and Udaipur. Cancer risk for adults was found to be in the recommended range of United States environment protection agency (USEPA), while it exceeded the USEPA values for children.
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http://dx.doi.org/10.1038/s41598-020-65030-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229043PMC
May 2020

A Mixed-Methods Approach to Understanding Knowledge of Mosquito-Borne Infections and Barriers for Protection in Hanoi, Vietnam.

Trop Med Infect Dis 2020 May 1;5(2). Epub 2020 May 1.

Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala SE-751 05, Sweden.

Dengue is a growing problem in Hanoi, with cyclical epidemics of increasing frequency and magnitude. In June 2019, we conducted a cross-sectional survey using mixed methods to investigate how inhabitants of Hanoi perceive and respond to the risk of mosquito-borne diseases (MBD). A total of 117 participants recruited using a stratified random sampling method were interviewed in three districts of Hanoi. Knowledge and practices (KP) regarding MBDs were assessed using a pre-tested questionnaire. Inferential statistics were used to identify factors associated with KP scores and describe the relationship between variables. Additionally, a "risk-mapping" exercise was conducted in a subsample through semi-structured interviews and analyzed qualitatively and quantitatively using the System Effects platform. Factors significantly associated with knowledge scores were education and family history of MBDs. While knowledge and practice scores were found to be positively correlated in the statistical analysis, this was not corroborated by our observations on the field. The results also revealed gaps in knowledge about MBDs and vectors and highlighted a general feeling of powerlessness which prevented the adoption of protective behaviors. Therefore, educational interventions which provide concrete tools to empower communities should have a positive impact on improving vector control.
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http://dx.doi.org/10.3390/tropicalmed5020066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345065PMC
May 2020

Evaluation of a COVID-19 IgM and IgG rapid test; an efficient tool for assessment of past exposure to SARS-CoV-2.

Infect Ecol Epidemiol 2020 14;10(1):1754538. Epub 2020 Apr 14.

Department of Medical Biochemistry and Microbiology, Zoonosis Science Center (ZSC), Uppsala University, Uppsala, Sweden.

COVID-19 is the most rapidly growing pandemic in modern time, and the need for serological testing is most urgent. Although the diagnostics of acute patients by RT-PCR is both efficient and specific, we are also crucially in need of serological tools for investigating antibody responses and assessing individual and potential herd immunity. We evaluated a commercially available test developed for rapid (within 15 minutes) detection of SARS-CoV-2-specific IgM and IgG by 29 PCR-confirmed COVID-19 cases and 124 negative controls. The results revealed a sensitivity of 69% and 93.1% for IgM and IgG, respectively, based solely on PCR-positivity due to the absence of a serological gold standard. The assay specificities were shown to be 100% for IgM and 99.2% for IgG. This indicates that the test is suitable for assessing previous virus exposure, although negative results may be unreliable during the first weeks after infection. More detailed studies on antibody responses during and post infection are urgently needed.
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http://dx.doi.org/10.1080/20008686.2020.1754538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178815PMC
April 2020

A Review of the Impact of Mycotoxins on Dairy Cattle Health: Challenges for Food Safety and Dairy Production in Sub-Saharan Africa.

Toxins (Basel) 2020 04 2;12(4). Epub 2020 Apr 2.

Department of Pathology, Parasitology and Microbiology, Faculty of Veterinary Medicine, University of Nairobi, PO Box 29053, 00100 Nairobi, Kenya.

Mycotoxins are secondary metabolites of fungi that contaminate food and feed and have a significant negative impact on human and animal health and productivity. The tropical condition in Sub-Saharan Africa (SSA) together with poor storage of feed promotes fungal growth and subsequent mycotoxin production. Aflatoxins (AF) produced by species, fumonisins (FUM), zearalenone (ZEN), T-2 toxin (T-2), and deoxynivalenol (DON) produced by species, and ochratoxin A (OTA) produced by and species are well-known mycotoxins of agricultural importance. Consumption of feed contaminated with these toxins may cause mycotoxicoses in animals, characterized by a range of clinical signs depending on the toxin, and losses in the animal industry. In SSA, contamination of dairy feed with mycotoxins has been frequently reported, which poses a serious constraint to animal health and productivity, and is also a hazard to human health since some mycotoxins and their metabolites are excreted in milk, especially aflatoxin M1. This review describes the major mycotoxins, their occurrence, and impact in dairy cattle diets in SSA highlighting the problems related to animal health, productivity, and food safety and the up-to-date post-harvest mitigation strategies for the prevention and reduction of contamination of dairy feed.
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http://dx.doi.org/10.3390/toxins12040222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232242PMC
April 2020

Aflatoxin Contamination of Milk Produced in Peri-urban Farms of Pakistan: Prevalence and Contributory Factors.

Front Microbiol 2020 4;11:159. Epub 2020 Mar 4.

International Livestock Research Institute (ILRI), Islamabad, Pakistan.

Aflatoxin M contamination of milk in Pakistan, like many developing countries, is poorly understood. The present study was therefore conducted to determine AFM contamination of milk and its contributory factors in Pakistan. We sampled milk and feedstuffs from 450 peri-urban dairy farms in seven major cities following a cross-sectional study design. Analysis of milk using ELISA revealed high contamination with an overall average of 3164.5 ng of AFM/L, and significant differences ( < 0.001) between cities. The milk sampled from Gilgit, in northern hilly areas, had an average AFM level of 92.5 ng/L. Milk from other cities had 3529.7 ng/L average contamination, with only 5.7% samples qualifying the maximum tolerable limit of 500 ng of AFM/L. Heavy mean aflatoxin contamination was found in bakery waste (724.6 μg/kg), and cottonseed cake (600.8 μg/kg). Rest of the other feedstuffs had moderate to low mean aflatoxin contamination, ranging from 66.0 μg/kg in maize stover to 3.4 μg/kg in wheat bran. The mean aflatoxin level in commercial dairy concentrates was 32.7 µg/kg. About 80% of the total aflatoxin intake of dairy animals was contributed by cottonseed cake alone due to its high aflatoxin contamination and proportion in dairy rations. On-farm storage time of oilseed cakes varied ( < 0.01) in different cities but was not associated with aflatoxin contamination. The exceptionally high AFM contamination suggests that milk from peri-urban dairy farms is a serious public health threat in Pakistan. This situation can be mitigated by reducing aflatoxin contamination in cottonseed cake and promoting the use of commercial concentrates and other feedstuffs with low contamination.
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http://dx.doi.org/10.3389/fmicb.2020.00159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064436PMC
March 2020

Zoonotic pathogens in urban animals: Enough research to protect the health of the urban population?

Anim Health Res Rev 2020 06 13;21(1):50-60. Epub 2020 Feb 13.

Department of Clinical Sciences, Swedish University of Agricultural Sciences, Box 7054, 75007Uppsala, Sweden.

With more than half of the global population living in cities, the urban areas are also teeming with animals, including peridomestic wildlife, pets, and livestock. Urban animals may carry zoonotic pathogens, and crowded conditions in cities can increase the risk for the human population. We used a systematic approach to screen two publication databases as well as gray literature, and quantified the studies conducted on zoonoses in urban animals with respect to the geographic distribution, the host animal and pathogens. Out of 876 references found, 93 were included into final data extraction. Few studies were from the rapidly expanding cities in low- and middle-income countries where urban livestock-keeping is far more prominent than in high-income countries. Most studies were performed in peridomestic wildlife and pets, less in livestock. The most common category of pathogens studied were gastrointestinal parasites followed by gastrointestinal bacteria, whereas studies on some other zoonoses internationally recognized as critical for public health were few or absent. In conclusion, to mitigate the risks of emergence of zoonoses from urban animals this review highlights the research gaps on zoonoses, particularly in livestock in rapidly growing tropical cities and a more comprehensive inclusion of pathogens prioritized by WHO and OIE.
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http://dx.doi.org/10.1017/S1466252319000100DOI Listing
June 2020

The extent and structure of pig rearing system in urban and peri-urban areas of Guwahati.

Infect Ecol Epidemiol 2020 8;10(1):1711576. Epub 2020 Jan 8.

Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya.

Livestock is common in Indian cities and contribute to food security as well as livelihoods. Urban livestock keeping has been neglected, and in India, little is known about the topic. Therefore, urban and peri-urban pig farms of Guwahati, Assam, India, were surveyed in order to understand more about the pig rearing systems and risks of diseases. A total of 34 urban and 66 peri-urbanpig farms were selected randomly. All reared cross-bred pigs. Free-range pig rearing was common in both urban (58.8%) and peri-urban (45.45%) farms. Artificial insemination was used by around half of the pig farmers. Disinfection in pig farms was practiced in 26.5% of urban and 28.8% of peri-urban farms. More urban pig farms were observed to be moderately clean in (82.4%) compared to peri-urban (69.7%). However, more urban (67.7%) than peri-urban farms (57.6%) reported ahighrodent burden. Pig sheds were mostly basic, with bricked floors in 18.2% farms in peri-urban areas, and more than 80% had corrugated iron roofing sheets. In conclusion, free-roaming pigs in both urban and peri-urban areas of Guwahati can contribute to disease transmission, and the low standard of hygiene and buildings may further increase the risk of diseases.
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http://dx.doi.org/10.1080/20008686.2020.1711576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968384PMC
January 2020

Relative Distribution, Diversity, and Bloodmeal Sources of Mosquitoes and Known Vectors of Rift Valley Fever Phlebovirus in Three Differing Ecosystems in Bura, Tana River County, Kenya.

Vector Borne Zoonotic Dis 2020 05 28;20(5):365-373. Epub 2020 Jan 28.

Institute for Parasitology and Tropical Veterinary Medicine, Freie Universitaet Berlin, Berlin, Germany.

Environmental modifications disturb the equilibrium of mosquito populations, altering the risk of mosquito-borne diseases. Mosquito distribution, diversity, and bloodmeal sources were examined to compare Rift Valley fever (RVF) risk among irrigated, riverine, and pastoral ecosystems in Bura, Tana River County, Kenya, between September 2014 and June 2015. Thirty-eight households and 21 irrigation fields were selected for the study. Mosquitoes were trapped with carbon dioxide-impregnated CDC traps, one trap per household and three traps per irrigated field, and morphologically identified using taxonomic keys. Host DNA was extracted from engorged females and cytochrome b genes amplified by PCR to identify sources of bloodmeals. A total of 21,015 mosquitoes were collected; 5742 within households in the 3 ecosystems and 15,273 within irrigated fields. Mosquitoes collected within irrigated fields belonged to 8 genera and 37 species, while those from households within the irrigation scheme belonged to 6 genera and 29 species. Collections from riverine and pastoral households belonged to five and four genera, respectively. The most abundant genera in the irrigated fields were (21%) and (22%), while (43%) was the most abundant within households. Most mosquitoes in riverine and pastoral households belonged to (76%) and (65%) genera, respectively. Seasonal variation driven by rainfall was evidenced by spikes in mosquito numbers within irrigated and riverine ecosystems. Host species identification revealed that goats and humans were the main sources of bloodmeal. There was an overall increase in mosquito abundance and diversity as a result of the presence of the irrigated ecosystem in this county, and an increased availability of highly RVF-susceptible hosts as a result of the establishment and concentration of residential areas, promoting potential vector-host contacts. These results highlight the impact of anthropogenic changes on mosquito ecology, potentially heightening the risk of transmission and maintenance of RVF in this region.
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http://dx.doi.org/10.1089/vbz.2019.2503DOI Listing
May 2020

Preliminary study on the relationship between aflatoxin-bovine serum albumin adducts in blood and aflatoxin M1 levels in milk of dairy cows.

Mycotoxin Res 2020 May 17;36(2):207-211. Epub 2019 Dec 17.

School of Medicine, University of Leeds, Leeds, UK.

The aflatoxin (AF) albumin adduct is often used as a biomarker for aflatoxin exposure in humans. An ELISA method previously used for aflatoxin serum albumin in human blood was used to analyse bovine serum samples (n = 22) collected from dairy cattle during an aflatoxin mitigation study in Kenya. Albumin adduct data were compared with aflatoxin M (AFM) levels in corresponding milk samples from these cows. The concentration ranged from < LOD to 487.9 pg/mL for AFM and < LOD and 96.3 pg/mg for aflatoxin-albumin. This study indicates that aflatoxin-albumin adducts could be used as a measure of chronic aflatoxin exposure in dairy cattle.
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http://dx.doi.org/10.1007/s12550-019-00383-7DOI Listing
May 2020

Spatiotemporal analysis of historical records (2001-2012) on dengue fever in Vietnam and development of a statistical model for forecasting risk.

PLoS One 2019 27;14(11):e0224353. Epub 2019 Nov 27.

National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.

Background: Dengue fever is the most widespread infectious disease of humans transmitted by Aedes mosquitoes. It is the leading cause of hospitalization and death in children in the Southeast Asia and western Pacific regions. We analyzed surveillance records from health centers in Vietnam collected between 2001-2012 to determine seasonal trends, develop risk maps and an incidence forecasting model.

Methods: The data were analyzed using a hierarchical spatial Bayesian model that approximates its posterior parameter distributions using the integrated Laplace approximation algorithm (INLA). Meteorological, altitude and land cover (LC) data were used as predictors. The data were grouped by province (n = 63) and month (n = 144) and divided into training (2001-2009) and validation (2010-2012) sets. Thirteen meteorological variables, 7 land cover data and altitude were considered as predictors. Only significant predictors were kept in the final multivariable model. Eleven dummy variables representing month were also fitted to account for seasonal effects. Spatial and temporal effects were accounted for using Besag-York-Mollie (BYM) and autoregressive (1) models. Their levels of significance were analyzed using deviance information criterion (DIC). The model was validated based on the Theil's coefficient which compared predicted and observed incidence estimated using the validation data. Dengue incidence predictions for 2010-2012 were also used to generate risk maps.

Results: The mean monthly dengue incidence during the period was 6.94 cases (SD 14.49) per 100,000 people. Analyses on the temporal trends of the disease showed regular seasonal epidemics that were interrupted every 3 years (specifically in July 2004, July 2007 and September 2010) by major fluctuations in incidence. Monthly mean minimum temperature, rainfall, area under urban settlement/build-up areas and altitude were significant in the final model. Minimum temperature and rainfall had non-linear effects and lagging them by two months provided a better fitting model compared to using unlagged variables. Forecasts for the validation period closely mirrored the observed data and accurately captured the troughs and peaks of dengue incidence trajectories. A favorable Theil's coefficient of inequality of 0.22 was generated.

Conclusions: The study identified temperature, rainfall, altitude and area under urban settlement as being significant predictors of dengue incidence. The statistical model fitted the data well based on Theil's coefficient of inequality, and risk maps generated from its predictions identified most of the high-risk provinces throughout the country.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224353PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881000PMC
April 2020

Urban livestock-keeping and dengue in urban and peri-urban Hanoi, Vietnam.

PLoS Negl Trop Dis 2019 11 26;13(11):e0007774. Epub 2019 Nov 26.

Uppsala University, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden.

Urban livestock provides an important source of food and income, but it may increase the risks for disease transmission. Vectors, such as mosquitoes, might increase and thereby cause an enhanced transmission of infectious diseases, such as dengue fever; considered the most important mosquito-borne viral disease globally. This cross-sectional study evaluated the awareness of dengue fever and investigated how the presence of dengue vectors is affected by the keeping of livestock in urban households in the city of Hanoi, Vietnam. From February to March 2018, during the season of lowest occurrence of dengue in Hanoi, 140 households were interviewed, of which 69 kept livestock. A general trend was observed; respondents living in the Dan Phuong district, a peri-urban district, had better knowledge and practice regarding dengue as compared to the urban Ha Dong district. In total, 3899 mosquitoes were collected and identified, of which 52 (1.33%) were Aedes species. A significant difference between the two districts was observed, with more households in Ha Dong having Aedes spp. mosquitoes (p = 0.02) and a higher incidence of dengue fever (p = 0.001). There was no significant association between livestock-rearing and the presence of Aedes spp. mosquitoes (p = 0.955), or between livestock-rearing and the incidence of dengue fever (p = 0.08). In conclusion, this study could not find any indication that households keeping livestock were at higher risk of dengue virus infections in Hanoi during the season of lowest occurrence of dengue, but clearly indicated the need of more information provided to urban inhabitants, particularly on personal protection.
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http://dx.doi.org/10.1371/journal.pntd.0007774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879131PMC
November 2019

Positive association between Brucella spp. seroprevalences in livestock and humans from a cross-sectional study in Garissa and Tana River Counties, Kenya.

PLoS Negl Trop Dis 2019 10 17;13(10):e0007506. Epub 2019 Oct 17.

International Livestock Research Institute, Nairobi, Kenya.

Background: Brucella spp. is a zoonotic bacterial agent of high public health and socio-economic importance. It infects many species of animals including wildlife, and people may get exposed through direct contact with an infected animal or consumption of raw or undercooked animal products. A linked livestock-human cross-sectional study to determine seroprevalences and risk factors of brucellosis in livestock and humans was designed. Estimates were made for intra-cluster correlation coefficients (ICCs) for these observations at the household and village levels.

Methodology: The study was implemented in Garissa (specifically Ijara and Sangailu areas) and Tana River (Bura and Hola) counties. A household was the unit of analysis and the sample size was derived using the standard procedures. Serum samples were obtained from selected livestock and people from randomly selected households. Humans were sampled in both counties, while livestock could be sampled only in Tana River County. Samples obtained were screened for anti-Brucella IgG antibodies using ELISA kits. Data were analyzed using generalized linear mixed effects logistic regression models with the household (herd) and village being used as random effects.

Results: The overall Brucella spp. seroprevalences were 3.47% (95% confidence interval [CI]: 2.72-4.36%) and 35.81% (95% CI: 32.87-38.84) in livestock and humans, respectively. In livestock, older animals and those sampled in Hola had significantly higher seroprevalences than younger ones or those sampled in Bura. Herd and village random effects were significant and ICC estimates associated with these variables were 0.40 (95% CI: 0.22-0.60) and 0.24 (95% CI: 0.08-0.52), respectively. In humans, Brucella spp. seroprevalence was significantly higher in older people, males, and people who lived in pastoral areas than younger ones, females or those who lived in irrigated or riverine areas. People from households that had at least one seropositive animal were 3.35 (95% CI: 1.51-7.41) times more likely to be seropositive compared to those that did not. Human exposures significantly clustered at the household level; the ICC estimate obtained was 0.21 (95% CI: 0.06-0.52).

Conclusion: The presence of a Brucella spp.-seropositive animal in a household significantly increased the odds of Brucella spp. seropositivity in humans in that household. Exposure to Brucella spp. of both livestock and humans clustered significantly at the household level. This suggests that risk-based surveillance measures, guided by locations of primary cases reported, either in humans or livestock, can be used to detect Brucella spp. infections in livestock or humans, respectively.
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http://dx.doi.org/10.1371/journal.pntd.0007506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818805PMC
October 2019

Brucellosis in India: results of a collaborative workshop to define One Health priorities.

Trop Anim Health Prod 2020 Jan 15;52(1):387-396. Epub 2019 Oct 15.

South Asia Regional Office, NASC Complex, International Livestock Research Institute, Pusa, New Delhi, 110012, India.

Brucellosis is an important zoonosis worldwide. In livestock, it frequently causes chronic disease with reproductive failures that contribute to production losses, and in humans, it causes an often-chronic febrile illness that is frequently underdiagnosed in many low- and middle-income countries, including India. India has one of the largest ruminant populations in the world, and brucellosis is endemic in the country in both humans and animals. In November 2017, the International Livestock Research Institute invited experts from government, national research institutes, universities, and different international organizations to a one-day meeting to set priorities towards a "One Health" control strategy for brucellosis in India. Using a risk prioritization exercise followed by discussions, the meeting agreed on the following priorities: collaboration (transboundary and transdisciplinary); collection of more epidemiological evidence in humans, cattle, and in small ruminants (which have been neglected in past research); Economic impact studies, including cost effectiveness of control programmes; livestock vaccination, including national facilities for securing vaccines for the cattle population; management of infected animals (with the ban on bovine slaughter, alternatives such as sanctuaries must be explored); laboratory capacities and diagnostics (quality must be assured and better rapid tests developed); and increased awareness, making farmers, health workers, and the general public more aware of risks of brucellosis and zoonoses in general. Overall, the meeting participants agreed that brucellosis control will be challenging in India, but with collaboration to address the priority areas listed here, it could be possible.
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http://dx.doi.org/10.1007/s11250-019-02029-3DOI Listing
January 2020