EC 1 th SELECTED ZOONOTIC DISEASES SYMPOSIUMMay 30-31 2011

NICOSIA

Brucellosis in Italy: Epidemiology, Control and Eradication

Paolo PasqualiPaolo Pasquali

paolo.pasquali@iss.it

Department of Veterinary Public Health and Food Safety,Department of Veterinary Public Health and Food Safety,

Istituto Superiore di Sanità, Rome, Italy Istituto Superiore di Sanità, Rome, Italy

Caprine and ovine brucellosis is usually caused by Brucella melitensis

Bovine brucellosis is usually caused by Brucella abortus, less frequently by B. melitensis,

Clinically, the disease is characterised by one or more of the following signs:

• abortion,

• retained placenta,

• orchitis, epididymitis and, rarely, arthritis,

with excretion of the organisms in uterine discharges and in milk

There is a need to control brucellosis?

Why?

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EMERGING DISEASES, 1996-2004 (WHO source)

1. Cryptosporidium North America

2. Lyme borreliosis North America

3. Brucellosis worldwide

4. E.coli O157 North Europa

5. Salmonella (MDR) Northern Europe

6. Ebola Africa

7. Influenza Asia

8. BSE Europe

9. SARS Asia

10. EE Africa, America, Europe

11. Hendra/Nipah South East Asia, Australia

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2005

Perception of importance of zoonosisFAO 2005

rabiesbrucellosistuberculosis influenza

salmonellosiscysticercosishydatidosisleptospirosisprion diseases

anthraxtoxoplasmosiscampylobacteriosistrichinosisleishmaniosis

Source: FAO 2005. Survey based on 165 veterinary public health Source: FAO 2005. Survey based on 165 veterinary public health professionalsprofessionals

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Pappas G. et al. , Lancet Infect Dis 2006; 6: 91–99

more than 500 000 new cases annually

WHO/FAO COLLABORATING CENTRE FOR RESEARCH AND TRAINING IN VETERINARY PUBLIC HEALTH

Pappas G. et al. , Lancet Infect Dis 2006; 6: 91–99

Brucellosis, indeed, is a major problem with costs related to:

•Human population (disease)

•Animals (disease and production):

• (direct) abortion, milking

• (indirect) trade limitations

The disease in humans• intermittent or remittent fever accompanied by malaise, anorexia and prostration,

• may persist for weeks or months.

• typically, few objective signs are apparent.

• The acute phase may progress to a chronic one with relapse, development of persistent localized infection or a non-specific syndrome resembling the “chronic fatigue syndrome”.

how much the disease is acute?

Case study No.1

Majority was not simptomatic

Can you control the system? NO

Yes

Prevalence < 2% (true!) test and slaughter

> 2% vaccination and/or test and slaughter

• which animals?

• when?

• with what?

vaccination

Heat treatment of milk

• Mass vaccination• Vaccination of replacements• Vaccination of replacements and test and slaughter• Test and slaughter

Vaccination

Can induce abortion

•Adult not pregnant•Yungs after weaning (3-6 months of age)

1. Strain 19

PROS

• Strong efficacy against B.abortus

• High stability

CONS

• S19 induces antibodies detectable by using standard serological test, preventing differentiation of vaccinated versus infected animals.

• Although highly attenuated S19 is able to induce abortion in 1-2.5% of pregnant immunised cows

• S19 can be shed through milk

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2. B. melitensis Rev.1

Rev.1 vaccine is a live, smooth attenuated B. melitensis strain derived from a virulent B.melitensis isolate which became dependent on streptomycin for its growth, but lost this characteristic, although remaining streptomycin resistant, upon further subculture

It stimulates protection against infection with B. melitensis in sheep and goats and also protects rams against infection with B.ovis. This vaccine is attenuated when compared with field strains but retains some virulence.

PROS

• Strong efficacy against B.melitensis and B.abortus

• High stability

CONS

• REV 1 induces antibodies detectable by using standard serological test, preventing differentiation of vaccinated versus infected animals.

• Still able to induce abortion of pregnant immunised animals

• REV 1 can be shed through milk

3. B.abortus RB51

Rough strain devoid of the O-chain. Its roughness is very stable after multiple passages in vitro and in vivo through various species of animals

Strain RB51 is attenuated as indicated by studies carried out in mice, guinea pigs, goats and cattle, from all of which it is cleared in a relatively short time.

Two studies carried out in sheep suggests that strain RB51 does not induce protection versus B.melitensis

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Prevention of human brucellosis

As the ultimate source of human brucellosis is direct or indirect exposure to infected animals or their products, prevention must be based on elimination of such contact.

BRUCELLOSIS IS A “SYSTEM PROBLEMSYSTEM PROBLEM”

1.1. Awareness of farmers and population. Awareness of farmers and population. Risk factors Risk factors are milk and lamb delivery. are milk and lamb delivery.

2.2. PhysiciansPhysicians informed and trained informed and trained

3.3. LaboratoryLaboratory support to make diagnosis support to make diagnosis

4.4. ControlControl of animals (cattle and sheep) (trade and animal identification)

5. Vaccination… or or Elimination of infected animals

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Year 2008: Sheep and goat population (herds)

Total number of herdsYear 2008

10.001 - 20.000 (2)5.001 - 10.000 (8)2.001 - 5.000 (8) 500 - 2.000 (2)

Region Total number of herds

Total 117.519

Sardegna 15.377Lombardia 11.641Piemonte 9.617Sicilia 9.161Lazio 8.478Campania 8.313Calabria 7.970Toscana 7.111Basilicata 6.612Abruzzo 5.735Puglia 4.013Marche 3.918Bolzano 3.602Emilia Romagna 3.391Umbria 3.017Liguria 2.553Molise 2.364Veneto 2.310Trento 1.043Valle d'Aosta 768Friuli Venezia Giulia 525

Year 2008: Sheep and goat population (animals)

Total number of animalsYear 2008

500.001 - 4.000.000(4)

200.001 - 500.000 (4)

80.001 - 200.000 (7)

10.000 - 80.000 (5)

Region Total number of animals

Total 8.634.838

Sardegna 3.530.931Sicilia 946.368Lazio 818.767Toscana 525.243Calabria 463.932Puglia 411.672Basilicata 410.616Campania 303.109Lombardia 189.496Piemonte 185.062Abruzzo 183.479Marche 175.181Umbria 136.788Emilia Romagna 88.874Bolzano 69.043Veneto 58.063Molise 55.309Trento 31.059Liguria 26.088Friuli Venezia Giulia 15.439Valle d'Aosta 10.319

Sheep and goat herds tested in Italy

0,0%10,0%20,0%30,0%40,0%50,0%60,0%70,0%80,0%90,0%

100,0%

Perc

en

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f te

ste

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s

2003 2004 2005 2006 2007 2008 2009Year

Percent of tested herds

Percentage of infected flocks in 2009

Positive herds on controlled (%)Year 2009

2,50- 15,00 (2)

0,20 - 2,49 (2)0,0 - 0,19 (17)

Region

Total

Region Percentage infected flocks

Total 1,55%

Prevalence decreased in Calabria, Pugliaand Basilicata

Sicilia 13,19%

Calabria 2,81%

Puglia 1,87%

Campania 0,92%

Basilicata 0,19%

Emilia Romagna 0,08%

Abruzzo 0,04%

Lazio 0,03%

Lombardia 0,02%

Sardegna 0,01%

Bolzano 0,00%

Friuli Venezia Giulia 0,00%

Liguria 0,00%

Marche 0,00%

Molise 0,00%

Piemonte 0,00%

Toscana 0,00%

Trento 0,00%

Umbria 0,00%

Valle d'Aosta 0,00%

Veneto 0,00%

VACCINATION IN SICILYYEAR 2004 - 2009

Total number of holdings

eligible for vaccination

Total number of holdings vaccinated

Total number of young animals

vaccinated

Number of doses of vaccine used

2004 3.914 372.623 2.307 0 0 0

2005 9.162 1.060.611 3.389 1.177 46.277 46.277

2006 9.266 822.906 2.237 1.424 60.702 60.702

2007 9.241 1.010.667 2.475 1.316 60.247 60.247

2008 9.161 946.368 2.051 893 37.927 37.927

2009 9.009 1.015.103 4.847 388 14.138 14.138

YEARTotal number

of holdingsTotal number

of animals

Information on young animals subjected to the programme of vaccination

Take home message

1.Brucellosis is an insidious disease with high costs

2.Is very common in mediterranean Countries

3.The control strategy has to be tailored according to critical parameters (costs, epidemiology, needs, capability and so on ..)

4.There is not a perfect vaccine, so far

Thank you