Brucellosis: Implementation of control strategies to prevent animal and human infections. JM BLASCO

Regional Seminar for OIE National Focal Points for Animal Production Food Safety Hanoi. Vietnam. 24th – 26th June. 2014 Brucellosis: Implementation o...
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Regional Seminar for OIE National Focal Points for Animal Production Food Safety Hanoi. Vietnam. 24th – 26th June. 2014

Brucellosis: Implementation of control strategies to prevent animal and human infections Part 2. Ruminant Brucellosis: B. melitensis (sheep&goats) B. abortus (cattle and buffaloes)

JM BLASCO

[email protected]

BRUCELLA SPECIES: Ranking of importance in animals & humans

1. B. melitensis (bv 1 and 3) is GLOBALLY the most important zoonotic agent and causes also huge economical losses in animals 2. B. suis (bv 1 and 3) is the second, but can be the first in many countries because the high zoonotic and economical importance. and because this infection is fully neglected

(B. suis biovar 2 is also of high economical importance in domestic swine in the EU but not relevant as zoonotic agent) 3. B. abortus is the third in the ranking, having moderate zoonotic effect but high economical impact in most countries

B. melitensis = Sheep and goats......but buffaloes/camels/wildlife??

India Indonesia Bangladesh Philippines Pakistan Nepal Myanmar Viet Nam Korea

231.500.000 28.855.000 52.360.000 3.911.500 89.566.000 9.991.510 4.200.000 1.267.800 3.767.000

ca. 430 mill China Mongolia

281.070.359 31.603.100

SOUTH-EAST

ca. 312 mill Ca. 750 mill.

Afghanistan Azerbaijan Iran Iraq Jordan Kazakhstan Kyrgyzstan Oman Kuwait Georgia Israel Qatar Russian Federation Syria Tajikistan Turkey Turkmenistan Uzbekistan Yemen Armenia Lebanon Ukraine United Arab Emirates Saudi Arabia

21.897.000 8.559.315 72.500.000 9.760.000 3.016.830 17.988.100 5.288.119 2.149.900 648.703 630.400 552.000 431.393 21.819.840 20.365.000 4.618.600 29.382.930 16.400.000 15.340.500 18.300.000 532.515 655.000 1.731.700 3.400.000 8.200.000

NEAR/CENTRAL TOTALS ASIA

Ca. 300 mill Ca. 1 bill.

SITUATION IN ASIA - Lack of data in most countries: typically neglected - High collective prevalence when investigated (15-50%) - No or only few (FAO/SDC/AECID) suitable control programs implemented but discontinued MAIN PROBLEMS - lack of sustained official intervention - Lack of adequate formation (veterinarians & physicians) - Too many “so called experts” resulting in too many bayesian and statistical useless work…

Angola Ethiopia Benin Botswana Burkina Faso Burundi Cameroon Central Afric Repub Chad Cote d'Ivoire Congo Eritrea Ghana Guinea Guinea-Bissau Kenya Lesotho Malawi Mali Mozambique Namibia Niger Nigeria Rwanda Senegal Sierra Leone Somalia South Africa Togo Uganda Tanzania Zambia Zimbabwe

4.958.360 48.295.900 2.465.000 2.285.000 21.203.210 2.618.153 8.400.000 6.130.000 9.850.000 3.050.000 4.970.000 4.031.000 9.024.000 3.630.000 1.191.716 23.400.000 2.060.000 4.671.559 29.807.100 5.205.000 5.000.000 23.250.300 95.300.000 3.799.780 10.402.230 1.633.500 23.750.000 30.467.850 4.071.140 11.153.000 19.500.000 2.525.000 3.015.000

TOTAL MER. AFRICA

ca. 430 mill

Algeria Egypt Libya Morocco Tunisia Mauritania

28.544.000 9.695.400 9.700.000 24.400.000 8.280.710 14.450.000

TOTAL NORTH AFRICA TOTALS AFRICA

Ca. 120 mill Ca 550 mill

SITUATION IN AFRICA - Lack of data in most countries: mostly or fully neglected - No or only few control (Northern Africa) control programs assayed (FAO/AECID) but discontinued MAIN PROBLEMS

the same

SITUATION IN LATINAMERICA Argentina Bolivia Brazil Colombia Chile Cuba Ecuador Guatemala Haiti Mexico Others Peru Uruguay Venezuela TOTALS

20.500.000 11.132.220 27.000.000 4.800.000 4.300.000 3.000.000 2.000.000 800.000 2.000.000 17.000.000 1.500.000 16.000.000 7.500.000 2.000.000 Ca. 120 mill

- Lack of data in most countries: neglected in most cases - No or few control programs assayed but discontinued (Argentina) or applied improperly (Mexico/Peru…..)

MAIN PROBLEMS the same

B. abortus = cattle…buffaloes/yaks/camels/wildlife??

Indonesia Bangladesh India Laos Malaysia Myanmar Nepal Pakistan Philippines Thailand Viet Nam Japan Korea China Mongolia

14.824.000 23.121.000 210.824.000 1.520.000 925.000 13.608.900 7.226.050 35.568.000 2.518.400 6.680.000 5.436.600 4.230.000 3.353.350 83.000.000 2.400.000 Ca. 423 mill. Afghanistan 5.524.000 Azerbaijan 2.412.310 Belarus 4.151.300 Kazakhstan 6.175.300 Kyrgyzstan 1.338.580 Russian 19.967.900 Tajikistan 2.015.350 Turkmenistan 2.200.000 Ukraine 4.494.400 Uzbekistan 9.093.700 Syrian 1.158.000 Iran 8.600.000 Iraq 1.600.000 Turkey 11.369.800 Georgia 1.087.600 Ca 80 mill

SITUATION IN ASIA (cattle) - Lack of data in many countries:

partially neglected - No or only few (some inadequate) control programs implemented - Few eradication attempts, none successful MAIN PROBLEMS

-Lack of adequate official intervention -Lack of adequate formation complicated by the explosion of the poor science…too much “LITTERature” and too many “socalled brucellosis experts”

- RB51 introduced massively and other POOR vaccines used (M5, S2, A19…)

ASIA (BUFFALOES) Bangladesh Brazil Cambodia China Egypt India Indonesia Laos Myanmar Nepal Pakistan Philippines Sri Lanka Thailand Viet Nam

1.394.000 1.277.200 702.074 23.382.130 3.800.000 112.916.000 1.305.000 1.186.000 2.977.150 4.993.650 31.726.000 3.075.300 405.12 1.698.000 2.712.000 Ca 200 mill

Lack of data: fully neglected

MAIN PROBLEMS

-Diagnosis: no tests validated -Epidemiology unknown

- Vaccines: lack of safety/efficacy studies - Absence of true experts

Argentina Bolivia Brazil Colombia Chile Costa Rica Cuba Dom. Republic Ecuador El Salvador Guatemala Honduras Haiti Uruguay Mexico Nicaragua Panama Paraguay Peru Venezuela

48.000.000 8.400.440 212.798.000 28.874.800 3.760.000 1.380.000 4.059.100 2.950.000 5.358.900 1.015.140 3.388.220 2.650.000 1.455.000 11.808.000 32.936.300 3.750.000 1.660.500 12.437.100 5.689.170 17.350.000 ca. 424 mill

SITUATION IN LATINAMERICA most countries conduct eradication programs but none successful MAIN PROBLEMS -Lack of suitable official intervention (owner pays most costs) -Lack of adequate formation - RB51 vaccine introduced in most countries

SHOULD RUMINANT BRUCELLOSIS BE CONTROLLED OR ERADICATED? CONTROL Minimize disease effects by reducing prevalence to a minimum “controlled” = brucellosis effects minimized OR ERADICATION

Total elimination of Brucellae from ALL animal species involved in the epidemiological cycle

BRUCELLOSIS ERADICATION

diagnostic tests vaccines

BRUCELLOSIS ERADICATION

diagnostic tests vaccines

QUALITY OF VET. SERVICES DESIGN TO REAL EPIDEMIOLOGICAL SITUATION OFFICIAL INTERVENTION & BUDGET ACTIVE INVOLVEMENT OF FARMERS

CONTROL OR ERADICATION?: 1st DECISION TREE

YES

After an active search: is brucellosis present even restricted to a certain area?

Are veterinary services able to identify and control animal movements?

NOT

MASS VACCINATION (S19/Rev1) independently of prevalence

NOT Active Surveillance YES

2nd DECISION TREE

CONTROL OR ERADICATION?: 2nd DECISION TREE ▶ FINAL OBJECTIVE ⇨ ERADICATION ▶ BASIC OBJECTIVE ⇨ CONTROL

TWO IMPORTANT TASKS REQUIRED:

1. DEFINE THE EPIDEMIOLOGICAL UNIT(S) OF INTERVENTION

SAN JUAN RIVER SAN JUAN PROVINCE

MENDOZA PROVINCE

SAN JUAN

BRUCELLOSIS HAS NOT ADMINISTRATIVE BORDERS!

MENDOZA

2. DETERMINE HERD/FLOCK PREVALENCE

HIGH



  (CONTROL) MASS VACCINATION

 MODERATE  (ERADICATION)

 VERY LOW  (ERADICATION)

COMBINED PROGRAM (Vac.+ T&S)

T&S PROGRAM

FREE

OFFICIALLY FREE

Can brucellosis be eradicated (SHORT TERM) in THE DEVELOPED WORLD using the CURRENT GOOD vaccines (S19/Rev1) and diagnostic tools?

YES

No country has succeeded in eradicating brucellosis using RB51, even after 17 years of intensive use (ie Chile)

PROGRESS IN ERADICATING BOVINE BRUCELLOSIS IN SPAIN CENSUS (2010) - 6.2 mill. - 130.000 FLOCKS

ESTIMATED COSTS (2014) (flock prevalence = 0.1%) 10.5 mill. Euro Real picture. taken at Soba (Monforte de Lemos; Galicia; Spain) during summer 2009

EVOLUTION OF HERD PREVALENCE >16% 6.0

RB51 + T/S

5.0

S19 + T/S

4.0

3.0

2.0

T/S alone

1.0

0.0 1998

2000

2002

2004

2006

2007

2008

2009

ban of S19 (except Aragon)

2010

2011

2012

Can brucellosis be eradicated (SHORT TERM) in developing countries?

NO!!

Only CONTROL programs are feasible

BASIC REQUISITES FOR APPLYING ANY BRUCELLOSIS CONTROL STRATEGY 1. A minimum of BUDGET (vaccine and operative costs) 2. An ADEQUATE organisation of veterinary services involved:

- Owner & Animal registration required - Ability to vaccinate the whole target population in a very short time interval (lambing-calving season/lactation/pre-breeding period) - Ability/funds to repeat interventions

CONTROL STRATEGIES Strategy 1: mass vaccination every 2 years (WITH or WITHOUT ear tags) (the most practical and effective)

Ability to identify 100% of flocks and vaccinate 100% of animals identifying the ideal window of opportunity (usually only few weeks) to minimise Rev 1/S19 side effects

Year 1

Mass healthy vaccination

Inf.

2

Rep

3

Mass vaccination MV Rep Rep

i

4

Rep

i

5

MV Rep Rep Mass vaccination

MV

MV

i

CONTROL STRATEGIES Strategy 2: mass vaccination & individual identification the 1st year and vaccinating only new replacements next years - Ability to register 100% of flocks and vaccinate 100% of animals in the ideal window the first year - Ability to individually identify 100% of animals vaccinated and to vaccinate 100% of unidentified animals (and identify these also individually ) the next years

Eradication Programmes

1. Combined strategy (vaccin. + T&S) 2. Exclusive T & S (no vaccine)

Remember always the ICEBERG!!!! the better quality of vet. Services, the better animal identification&control policy, and the better support by owners are……..the better results would be

Combined eradication strategy (young replacement vaccination +T&S adults)

The ideal since allows eradication but, simultaneously also the protection of herds/flocks When? – Whenever ICEBERG conditions fulfilled – Low herd/flock prevalence < 1-5% Requirements – To individually identify 100% of animals/flocks – To vaccinate 100% of young replacements (both males&females Rev 1- or females only -S19-) annually (at the adequate time, age (3-4 months) and conjunctivally) – Regular sero-testing of ALL adult animals (good laboratory) – Rapid culling of positive animals (even full depopulation if needed) – Retest positive herds at short intervals (every 2 months) – Slaughter compensations for owners (real market prices)

Eradication by exclusive Test & Slaughter (vaccines forbidden) The most risky system since does not allow the protection of herds/flocks When abandoning vaccination? Whenever ICEBERG conditions fulfilled. and SIMULTANEOUSLY: - No active outbreaks in the epidemiological unit - Herd/flock prevalence is 0% - This situation is maintained by at least one entire generation (the example of France 2000-2006) - No risk of introduction from neighbouring epidemiological units Requirements exactly the same than in the case of the combined eradication system. but applying immediate and more stringent responses (full depopulation normally required and compulsory epidemiological investigation of outbreaks because of the FPSR problem)

PROGRESS OF ERADICATION IN SHEEP&GOATS IN SPAIN CENSUS 2010 Ovine 20 million Caprine 2.5 million Flocks 120.000

ESTIMATED COSTS (2014) (flock prevalence = 0.3%) c.a. 11 mill. Euro

EVOLUTION OF FLOCK PREVALENCE

Rev 1 banned

1997

2000

2002

2004

2006

2008

2010

2011

2012

Andalucía

31.7

29.6

25.7

13

11.56

8.5

3.2

2

1.1

Murcia

55.3

27

6

6

3.96

7

1.5

1.6

0.96

CLM

17.4

13.1

8

7.5

3.55

2.1

1.6

1.3

0.6

Cataluña

45.9

44.6

20.7

17.5

9.53

3.1

1.03

1.65

0.7

La Rioja

15.8

9.8

9.3

8.5

1.11

0.7

0.48

0.24

0.25

Madrid

39.2

15

6.2

5.6

6.44

4

1.2

0.6

0.15

Valencia

55.7

39.2

25.3

15.4

8.1

5.7

0.87

3.6

0.1

Extremadura

12.5

8.7

4.6

3.7

2.2

1

0.15

0.27

0.07

Aragón

64.6

42.6

13.2

5.9

1.6

0.7

0.09

0.05

0.05

C - León

35.3

20

5.7

6.4

1.97

1.5

0.08

0.01

0

Cantabria

3.1

2.5

1.8

1

0.5

0.8

0.05

0.02

0

País Vasco

0.6

0.2

0.2

0.3

0.1

0.1

0

0

0

Galicia

1.4

0.5

0.1

0.03

0.01

0

0

0

0

Baleares

1

0.8

0.0

0

0

0

0

0

0

Asturias

0.8

0.2

0.04

0

0

0

0

0

0

Navarra

9.5

2.5

0.1

0.1

0

0

0

0

0

Canarias

0

0

0

0

0

0

0

0

0

TOTAL

18.6

15.6

11.2

5.1

3.2

2.1

0.52

0.54

0.26

EVOLUTION OF HUMAN BRUCELLOSIS IN SPAIN

Casos de brucelosis humana

FIRST MASS VACCINATION CAMPAIGNS (several million sheep&goats were vaccinated)

10000 UE COMPULSORY ERADICATION PROGRAM

9000 8000 7000

GENERALISED CONJUNCTIVAL VACCINATION AND OVERALL INTENSIFICATION OF PROGRAMME

6000 5000 4000

85 cases in 2012

3000 2000 1000

YOUNG REPLACEMENT VACCINATION EXCLUSIVELY (SC)

0 1975

1978

1981

1984

1987

1990

1993

Años

1996

1999

2002

2005

2008

THANKS FOR BEING PATIENT………. AND MY APOLOGIES FOR PONTIFICATING…BUT WHITE HAIRS SHOULD GIVE ME THE RIGHT TO SOME INDULGENCES…

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