Concurrent Brucellosis and Q Fever Infection in Afghanistan

Both brucellosis and Q Fever have considerable health and economic impacts: an estimated 500,000 cases of brucellosis occur worldwide each year, while instances Q Fever go widely unreported. Both zoonoses occur widely in Afghanistan, where livestock constitute a primary livelihood. After a series of brucellosis outbreaks in Afghanistan, the Disease Early Warning System (DEWS) of the Afghan National Public Health Institute conducted a case study to identify risk factors and recommend strategies for prevention.  Using operational case definition, 147 cases of brucellosis were identified in Yakawlang and Punjab districts of Bamyan Province from 29 May to 4 June, 2011. Afterwards a case study was conducted by enrolling 100 randomly selected patients with an equal number of age-matched neighbor controls. An outbreak of brucellosis blood samples were collected for Rose Bengal Test and PCR for the confirmation of brucellosis and Q fever respectively. Data was collected using a structured questionnaire and Epi Info was used for analysis. We found significant association between dual-infection and being illiterate (OR=2.27;CI=1.13-4.58) and having the occupation of housewife (OR=8.32;CI=3.4-20.43). Other high-risk activities identified in the study included pasturing, milking, dunging, butchering, assisting in deliveries, using unboiled milk, living closely with animals, having contact with aborted materials and purchasing new animals. Out of 28 samples tested, all of them were positive for brucellosis and 27 were positive for Q fever. Livestock raising practices combined with close animal and animal product contact increase the risk of contracting brucellosis and Q fever in Afghanistan. Enhancing surveillance, providing immediate treatment for patients, and conducting health education campaigns are recommended.  Afghan veterinary and health departments should work jointly in order to prevent and control these zoonotic diseases.