Prevalence of Brucella Infections among Students of Amran University, Yemen

doi:10.21203/rs.3.rs-5249822/v1

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Prevalence of Brucella Infections among Students of Amran University, Yemen

https://doi.org/10.21203/rs.3.rs-5249822/v1

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Background and Aim: Brucella infection in animals is considered a significant problem in most countries around the world and is regarded as one of the important pathogenic zoonotic infections affecting humans. This study aimed to determine the prevalence of Brucella infections among students at Amran University, Yemen.

Methods: This is a cross-sectional study carried out among 247 students between January 2023 and November 2023. Blood samples were collected and analyzed using immunochromatographic technology.

Results: Out of 247 human samples, 2 (1.75%) were positive among males, and 15 (12.5%) were positive among females. Additionally, 49 (19.8%) of the positive cases were from Amran city, while 198 (80.2%) were from rural areas, with significant differences (P < 0.05). The risk factors for Brucella infection included ranching, consuming unpasteurized milk, and direct contact with livestock.

Conclusion: The prevalence of brucellosis was low among the study participants; however, it could become a serious problem that threatens the healthcare system in Yemen.

General Microbiology

Prevalence

Brucellosis

Students

Risk factors

Amran University

Brucellosis is a widespread zoonotic infection caused by Brucella spp., Gram-negative facultative intracellular pathogens, often leading to abortion or reproductive disorders in domestic and wild mammals [1–2].

The genus Brucella includes several species that were classified with respect to phenotypic characteristics, pathogenicity, and host preference, including Brucella melitensis (goats and sheep), Brucella abortus (cattle), Brucella canis (dog), Brucella ovis (sheep), Brucella neotomae (desert woodrat), and Brucella suis (swine) [3–4]. Its distribution is worldwide, apart from the few countries where it has been eradicated from the animal reservoir.

Although brucellosis commonly presents as an acute febrile illness, its clinical manifestations vary widely, and definitive signs indicative of the diagnosis may be lacking. Thus, the clinical diagnosis usually must be supported by the results of bacteriologic and/or serologic tests [2].

Consuming unpasteurized milk or cheese from infected sheep or goats is the primary source of the majority [5–8]. Every year, more than 500,000 new instances of the illness are recorded [9–14]. The World Health Organization (WHO) asserts, however, that this number has been exaggerated [15]. Brucella infection is a risk for people of all ages. However, some research revealed that men were more likely than women to contract Brucella, and it was determined that this was probably because they worked as butchers and slaughterhouse employees [16].

Yemen is one of the emerging nations lacking policies and plans in place to manage or stop the spread of harmful microbes among their populace [17–18]. Information on the frequency of Brucella infection among Amran University students is scarce. Thus, the goal of the current investigation was to ascertain the incidence of Brucella infection among students at Amran University, Yemen.

Study area and period

This is a cross-sectional study conducted among students of Amran University located in Amran Governorate during the period from January 2023 to November 2023.

Data collection

Data was collected using a structured questionnaire, which was given to each healthy participant who was subjected to the current study. The questionnaire composed questions related to demographic clinical data and some other information, including age, marital status on brucellosis. Also, information on potential risk factors.

Sample collection and Examination

A total 5 mL of whole blood was collected aseptically by a venipuncture from each student and serum was separated by centrifugation after clotting. The sera samples were kept at − 20°C until tested. All separated serum samples screened for Brucella antigen by using cassette test (Evan Care, China). The samples were transported to central Laboratories in Amran University for analysis.

Laboratory test

The brucella antigen rapid test cassete is a qualitative lateral flow immunochromatographic assay for the detection of brucella antigen in human whole blood, serum, or plasma specimens. Positive in addition to the control band, a distinct colored band also appears on the test region (T). Negative only one colored band appears in the control region (C), no apparent band on the test region (C).

Statistical analysis

The data were analyzed using the SPSS program (version 22.0). Categorical variables were reported as frequencies and percentages in tables and figures.

The study results included 247 students: the majority of specimens were collected from males (127, 51.4%), individuals in the age group of 24–30 years (198, 80.2%), single individuals (158, 63.9%), and those from rural areas (198, 80.2%), as listed in Table 1.

Table 1

Socio-demographic parameters of study subjects
Variables		Frequency	Rate (%)
Gender	Male	127	51.4
Gender	Female	120	48.6
Age group	18–23	49	19.8
Age group	24–30	198	80.2
Marital status	Single	158	63.9
Marital status	Married	89	36.8
Residence	Urban	49	19.8
Residence	Rural	198	80.2

The study showed that the 17 (6.9%) specimens were recorded as positive for the Brucella antigen test, while the rest 230 (93.1%) were negative for the Brucella antigen test (Fig. 1).

The study revealed that Brucella infections were significantly higher among females (12.5%) compared to males (1.57%). Additionally, the age group of 24–30 years had a higher rate of Brucella infections (57.9%) than the age group of 18–23 years (12.4%), with a significant difference (P < 0.05). Furthermore, a high rate of Brucella antigen was observed among single participants (22.6%) and individuals from rural areas (57.9%), also showing significant differences (P < 0.05), as shown in Table 2.

Table 2

Distribution of Brucella infections based on socio-demographic parameters of study subjects
Variables		Frequency	Infected No.(%)	Non-infected No. (%)	χ²	CI 95%	P-value
Gender	Male	127 (51.4)	2 (1.57)	125 (98.4)	0.198	1.443–1.569	0.656
Gender	Female	120 (48.6)	15 (12.5)	105 (87.5)	0.198	1.443–1.569	0.656
Age group	18–23	49 (19.8)	6 (12.4)	43 (87.7)	89.88	1.75–1.85	0.000
Age group	24–30	198 (80.2)	11 (57.9)	187 (94.4)	89.88	1.75–1.85	0.000
Marital status	Single	158 (63.9)	7 (22.6)	151 (95.6)	19.275	1.899–1.963	0.000
Marital status	Married	89 (36.8)	10 (11.2)	79 (88.8)	19.275	1.899–1.963	0.000
Residence	Urban	49 (19.8)	6 (12.4)	43 (87.7)	89.883	1.75–1.85	0.000
Residence	Rural	198 (80.2)	11 (57.9)	187 (94.4)	89.883	1.75–1.85	0.000

χ² = Chi-square test; 95% CI = 95% Confidence Interval; Significant statistics at p-value < 0.05.

A high rate of Brucella infection was reported among individuals with a family medical history (30.0%), those involved in ranching (22.2%), individuals with direct contact with livestock (10.5%), people drinking unpasteurized water (8.9%), and those who wash their hands before eating (7.7%). The statistical results indicated a significant difference in Brucella prevalence related to study risk factors, including ranching, direct contact with livestock, and family medical history, as detailed in Table 3.

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Table 3

The major risk factors of Brucella infection
Variables		Frequency	Infected No. (%)	Non-infected No. (%)	P-value
Washing hands	Yes	130	10 (7.7)	120 (92.3)	0.598
Washing hands	No	117	7 (6.0)	110 (94.0)	0.598
Ranching	Yes	40	9 (22.5)	31 (77.5)	0.000
Ranching	No	207	8 (4.0)	199 (96.0)	0.000
Drink milk without pasteurization	Yes	124	11 (8.9)	113 (91.1)	0.217
Drink milk without pasteurization	No	123	6 (4.9)	117 (95.1)	0.217
Direct contact with livestock	Yes	87	10 (10.5)	77 (88.5)	0.035
Direct contact with livestock	No	160	7 (4.4)	153 (95.6)	0.035
Family medical history	Yes	64	14 (30.0)	50 (70.0)	0.000
Family medical history	No	183	3 (1.6)	180 (98.4)	0.000
Significant statistics at p-value < 0.05

Brucellosis is a bacterial zoonosis transmitted directly or indirectly to humans from infected animals, predominantly domesticated ruminants and swine. The disease is known colloquially as undulant fever because of its remittent characteristics [19].

The prevalence of brucellosis were (6.9%), the prevalence for this study was lower than study that studies in Yemen (7.9–29%), [20–21], Saudi Arabia (23%) [22], Ethiopia (31.5%) [23], India (22.5%, 29.4%) [24, 25], Pakistan (10.1%) [26], south-western Uganda (14.9%) [27], and Nigeria (14.9%) [28]. In contrast, the current result was higher than that reported in Yemen (6.7%) [29] and Bangladesh (2.0%) [30]. The discrepancy in the prevalence rate of Brucella infection could be attributed to a variety of factors, including geographical location, survey duration, study subject characteristics, diagnostic approach, sample size, use of control and prevention measures.

In the current study, the proportion of Brucella antibodies among females was 12.5%, while this rate in males was 1.57% lower than in females. Similar results were also recorded in Iraq [31]. In contrast, this result differs from previous studies in Yemen and India, where the incidence among males is higher [24–25, 32].

Current data indicate that most females were housewives and exposed to brucellosis risk factors as they directly handled milk or meat or looked after animals [32]. The results showed 49 (19.8%) from Amran city, while 198 (80.2%) were from rural areas, and the prevalence of Brucellosis was higher among students in the age group of 24-to-30 years. This is in contrast to the higher risks for the 20-year-old group, which were found in Egypt (62%) [33], Ethiopia (48.1%) [23], and northern Tanzania (46%) [34].

Currently, there is a clear need for doctors in Yemen to be made aware of the frequency of this infection and the means available for clinical and laboratory diagnosis and effective treatment, and the health authorities should recognize these efforts by researchers and be prepared to help them with more studies in infectious diseases, particularly brucellosis, in the future.

There are various explanations behind Yemen's high prevalence of infections, particularly in Amran governorate. These challenges encompass living situations, economic and environmental factors, a lack of public health awareness, a lack of sanitary facilities and infrastructure, a lack pasteurization of milk, and a lack of access to safe drinking water [35–40]

Limitations of the study

The sample size in this study was small, the tests were serological using rapid tests, and the lack of more advanced diagnostic techniques such as enzyme-linked immunosorbent assay (ELISA), which is a highly accurate and reliable test, is due to limited resources.

These findings revealed a low prevalence of human brucellosis among students of Amran University in Amran governorate; however, it could become a serious problem threatening the healthcare system in Yemen. Therefore, awareness programs should be developed for students and the general population about Brucella infection and its risk factors. Increasing awareness of brucellosis transmission routes can guide the community and help prevent further infections.

The ethical statement of the study was approved by the Research Ethics Review Committee of Amran University, Yemen. The administrator of the education office also gave permission to start data collection. Before data and specimen collection began, participants were informed about the study objectives and procedures. Informed consent was then obtained from each participant. This study was performed in accordance with relevant guidelines/regulations and the Declaration of Helsink.

Conflict of Interest

The authors have no conflict of interest.

Acknowledgments

"The authors would like to thank the investigative team, including Afaf A. Al-Dali, Zayed H. Al-Jaara, Iman M. Al-Qahali, Fouad M. Al-Haiti, Bakil S. Hajj, Ibrahim Al-Jathim, Tayseer M. Naji, Hassan A. Al-Kabsh, Loza Q. Al-Shayba, Widad Y. Al-Zaarour, Hussain H. Al-Jahali, and Sadam H. Al-Hamdi, for their generous assistance in collecting data and specimens. All authors express their heartfelt gratitude to the students of Amran University, as well as to the teachers and doctors, for their contributions and support throughout various aspects of the study.

Author Contributions

Al-Hadheq and Al-Mahbashi Conceived and designed the experiments. Al-Hadheq performed the experiments: Al-Hadheq and Al-Wajeeh analyzed the data and wrote the first draft of the manuscript. Al-Haj contributed to the writing of the manuscript. Al-Hadheq and Edrees agree with the manuscript results and conclusions. All authors have read, revised, and approved the final manuscript.Here’s a revised version of your text:

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The authors declare no competing interests.

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Prevalence of Brucella Infections among Students of Amran University, Yemen

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Abstract

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Introduction

Materials and Methods

Study area and period

Data collection

Sample collection and Examination

Statistical analysis

Results

Discussion

Limitations of the study

Conclusion

Declarations

References

Additional Declarations

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