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R"��&*Seroprevalence of brucellosis and Q-fever in southeast Ethiopian pastoral livestock

Balako Gumi*1, Rebuma Firdessa2, Lawrence Yamuah2 Teshale Sori3, Tadele Tolosa4, Abraham Aseffa2, Jakob Zinsstag5, 6 and Esther Schelling5, 6

Bule Hora University, P.O. Box 144, Bule Hora, Ethiopia1, Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia2 , Addis Ababa University Faculty of Veterinary Medicine, P.O. Box 34, Debrezeit, Ethiopia3 , Jimma University College of Agriculture and Veterinary Medicine, P. O. Box 307,  Jimma, Ethiopia4 , Swiss Tropical and Public Health Institute, P.O. Box CH-4002 Basel, Switzerland5  University of Basel, Switzerland6 

Abstract To assess seroprevalences of brucellosis and Q-fever in pastoral livestock in southeast Ethiopia, cross-sectional study was carried out in three livestock species (cattle, camels and goats). Study was conducted from July 2008 to August 2010 in eight pastoral associations (PAs) from the selected districts were included in the study. Sera from a total of 1,830 animals comprising 862 cattle, 458 camels and 510 goats were screened initially with Rose Bengal plate test (RBPT) for brucellosis. All RBPT positive and 25% of randomly selected negative sera were further tested by ELISA. These comprise a total of 460 animals (211 cattle, 102 camels and 147 goats). Out of sera from total 1830 animals 20% were randomly selected (180 cattle, 90 camels and 98 goats) and tested for Q-fever using ELISA. The seroprevalences of brucellosis was 1.4% (95% confidence interval (CI), 0.8-2.6), 0.9% (95% CI, 0.3-2.7) and 9.6% (95% CI, 5.2-17.1) in cattle, camels and goats, respectively. Goats and the older animal were at higher risk of infection (OR=7.3, 95% CI, 2.8-19.1) and (OR=1.7 95% CI, 0.9-2.9), respectively. Out of 98 RBPT negative camel sera, 12.0% was positive for ELISA. The seroprevalences of Q-fever was 31.6% (95% CI, 24.7-39.5), 90.0% (95% CI, 81.8-94.7) and 54.2% (95% CI, 46.1-62.1) in cattle, camels and goats, respectively. We found positive animals for Q-fever test in all tested PAs for all animal species. Being camel and older animal was risk factor for infection (OR=19.0, 95% CI, 8.9-41.2) and (OR=3.6, 95% CI, 2.0-6.6), respectively. High seropositivity of Q-fever in all livestock species tested and higher seropositive in goats for brucellosis implies risks of human infection by both diseases. Thus, merit necessity of further study of both diseases in animals and humans in the area.
Keyword: Brucellosis, Q-fever, seroprevalence, pastoral livestock, southeast Ethiopia
* Corresponding Author: Tel. +251917800178 Fax. +251464430355 
E-mail address balako.gumi@yahoo.com



Introduction 
Brucellosis is a disease of animals, especially livestock (cattle, goats, sheep, camels and pigs) but also wild animals. It is caused by bacteria of the genus Brucella spp. In livestock it is primarily a reproductive disease characterized by late abortion, retained foetal membranes, orchitis and impaired fertility  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"s8j13mgra","properties":{"formattedCitation":"[1]","plainCitation":"[1]"},"citationItems":[{"id":855,"uris":["http://zotero.org/users/60721/items/CKENV26B"],"uri":["http://zotero.org/users/60721/items/CKENV26B"],"itemData":{"id":855,"type":"chapter","title":"Brucellosis","container-title":"Oxford Textbook of Zoonoses","page":"54-64","edition":"2nd","author":[{"family":"Zinsstag","given":"J"},{"family":"Schelling","given":"E"},{"family":"Solera","given":"X"},{"family":"Blasco","given":"JM"},{"family":"Moriyon","given":"I"}],"issued":{"date-parts":[[2011]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [1]. B. melitensis is considered to have the highest zoonotic potential, followed by B. abortus, and B. suis. Brucellosis remains one of the most common zoonotic diseases worldwide with more than 500,000 human cases reported annually, particularly from developing countries  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"22777qcf6a","properties":{"formattedCitation":"{\\rtf [2\\uc0\\u8211{}4]}","plainCitation":"[2�4]"},"citationItems":[{"id":350,"uris":["http://zotero.org/users/60721/items/NNDMEPK5"],"uri":["http://zotero.org/users/60721/items/NNDMEPK5"],"itemData":{"id":350,"type":"article-journal","title":"Brucellosis: a worldwide zoonosis","container-title":"Current Opinion in  Microbiology","page":"58-64","volume":"4","issue":"1","author":[{"family":"Boschiroli","given":"M. L."},{"family":"Foulongne","given":"V"},{"family":"O�Callaghan","given":"D"}],"issued":{"date-parts":[[2001]]}},"label":"page"},{"id":1214,"uris":["http://zotero.org/users/60721/items/MDWAZFNC"],"uri":["http://zotero.org/users/60721/items/MDWAZFNC"],"itemData":{"id":1214,"type":"article-journal","title":"Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials","container-title":"BMJ","page":"701 -704","volume":"336","issue":"7646","source":"Highwire 2.0","abstract":"Objectives To determine and quantify differences in efficacy between treatment regimens for brucellosis.Design Systematic review and meta-analysis of randomised controlled trials assessing different antibiotic regimens and durations of treatment for human brucellosis.Data sources PubMed, CENTRAL, Lilacs, conference proceedings, and bibliographies with no restrictions on language, study year, or publication status.Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality independently performed in duplicate. Primary outcomes were relapse and overall failure resulting from primary failure or relapse. Relative risks with 95% confidence intervals were calculated and pooled with a fixed effect model.Results 30 trials and 77 treatment arms were included. Overall failure was significantly higher with doxycycline-rifampicin compared to doxycycline-streptomycin, mainly due to a higher rate of relapse (relative risk 2.80, 95% confidence interval 1.81 to 4.36; 13 trials, without heterogeneity). Results were consistent among patients with bacteraemia and complicated brucellosis. Doxycycline-streptomycin resulted in a significantly higher rate of failure than doxycycline-rifampicin-aminoglycoside (triple drug regimen) (2.50, 1.26 to 5.00; two trials). Gentamicin was not inferior to streptomycin (1.45, 0.52 to 4.00 for failure; two trials). Quinolones combined with rifampicin were significantly less effective than doxycycline combined with rifampicin or streptomycin (1.83, 1.11 to 3.02, for failure; five trials). Monotherapy was associated with a higher risk of failure than combined treatment when administered for a similar duration (2.56, 1.55 to 4.23; five trials). Treatment for six weeks or more offered an advantage over shorter treatment durations.Conclusions There are significant differences in effectiveness between currently recommended treatment regimens for brucellosis. The preferred treatment should be with dual or triple regimens including an aminoglycoside.","DOI":"10.1136/bmj.39497.500903.25","shortTitle":"Treatment of human brucellosis","author":[{"family":"Skalsky","given":"Keren"},{"family":"Yahav","given":"Dafna"},{"family":"Bishara","given":"Jihad"},{"family":"Pitlik","given":"Silvio"},{"family":"Leibovici","given":"Leonard"},{"family":"Paul","given":"Mical"}],"issued":{"date-parts":[["2008",3,29]]},"accessed":{"date-parts":[[2011,2,12]]}},"label":"page"},{"id":1221,"uris":["http://zotero.org/users/60721/items/T922M3AV"],"uri":["http://zotero.org/users/60721/items/T922M3AV"],"itemData":{"id":1221,"type":"article-journal","title":"Brucellosis: a re-emerging zoonosis","container-title":"Veterinary Microbiology","page":"392-398","volume":"140","issue":"3-4","source":"NCBI PubMed","abstract":"Brucellosis, especially caused by Brucella melitensis, remains one of the most common zoonotic diseases worldwide with more than 500,000 human cases reported annually. The bacterial pathogen is classified by the CDC as a category (B) pathogen that has potential for development as a bio-weapon. Brucella spp. are considered as the most common laboratory-acquired pathogens. The geographical distribution of brucellosis is constantly changing with new foci emerging or re-emerging. The disease occurs worldwide in both animals and humans, except in those countries where bovine brucellosis has been eradicated. The worldwide economic losses due to brucellosis are extensive not only in animal production but also in human health. Although a number of successful vaccines are being used for immunization of animals, no satisfactory vaccine against human brucellosis is available. When the incidence of brucellosis is controlled in the animal reservoirs, there is a corresponding and significant decline in the incidence in humans.","DOI":"10.1016/j.vetmic.2009.06.021","ISSN":"1873-2542","note":"PMID: 19604656","shortTitle":"Brucellosis","journalAbbreviation":"Vet. Microbiol","author":[{"family":"Seleem","given":"Mohamed N"},{"family":"Boyle","given":"Stephen M"},{"family":"Sriranganathan","given":"Nammalwar"}],"issued":{"date-parts":[["2010",1,27]]},"accessed":{"date-parts":[[2011,2,12]]}},"label":"page"}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [2�4]. 
The economic and public health impact of brucellosis remains of concern in developing countries  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2en1ea6nv9","properties":{"formattedCitation":"[5]","plainCitation":"[5]"},"citationItems":[{"id":502,"uris":["http://zotero.org/users/60721/items/EDXZKM4E"],"uri":["http://zotero.org/users/60721/items/EDXZKM4E"],"itemData":{"id":502,"type":"article-journal","title":"Human health benefits from livestock vaccination for brucellosis: case study.","container-title":"Bulletin of the World Health Organization","page":"867-876","volume":"81","issue":"12","source":"PubMed Central","abstract":"OBJECTIVE: To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock. METHODS: Cost-effectiveness and economic benefit for human society and the agricultural sector of mass vaccination against brucellosis was modelled. The intervention consisted of a planned 10-year livestock mass vaccination campaign using Rev-1 livestock vaccine for small ruminants and S19 livestock vaccine for cattle. Cost-effectiveness, expressed as cost per disability-adjusted life year (DALY) averted, was the primary outcome. FINDINGS: In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49,027 DALYs could be averted. Estimated intervention costs were US$ 8.3 million, and the overall benefit was US$ 26.6 million. This results in a net present value of US$ 18.3 million and an average benefit-cost ratio for society of 3.2 (2.27-4.37). If the costs of the intervention were shared between the sectors in proportion to the benefit to each, the public health sector would contribute 11%, which gives a cost-effectiveness of US$ 19.1 per DALY averted (95% confidence interval 5.3-486.8). If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the cost-effectiveness would decrease to US$ 71.4 per DALY averted. CONCLUSION: If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors.","ISSN":"0042-9686","note":"PMID: 14997239\nPMCID: 2572379","shortTitle":"Human health benefits from livestock vaccination for brucellosis","journalAbbreviation":"Bull World Health Organ","author":[{"family":"Roth","given":"Felix"},{"family":"Zinsstag","given":"Jakob"},{"family":"Orkhon","given":"Dontor"},{"family":"Chimed-Ochir","given":"G."},{"family":"Hutton","given":"Guy"},{"family":"Cosivi","given":"Ottorino"},{"family":"Carrin","given":"Guy"},{"family":"Otte","given":"Joachim"}],"issued":{"date-parts":[[2003]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [5]. The disease poses a barrier to trade of animals and animal products, causes a public health hazard, and is an impediment to free animal movement  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"svXWv69i","properties":{"formattedCitation":"[1]","plainCitation":"[1]"},"citationItems":[{"id":855,"uris":["http://zotero.org/users/60721/items/CKENV26B"],"uri":["http://zotero.org/users/60721/items/CKENV26B"],"itemData":{"id":855,"type":"chapter","title":"Brucellosis","container-title":"Oxford Textbook of Zoonoses","page":"54-64","edition":"2nd","author":[{"family":"Zinsstag","given":"J"},{"family":"Schelling","given":"E"},{"family":"Solera","given":"X"},{"family":"Blasco","given":"JM"},{"family":"Moriyon","given":"I"}],"issued":{"date-parts":[[2011]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [1]. In Africa and Central Asia, the incidence of brucellosis is generally considered higher in livestock raised in pastoral production systems  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"k68hjechv","properties":{"formattedCitation":"[6]","plainCitation":"[6]"},"citationItems":[{"id":731,"uris":["http://zotero.org/users/60721/items/6CRUMSAK"],"uri":["http://zotero.org/users/60721/items/6CRUMSAK"],"itemData":{"id":731,"type":"article-journal","title":"Brucellosis in sub-Saharan Africa: epidemiology, control and impact","container-title":"Veterinary Microbiology","page":"111-134","volume":"90","issue":"1-4","source":"ScienceDirect","abstract":"Brucellosis is an important disease among livestock and people in sub-Saharan Africa. In general, the incidence is the highest in pastoral production systems and decreases as herd size and size of landholding decreases. The prevalence of risk factors for infections are best understood for bovine brucellosis and to a lesser extent for ovine and caprine brucellosis. The occurrence and epidemiology of brucellosis in pigs is poorly understood. This species bias is also reflected in control activities. As with other public-sector animal health services, the surveillance and control of brucellosis in sub-Saharan Africa is rarely implemented outside southern Africa. Brucellosis is even more ignored in humans and most cases go undiagnosed and untreated, leading to considerable suffering for those affected. Decision-making to determine the importance of brucellosis control relative to other public concerns and what brucellosis control strategies should be applied is urgently required. A strategy for how brucellosis decision-making might be considered and applied in future is outlined.","DOI":"10.1016/S0378-1135(02)00249-3","ISSN":"0378-1135","shortTitle":"Brucellosis in sub-Saharan Africa","author":[{"family":"McDermott","given":"John J."},{"family":"Arimi","given":"S. M."}],"issued":{"date-parts":[["2002",12,20]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [6], however, increasing intensified peri-urban production leads nowadays often to higher prevalence than in pastoral production systems. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1l0p9e2l1f","properties":{"formattedCitation":"[7]","plainCitation":"[7]"},"citationItems":[{"id":714,"uris":["http://zotero.org/users/60721/items/KQE38SHI"],"uri":["http://zotero.org/users/60721/items/KQE38SHI"],"itemData":{"id":714,"type":"article-journal","title":"Seroprevalence of bovine brucellosis in smallholder farms in central Ethiopia (Wuchale-Jida district).","container-title":"Revue M�d V�t,","page":"3-9","volume":"159","author":[{"family":"Kebede","given":"T"},{"family":"Ejeta","given":"G"},{"family":"Ameni","given":"G."}],"issued":{"date-parts":[[2008]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [7]. Brucellosis is endemic in humans and livestock in the Mediterranean region, Africa, the Near East, Central Asia and Central America  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"20i75tiiu5","properties":{"formattedCitation":"[8]","plainCitation":"[8]"},"citationItems":[{"id":1237,"uris":["http://zotero.org/users/60721/items/AVG6TJ8D"],"uri":["http://zotero.org/users/60721/items/AVG6TJ8D"],"itemData":{"id":1237,"type":"article-journal","title":"The new global map of human brucellosis","container-title":"The Lancet Infectious Diseases","page":"91-99","volume":"6","issue":"2","source":"ScienceDirect","abstract":"Summary\r\nThe epidemiology of human brucellosis, the commonest zoonotic infection worldwide, has drastically changed over the past decade because of various sanitary, socioeconomic, and political reasons, together with the evolution of international travel. Several areas traditionally considered to be endemic--eg, France, Israel, and most of Latin America--have achieved control of the disease. On the other hand, new foci of human brucellosis have emerged, particularly in central Asia, while the situation in certain countries of the near east (eg, Syria) is rapidly worsening. Furthermore, the disease is still present, in varying trends, both in European countries and in the USA. Awareness of this new global map of human brucellosis will allow for proper interventions from international public-health organisations.","DOI":"10.1016/S1473-3099(06)70382-6","ISSN":"1473-3099","author":[{"family":"Pappas","given":"Georgios"},{"family":"Papadimitriou","given":"Photini"},{"family":"Akritidis","given":"Nikolaos"},{"family":"Christou","given":"Leonidas"},{"family":"Tsianos","given":"Epameinondas V"}],"issued":{"date-parts":[["2006",2]]},"accessed":{"date-parts":[[2011,2,14]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [8]. Brucellosis in livestock and humans is re-emerging as a major epidemic in countries of the former Soviet Union  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"17qtft818p","properties":{"formattedCitation":"[5]","plainCitation":"[5]"},"citationItems":[{"id":502,"uris":["http://zotero.org/users/60721/items/EDXZKM4E"],"uri":["http://zotero.org/users/60721/items/EDXZKM4E"],"itemData":{"id":502,"type":"article-journal","title":"Human health benefits from livestock vaccination for brucellosis: case study.","container-title":"Bulletin of the World Health Organization","page":"867-876","volume":"81","issue":"12","source":"PubMed Central","abstract":"OBJECTIVE: To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock. METHODS: Cost-effectiveness and economic benefit for human society and the agricultural sector of mass vaccination against brucellosis was modelled. The intervention consisted of a planned 10-year livestock mass vaccination campaign using Rev-1 livestock vaccine for small ruminants and S19 livestock vaccine for cattle. Cost-effectiveness, expressed as cost per disability-adjusted life year (DALY) averted, was the primary outcome. FINDINGS: In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49,027 DALYs could be averted. Estimated intervention costs were US$ 8.3 million, and the overall benefit was US$ 26.6 million. This results in a net present value of US$ 18.3 million and an average benefit-cost ratio for society of 3.2 (2.27-4.37). If the costs of the intervention were shared between the sectors in proportion to the benefit to each, the public health sector would contribute 11%, which gives a cost-effectiveness of US$ 19.1 per DALY averted (95% confidence interval 5.3-486.8). If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the cost-effectiveness would decrease to US$ 71.4 per DALY averted. CONCLUSION: If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors.","ISSN":"0042-9686","note":"PMID: 14997239\nPMCID: 2572379","shortTitle":"Human health benefits from livestock vaccination for brucellosis","journalAbbreviation":"Bull World Health Organ","author":[{"family":"Roth","given":"Felix"},{"family":"Zinsstag","given":"Jakob"},{"family":"Orkhon","given":"Dontor"},{"family":"Chimed-Ochir","given":"G."},{"family":"Hutton","given":"Guy"},{"family":"Cosivi","given":"Ottorino"},{"family":"Carrin","given":"Guy"},{"family":"Otte","given":"Joachim"}],"issued":{"date-parts":[[2003]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [5]. 
In Ethiopia, serological studies of brucellosis have been carried out in farm animals. The presence in livestock varies between different parts of the country  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"UX1tTVVF","properties":{"formattedCitation":"{\\rtf [9\\uc0\\u8211{}12]}","plainCitation":"[9�12]"},"citationItems":[{"id":727,"uris":["http://zotero.org/users/60721/items/NXI7EJ3T"],"uri":["http://zotero.org/users/60721/items/NXI7EJ3T"],"itemData":{"id":727,"type":"article-journal","title":"A Seroprevalence Study of Camel Brucellosis in Three Camel-rearing Regions of Ethiopia","container-title":"Tropical Animal Health and Production","page":"381-390","volume":"35","issue":"5","source":"SpringerLink","abstract":"A cross-sectional investigation was made into the seroprevalence of brucellosis in camels in three arid and semi-arid camel-rearing regions of Ethiopia (Afar, Somali and Borena) between November 2000 and April 2001. When sera collected from 1442 accessible camels were screened with the Rose Bengal plate test (RBPT), 82 (5.7%) of them reacted. The results of a complement fixation test (CFT) on those sera that had given a positive reaction to the screening test then indicated a 4.2% prevalence of brucellosis in the tested camels. There was a significant difference in the prevalence of brucellosis (?2 = 7.91, pppp>0.05). Although a higher prevalence (6.3%) was observed in camels over 3 years old in Afar, there was no significant overall age difference (p>0.05).","DOI":"10.1023/A:1025874310261","author":[{"family":"Teshome","given":"H."},{"family":"Molla","given":"B."},{"family":"Tibbo","given":"M."}],"issued":{"date-parts":[["2003",10,1]]},"accessed":{"date-parts":[[2009,12,27]]}}},{"id":1263,"uris":["http://zotero.org/users/60721/items/V3K7FCTD"],"uri":["http://zotero.org/users/60721/items/V3K7FCTD"],"itemData":{"id":1263,"type":"article-journal","title":"Seroepidemiological Investigation of Bovine Brucellosis in the Extensive Cattle Production System of Tigray Region of Ethiopia","container-title":"International Journal of Applied Research in Veterinary Medicine","page":"65-71","volume":"5","issue":"2","abstract":"A cross-sectional epidemiological study was\ncarried out from September 2004 to March\n2005 to determine the seroprevalence and\nidentify risk factors for seropositivity of\nbovine brucellosis in the extensive cattle\nproduction systems of Tigray Region. The\nstudy populations comprised indigenous\nbreed cattle in the region, and samples were\nselected by 2-stage cluster sampling. Serum\nsamples collected from 816 extensively\nmanaged cattle herds above 6 months of\nage were screened for Brucella antibodies\nby the Rose Bengal Plate Test and reactor\nsera were further tested by the Complement\nFixation Test (CFT). Moreover, information\nwas gathered on individual animal\nand farm-level risk factors and other farm\ncharacteristics using a questionnaire. In\nthis study, the overall seroprevalence of\nBrucella antibodies in the extensively managed\ncattle was 3.19% based on CFT. The\noverall herd-level prevalence was 42.31%\nand the within-herd prevalence varies from\n0% to 15.15% based on CFT. The results\nof univariate logistic regression analysis\nrevealed that seropositivity to brucellosis\nwas significantly higher in animals kept\nunder the transhumance management system\nthan animals in the sedentary system (P <\n0.001). The results also indicated that there\nwas a statistically significant increase in\nseroprevalence to brucellosis with increasing\nage (P < 0.01) but not parity (P > 0.05).\nSignificant increment of seropositivity was\nalso observed as herd size increases from\nsmall to medium (P < 0.05) and then to large\nsizes (P < 0.001). In addition, a significantly\nhigher seroprevalence was found in animals\nin the lowland than those in the highland\nagro-climatic zones. Nevertheless, in the\nmultivariate logistic regression analysis,\nsystemic factor (odds ratio [OR] = 10.6%,\n95% confidence interval [CI] = 2.3-49.3, P <\n0.01) and age (OR = 4.2, 95% CI = 2.3-49.3,\nP < 0.01) were identified as the major risk\nfactors for individual animal seroprevalence.\nFurthermore, Fisher�s Exact Test revealed\nthat seropositivity to brucellosis had statistically\nsignificant association with history\nof previous abortions and stillbirths. The\nresults of this study showed that brucellosis\nis an endemic and widely distributed disease\nin Tigray Region.","author":[{"family":"Berhe","given":"G"},{"family":"Belihu","given":"K"},{"family":"Asfaw","given":"Y"}],"issued":{"date-parts":[[2007]]}}},{"id":1262,"uris":["http://zotero.org/users/60721/items/A3I3STQB"],"uri":["http://zotero.org/users/60721/items/A3I3STQB"],"itemData":{"id":1262,"type":"article-journal","title":"Brucellosis in extensive management system of Zebu cattle in Sidama Zone, Southern Ethiopia","container-title":"African Journal of Agricultural Research","page":"252-263","volume":"5","issue":"3","abstract":"The study was conducted in six districts of Sidama Zone, Southern Ethiopia. During the study a total of\n1627 indigenous zebu cattle in 124 herds were considered from extensive management system. Serum\nsamples collected were screened using Rose Bengal Plate Test (RBPT) and positive reactors were\nfurther subjected to complement fixation test to maximize specifity and positive predictive value. In the\nstudy, an over all prevalence of 1.66% has been established and the herd level infection rate was 13.70\n% (n = 124). Infected herds have been detected from all districts except Arroresa. Accordingly, the rate\nof seroreactor herds observed were, 33.3% (n = 6) for Awassa, 15.38% (n = 26) for Yirgalem, 13.15% (n =\n38) for Aletawendo, 14.29% (n = 14) for Hagereselam and 18.18% (n = 22) for Arbegona in extensive\nmanagement. Regarding herd size, 4.81% for small, 50% for medium and 70% infection rate was\nrecorded for large herds. The variation between small and large herd size was statistically significant (P\n< 0.01). In general the study concluded that brucellosis is prevalent at low rate in individual level, while\nrelatively high in herd level and wide in geographic distribution.","author":[{"family":"Asmare","given":"K"},{"family":"Asfaw","given":"Y"},{"family":"Gelaye","given":"E"},{"family":"Ayelet","given":"G"}],"issued":{"date-parts":[[2010]]}}},{"id":1204,"uris":["http://zotero.org/users/60721/items/8MQXT6SR"],"uri":["http://zotero.org/users/60721/items/8MQXT6SR"],"itemData":{"id":1204,"type":"article-journal","title":"Seroprevalence of brucellosis and its contribution to abortion in cattle, camel, and goat kept under pastoral management in Borana, Ethiopia","container-title":"Tropical Animal Health and Production","page":"651-656","volume":"43","issue":"3","source":"CrossRef","DOI":"10.1007/s11250-010-9748-2","ISSN":"0049-4747","journalAbbreviation":"Trop Anim Health Prod","author":[{"family":"Megersa","given":"Bekele"},{"family":"Biffa","given":"Demelash"},{"family":"Abunna","given":"Fufa"},{"family":"Regassa","given":"Alemayehu"},{"family":"Godfroid","given":"Jacques"},{"family":"Skjerve","given":"Eystein"}],"issued":{"date-parts":[[2010,11]]},"accessed":{"date-parts":[[2011,2,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [9�12]. Only few serological studies of brucellosis have demonstrated the occurrence of the disease among Borana and Hamer pastoralists; however these have highlighted the public health significance  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"C2CbyeEq","properties":{"formattedCitation":"[13]","plainCitation":"[13]"},"citationItems":[{"id":1194,"uris":["http://zotero.org/users/60721/items/CVWN2IZ9"],"uri":["http://zotero.org/users/60721/items/CVWN2IZ9"],"itemData":{"id":1194,"type":"article-journal","title":"Human Brucellosis in Traditional Pastoral Communities in Ethiopia","container-title":"International Journal of Tropical Medicine","page":"59-64","volume":"4","issue":"2","author":[{"family":"Regassa","given":"G"},{"family":"Mekonnen","given":"D"},{"family":"Yamuah","given":"L"},{"family":"Tilahun","given":"H"},{"family":"Guta","given":"T"},{"family":"Gebreyohannes","given":"A"},{"family":"Aseffa","given":"A"},{"family":"Abdoel","given":"T"},{"family":"Smits","given":"H"}],"issued":{"date-parts":[[2009]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [13].
Q-fever is a zoonotic disease caused by Coxiella burnetii. Livestock (cattle, sheep, camels and goats) are the main reservoirs of infection to humans ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"VIFNrRW6","properties":{"formattedCitation":"[14,15]","plainCitation":"[14,15]"},"citationItems":[{"id":764,"uris":["http://zotero.org/users/60721/items/S6ST9M5I"],"uri":["http://zotero.org/users/60721/items/S6ST9M5I"],"itemData":{"id":764,"type":"article-journal","title":"La fi�vre Q en Tunisie","container-title":"Pathologie Biologie","page":"439-443","volume":"57","issue":"5","source":"ScienceDirect","abstract":"R�sum�\r\nCoxiella burnetii, bact�rie intracellulaire obligatoire est l'agent de la fi�vre Q. Cette maladie est une anthropozoonose ubiquitaire qui atteint principalement les personnes en contact avec les animaux. La contamination se fait le plus souvent par a�rosol. La fi�vre Q est classiquement divis�e en infection aigu� et infection chronique. Les deux entit�s se distinguent par une �volution clinique, un profil s�rologique et un traitement diff�rents. En Tunisie, la fi�vre Q existe, mais rarement �voqu� par les cliniciens. Dans cette mise au point, nous rapportons les aspects et les particularit�s �pid�miologiques, cliniques et th�rapeutiques de la fi�vre Q en Tunisie.\r\nQ fever is a common zoonosis with almost a worldwide distribution caused by Coxiella burnetii. Farm animals and pets are the main reservoirs of infection and transmission to humans is usually via inhalation of contaminated aerosols. Infection in humans is often asymptomatic, but it can manifest as an acute disease (usually a self-limited flu-like illness, pneumonia or hepatitis) or as a chronic form (mainly endocarditis, but also hepatitis and chronic-fatigue syndrome). In Tunisia, although prevalence of anti-Coxiella burnetii was high among blood donors, Q fever was rarely reported and frequently miss diagnosed by physicians. This study is a review of epidemiological and clinical particularities of Q fever in Tunisia.","DOI":"10.1016/j.patbio.2008.04.009","ISSN":"0369-8114","author":[{"family":"Kaabia","given":"N."},{"family":"Letaief","given":"A."}],"issued":{"date-parts":[["2009",7]]},"accessed":{"date-parts":[[2009,12,27]]}},"label":"page"},{"id":936,"uris":["http://zotero.org/users/60721/items/29JMBHNG"],"uri":["http://zotero.org/users/60721/items/29JMBHNG"],"itemData":{"id":936,"type":"article-journal","title":"Q Fever","container-title":"Veterinary microbiology","page":"297-309","volume":"140","issue":"3-4","source":"NCBI PubMed","abstract":"Q fever is a zoonotic disease caused by the ubiquitous pathogen Coxiella burnetii responsible for acute and chronic clinical manifestations. Farm animals and pets are the main reservoirs of infection, and transmission to human beings is mainly accomplished through inhalation of contaminated aerosols. This illness is associated with a wide clinical spectrum, from asymptomatic or mildly symptomatic seroconversion to fatal disease. In humans Q fever can manifest as an acute disease (mainly as a self-limited febrile illness, pneumonia, or hepatitis) or as a chronic disease (mainly endocarditis), especially in patients with previous valvulopathy and to a lesser extent in immunocompromised hosts and in pregnant women. In contrast in animals, Q fever is in most cases, strikingly asymptomatic. The definite diagnosis of Q fever is made based on a significant increase in serum antibody titers, the determination of which often requires considerable time, and therefore patients must be monitored for a certain period. The treatment is effective and well tolerated, but must be adapted to the acute or chronic pattern with the tetracyclines to be considered the mainstay of antibiotic therapy. Several actions have been proposed to prevent and reduce the animal and environmental contamination. Vaccination of animals in infected flocks, as well as in uninfected ones close to them, with an efficient vaccine can prevent abortions and shedding of the bacteria.","DOI":"10.1016/j.vetmic.2009.07.016","ISSN":"1873-2542","note":"PMID: 19875249","journalAbbreviation":"Vet. Microbiol.","author":[{"family":"Angelakis","given":"Emmanouil"},{"family":"Raoult","given":"Didier"}],"issued":{"date-parts":[["2010",1,27]]},"accessed":{"date-parts":[[2012,7,29]]}},"label":"page"}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [14,15]  It is also known as an occupational disease of veterinarians, farmers and abattoir workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ynCqQOg0","properties":{"formattedCitation":"[16]","plainCitation":"[16]"},"citationItems":[{"id":938,"uris":["http://zotero.org/users/60721/items/ZZZH8GWU"],"uri":["http://zotero.org/users/60721/items/ZZZH8GWU"],"itemData":{"id":938,"type":"article-journal","title":"Risk factors of Coxiella burnetii (Q fever) seropositivity in veterinary medicine students","container-title":"PloS one","page":"e32108","volume":"7","issue":"2","source":"NCBI PubMed","abstract":"BACKGROUND\n\nQ fever is an occupational risk for veterinarians, however little is known about the risk for veterinary medicine students. This study aimed to assess the seroprevalence of Coxiella burnetii among veterinary medicine students and to identify associated risk factors.\n\n\nMETHODS\n\nA cross-sectional study with questionnaire and blood sample collection was performed among all veterinary medicine students studying in The Netherlands in 2006. Serum samples (n
 =
 674), representative of all study years and study directions, were analyzed for C. burnetii IgG and IgM phase I and II antibodies with an immunofluorescence assay (IFA). Seropositivity was defined as IgG phase I and/or II titer of 1:32 and above.\n\n\nRESULTS\n\nOf the veterinary medicine students 126 (18.7%) had IgG antibodies against C. burnetii. Seropositivity associated risk factors identified were the study direction 'farm animals' (Odds Ratio (OR) 3.27 [95% CI 2.14-5.02]), advanced year of study (OR year 6: 2.31 [1.22-4.39] OR year 3-5 1.83 [1.07-3.10]) having had a zoonosis during the study (OR 1.74 [1.07-2.82]) and ever lived on a ruminant farm (OR 2.73 [1.59-4.67]). Stratified analysis revealed study direction 'farm animals' to be a study-related risk factor apart from ever living on a farm. In addition we identified a clear dose-response relation for the number of years lived on a farm with C. burnetii seropositivity.\n\n\nCONCLUSIONS\n\nC. burnetii seroprevalence is considerable among veterinary medicine students and study related risk factors were identified. This indicates Q fever as an occupational risk for veterinary medicine students.","DOI":"10.1371/journal.pone.0032108","ISSN":"1932-6203","note":"PMID: 22363803","journalAbbreviation":"PLoS ONE","author":[{"family":"de Rooij","given":"Myrna M T"},{"family":"Schimmer","given":"Barbara"},{"family":"Versteeg","given":"Bart"},{"family":"Schneeberger","given":"Peter"},{"family":"Berends","given":"Boyd R"},{"family":"Heederik","given":"Dick"},{"family":"van der Hoek","given":"Wim"},{"family":"Wouters","given":"Inge M"}],"issued":{"date-parts":[[2012]]},"accessed":{"date-parts":[[2012,7,29]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [16] Coxiella burnetii  the causative agent has been isolated from  ticks. Infection in humans is often asymptomatic, but it can manifest as an acute disease (usually a self-limited flu-like illness, pneumonia or hepatitis) or as a chronic form (mainly endocarditis, but also hepatitis and chronic-fatigue syndrome). Q-fever is frequently misdiagnosed by physicians  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qapTEms5","properties":{"formattedCitation":"[14]","plainCitation":"[14]"},"citationItems":[{"id":764,"uris":["http://zotero.org/users/60721/items/S6ST9M5I"],"uri":["http://zotero.org/users/60721/items/S6ST9M5I"],"itemData":{"id":764,"type":"article-journal","title":"La fi�vre Q en Tunisie","container-title":"Pathologie Biologie","page":"439-443","volume":"57","issue":"5","source":"ScienceDirect","abstract":"R�sum�\r\nCoxiella burnetii, bact�rie intracellulaire obligatoire est l'agent de la fi�vre Q. Cette maladie est une anthropozoonose ubiquitaire qui atteint principalement les personnes en contact avec les animaux. La contamination se fait le plus souvent par a�rosol. La fi�vre Q est classiquement divis�e en infection aigu� et infection chronique. Les deux entit�s se distinguent par une �volution clinique, un profil s�rologique et un traitement diff�rents. En Tunisie, la fi�vre Q existe, mais rarement �voqu� par les cliniciens. Dans cette mise au point, nous rapportons les aspects et les particularit�s �pid�miologiques, cliniques et th�rapeutiques de la fi�vre Q en Tunisie.\r\nQ fever is a common zoonosis with almost a worldwide distribution caused by Coxiella burnetii. Farm animals and pets are the main reservoirs of infection and transmission to humans is usually via inhalation of contaminated aerosols. Infection in humans is often asymptomatic, but it can manifest as an acute disease (usually a self-limited flu-like illness, pneumonia or hepatitis) or as a chronic form (mainly endocarditis, but also hepatitis and chronic-fatigue syndrome). In Tunisia, although prevalence of anti-Coxiella burnetii was high among blood donors, Q fever was rarely reported and frequently miss diagnosed by physicians. This study is a review of epidemiological and clinical particularities of Q fever in Tunisia.","DOI":"10.1016/j.patbio.2008.04.009","ISSN":"0369-8114","author":[{"family":"Kaabia","given":"N."},{"family":"Letaief","given":"A."}],"issued":{"date-parts":[["2009",7]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [14]. It is endemic both in livestock and humans in North and Sub-Saharan Africa  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qDfF6Zyc","properties":{"formattedCitation":"{\\rtf [17\\uc0\\u8211{}20]}","plainCitation":"[17�20]"},"citationItems":[{"id":746,"uris":["http://zotero.org/users/60721/items/8UDSPB4J"],"uri":["http://zotero.org/users/60721/items/8UDSPB4J"],"itemData":{"id":746,"type":"article-journal","title":"Q fever in Zimbabwe. A review of the disease and the results of a serosurvey of humans, cattle, goats and dogs","container-title":"South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde","page":"21-25","volume":"83","issue":"1","source":"NCBI PubMed","abstract":"Sera from 494 humans, 180 cattle, 180 goats and 27 dogs, collected from different regions of Zimbabwe, were examined by indirect fluorescence for antibodies reactive with phase II Coxiella burnetii antigen. Overall, 37% of humans were reactive at a titre of 1/40 or greater, and there was no evidence of age- or sex-related differences in seroprevalence. A review of clinical and epidemiological features of Q fever is presented in order to alert health workers to this infection, which apparently occurs frequently in Zimbabwe even though clinical cases have not been reported. In animals, serological evidence of Q fever infection was found in 39% of cattle, but only 15% of dogs and 10% of goats. These results suggest that cattle are important reservoirs of C. burnetii in Zimbabwe.","ISSN":"0256-9574","note":"PMID: 8424194","journalAbbreviation":"S. Afr. Med. J","author":[{"family":"Kelly","given":"P J"},{"family":"Matthewman","given":"L A"},{"family":"Mason","given":"P R"},{"family":"Raoult","given":"D"}],"issued":{"date-parts":[["1993",1]]},"accessed":{"date-parts":[[2009,12,27]]}}},{"id":782,"uris":["http://zotero.org/users/60721/items/9EBUS6F6"],"uri":["http://zotero.org/users/60721/items/9EBUS6F6"],"itemData":{"id":782,"type":"article-journal","title":"Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad","container-title":"Preventive Veterinary Medicine","page":"279-293","volume":"61","issue":"4","source":"ScienceDirect","abstract":"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals.\r\nQ-fever-seropositive blood samples were taken from 11 Arab camel and 4 Arab cattle breeders (seroprevalence 1%). Being a camel breeder was associated with Q-fever seropositivity in humans (OR=9). Camels had the highest Q-fever seroprevalence (80%) among livestock species.\r\nAlthough there was high-risk human behaviour for the acquisition of brucellosis and Q-fever from livestock through raw-milk consumption (98%) and contact with placentas of livestock (62%), we concluded that seroprevalences in humans were relatively low (likely due to limited active foci in livestock).","DOI":"10.1016/j.prevetmed.2003.08.004","ISSN":"0167-5877","author":[{"family":"Schelling","given":"E."},{"family":"Diguimbaye","given":"C."},{"family":"Daoud","given":"S."},{"family":"Nicolet","given":"J."},{"family":"Boerlin","given":"P."},{"family":"Tanner","given":"M."},{"family":"Zinsstag","given":"J."}],"issued":{"date-parts":[["2003",12,12]]},"accessed":{"date-parts":[[2009,12,27]]}}},{"id":776,"uris":["http://zotero.org/users/60721/items/8HI4UT69"],"uri":["http://zotero.org/users/60721/items/8HI4UT69"],"itemData":{"id":776,"type":"article-journal","title":"Seroprevalence of Q-fever in febrile individuals in Mali","container-title":"Tropical Medicine & International Health","page":"612-617","volume":"10","issue":"6","source":"Wiley InterScience","abstract":"Objectives�We conducted a serological survey for Q-fever among febrile patients in Bamako and Mopti (Mali) and investigated the main risk factors for seroconversion.Methods� Blood samples from 156 febrile patients were collected in healthcare facilities of Bamako and Mopti and examined with the microimmunofluorescence test.Results� Forty per cent (n�=�63) were seropositive for Q-fever, 28% in Bamako and 51% in Mopti. A more recent infection was suspected in 9.5% (n�=�6) of all seropositive patients. This is the first time that Q-fever seropositivity is reported in febrile individuals in Mali. The patients' symptoms and diagnoses spanned a wide range of conditions; none had been diagnosed with Q fever by their treating physician. No risk factors for seropositivity could be identified with the exception of the city of residence and none could be identified with a logistic regression model with 'city' taken as random effect.Conclusion� A high rate of seropositivity to C. burnetii was found among febrile urban patients in Mali but no risk factors for seropositivity could be identified in this study.","DOI":"10.1111/j.1365-3156.2005.01420.x","author":[{"family":"Steinmann","given":"P."},{"family":"Bonfoh","given":"B."},{"family":"P�ter","given":"O."},{"family":"Schelling","given":"E."},{"family":"Traor�","given":"M."},{"family":"Zinsstag","given":"J."}],"issued":{"date-parts":[[2005]]},"accessed":{"date-parts":[[2009,12,27]]}}},{"id":770,"uris":["http://zotero.org/users/60721/items/JAG4J54H"],"uri":["http://zotero.org/users/60721/items/JAG4J54H"],"itemData":{"id":770,"type":"article-journal","title":"Q fever (Coxiella burnetii) among man and farm animals in North Sinai, Egypt","container-title":"Journal of the Egyptian Society of Parasitology","page":"135-142","volume":"37","issue":"1","source":"NCBI PubMed","abstract":"Antibodies against Coxiella burnetii were estimated among sheep, goats and camels (190), their owners (150 patients with pyrexia of unknown origin) and 30 normal individuals in North Sinai over the 2006 by indirect immounofluorescence assay. Nested polymerase chain reaction was used to detect Com-1 gene (genetic target of C. burnetii) encoding a 27-kDa outer membrane protein in the samples. C. burnetii IFA antibodies (IgM & IgG) in patients were 8 (5.3%) and a healthy control (3.3%). The overall was 9 of 180 (5.0%). C. burnetii IgM were detected in 3/150 (2%) patients with positive genome, while IgG were detected in 5/150 patients, only the three who had IgM and IgG had positive genome suffered high fever. C. burnetii antibodies were detected in 20 (22.5%), 12 (16.8%) & 4 (13.3%) of sheep, goats, camels, which total 36/190 (18.9%). The positive genome of these IFA positive animals was 10 (50.0%), 4 (33.3%) & zero (0.0%) respectively. On the other hand, Rhipicephalus sanguineus (dog tick) and Dermacentor andersoni (wood tick) were identified on some Q fever infected animals. The results were discussed.","ISSN":"0253-5890","note":"PMID: 17580573","journalAbbreviation":"J Egypt Soc Parasitol","author":[{"family":"Mazyad","given":"Said A M"},{"family":"Hafez","given":"Adel Omar"}],"issued":{"date-parts":[["2007",4]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [17�20].
 In Ethiopia, the existence of antibody against C. burnetii was reported in goats and sheep slaughtered at Addis Ababa abattoir and its peri-urban zone  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"eVEfemOM","properties":{"formattedCitation":"[21]","plainCitation":"[21]"},"citationItems":[{"id":1244,"uris":["http://zotero.org/users/60721/items/UJ4TUTGB"],"uri":["http://zotero.org/users/60721/items/UJ4TUTGB"],"itemData":{"id":1244,"type":"article-journal","title":"Evidence of rickettsial disease agents in ticks from Ethiopian cattle","container-title":"Bulletin of the World Health Organization","page":"127-131","volume":"35","issue":"2","source":"PubMed Central","abstract":"Evidence has recently been accumulating that domestic animals may play an ancillary role in rickettsial zoonoses. In particular, attention has been focused on the activity of Rickettsia prowazekii in Egyptian and Ethiopian livestock and their ticks. An attempt has now been made to confirm previous findings of R. prowazekii in the sera of zebus, sheep and goats in Ethiopia, which brought epidemic typhus into the category of a zoonosis. This attempt was not successful, but tests did indicate that some ticks were infected with R. conori (boutonneuse fever or tick-borne typhus) and Coxiella burneti (Q fever), this being the first evidence for the existence of these agents in Ethiopia.\r\n\r\nAntibodies against R. conori were found in significant numbers in the sera of sheep and goats from one locality, but Q-fever antibodies were surprisingly rare.","ISSN":"0042-9686","note":"PMID: 52969965296996\nPMCID: 2476120","journalAbbreviation":"Bull World Health Organ","author":[{"family":"Philip","given":"Cornelius B."},{"family":"Hoogstraal","given":"Harry"},{"family":"Reiss-Gutfreund","given":"Ruth"},{"family":"Clifford","given":"Carleton M."}],"issued":{"date-parts":[[1966]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [21]. A seroprevalence of 6.5% was also reported in Addis Ababa abattoir workers  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"JvuldTOX","properties":{"formattedCitation":"[22]","plainCitation":"[22]"},"citationItems":[{"id":742,"uris":["http://zotero.org/users/60721/items/SJXBC8WF"],"uri":["http://zotero.org/users/60721/items/SJXBC8WF"],"itemData":{"id":742,"type":"article-journal","title":"Prevalence of Q fever infection in the Addis Ababa abattoir","container-title":"Ethiopian Medical Journal","page":"119-122","volume":"28","issue":"3","source":"NCBI PubMed","abstract":"A total of 465 human sera were collected for a serological survey of Q fever Infection from the Addis Ababa, Ethiopia, abattoir, in 1988. The subjects' sera were tested for antibodies against Coxiella burnetti antigen using the complement fixation test. Results indicate a prevalence rate of 6.5%. This finding clearly demonstrates serological evidence of post infection with Q fever in employees of the abattoir.","ISSN":"0014-1755","note":"PMID: 2209579","journalAbbreviation":"Ethiop. Med. J","author":[{"family":"Abebe","given":"A"}],"issued":{"date-parts":[["1990",7]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [22]. To our knowledge, there was no study on Q-fever in Ethiopian herds or in pastoral zones, where people live in very close contact to their livestock. Information on both diseases is scares in study zones. The objective of the present study was to assess the seroprevalences of brucellosis and Q-fever in pastoral livestock in southern Ethiopia and factors associated with seropositivity. 

Materials and Methods

Study areas A cross-sectional study with a cluster sampling design was conducted from July 2008 to August 2010 in South Eastern Ethiopian pastoral zones of the Somali and Oromia regional states. The area was situated between the 39.21� and 41.24�E longitudes and 4.18�5.5�N latitude. Extensive pastoral livestock production is the main system and the basis of livelihood for millions of pastoralists in the study area. Climatic condition of the selected study areas is characterized by arid and semi-arid climate with bimodal rainfall pattern. Two districts were conveniently selected based on accessibility and security reasons from each of the two regional states. Liben and Filtu districts from Oromia and Somali Regional States were included. Eight pastoral associations (PAs) � each one of the cardinal directions per zonal capital were included in the study. These were Dhuko, Sirba, Arda-Bururi and Siminto PA`s from Oromia and Bifatu, Melkalibe, Hayadimtu and Bakaka PAs from Somali Regional State. 
Sample size The sample size estimation considered clustering of animals within herds  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pFEI1ST4","properties":{"formattedCitation":"[23]","plainCitation":"[23]"},"citationItems":[{"id":13973,"uris":["http://zotero.org/users/60721/items/UHTR6KM5"],"uri":["http://zotero.org/users/60721/items/UHTR6KM5"],"itemData":{"id":13973,"type":"article-journal","title":"A simplified general method for cluster-sample surveys of health in developing countries","container-title":"World Health Statistics Quarterly. Rapport Trimestriel De Statistiques Sanitaires Mondiales","page":"98-106","volume":"44","issue":"3","source":"NCBI PubMed","abstract":"General guidelines are presented for the use of cluster-sample surveys for health surveys in developing countries. The emphasis is on methods which can be used by practitioners with little statistical expertise and no background in sampling. A simple self-weighting design is used, based on that used by the World Health Organization's Expanded Programme on Immunization (EPI). Topics covered include sample design, methods of random selection of areas and households, sample-size calculation and the estimation of proportions, ratios and means with standard errors appropriate to the design. Extensions are discussed, including stratification and multiple stages of selection. Particular attention is paid to allowing for the structure of the survey in estimating sample size, using the design effect and the rate of homogeneity. Guidance is given on possible values for these parameters. A spreadsheet is included for the calculation of standard errors.","DOI":"1949887","ISSN":"0379-8070","note":"PMID: 1949887","journalAbbreviation":"World Health Stat Q","author":[{"family":"Bennett","given":"S"},{"family":"Woods","given":"T"},{"family":"Liyanage","given":"W M"},{"family":"Smith","given":"D L"}],"issued":{"date-parts":[[1991]]},"accessed":{"date-parts":[[2008,10,20]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [23], the sought precision of �3% (standard error of 1.5%), assumed an intraclass correlation coefficient (rho) of 0.2 and an expected seroprevalence of 3% of brucellosis. The total sample size calculated was 480 per species of animals per study site and a total of 128 herds. In Oromia, only cattle were sampled, whereas in Somali region, cattle, camels and goats were present for sampling. Twenty percent of total sample was tested for Q-fever.
Selection of Pastoral Households within PAs In each of the 8 PAs, fifteen animals per herd and species were selected randomly in eight herds. After discussion and agreement on procedures at the general PA meeting of each site, interested households were asked to register for participation. Using a list of registered households per PA as sampling frame, 8 households were selected with random numbers. 
Sample Collection About 10ml of blood sample was collected from the jugular vein of each animal using plain vacutainer tubes and needles. Each sample was labelled with unique identification number. The tubes were kept overnight at room temperature to allow clotting of blood. The next morning sera was removed from the clot and stored in cryotubes at -20�C until analyses in the laboratory
Serology All sera were initially tested by Rose Bengal Test (RBPT). For RBPT 30� of serum and 30� of antigen (Rose Bengal stained B. abortus antigen obtained from BIO-RAD, Marnes-la-Coquette, France) were mixed and rotated on a glass plate for 4 min. Sera with no visible agglutination were recorded as negative while sera showing agglutination were considered positive.  For further analysis, all RBPT-positive and randomly selected 25% RBT-negative sera were tested by using ELISA kits for Brucella abortus. In addition, another randomly selected 20% of sera from 1830 total samples per species were tested for Coxiella burnetii.  ELISA kit was obtained from IDEXX, Liebefeld-Bern Switzerland and tests were performed according to manufacturer�s instructions. All samples and controls in the brucellosis and Q-fever ELISA  were tested in duplicate and the mean OD values were used. Results were expressed as the percentage of the ratio between the sample OD and positive control OD (S/P-ratio) and were calculated as follows:

 EMBED Equation.3   EMBED Equation.3  

The samples were considered seropositive for brucellosis if the percentage of the ratio was > 80% and negative if lower; and for Q-fever seropositive if > 40%; doubtful for values between 30% and 40% and negative if < 30 %. These threshold-values for both tests were recommended by the manufacturers
Data analysis 
The data was double-entered in Microsoft Access 2002 (Microsoft Corp., USA) and validated with EpiInfo version 3.3.2 before being imported to STATA 10/SE (STATA Corp., College Station, TX) for analysis We have used the xtgee model to determine the seroprevalence for each animal species while considering clustering within herds and to see if species, age category and sex were associated with sero-status. 
Age categories were for cattle and goats <=1 years, 1-<=3 years and >3 years, and for camels <=2 years, 2-<=4 years and >4 years. Since not all sera were tested with the brucellosis ELISA, we present only results with the outcome of the RBPT- binarily classified sero-status. 

Results 
Brucellosis seroprevalence A total of 862 cattle, 458 camels and 510 goats were tested for brucella anti-body, from 59, 32 and 34 herds, respectively. The sero-prevalences per species were 1.4% (95% CI, 0.8-2.6), 0.9% (95% CI, 0.3-2.7%) and 9.6% (95% CI, 5.2-17.1%) in cattle, camels and goats, respectively (table1). In 10 out of 59 cattle herds and 5 of the 8 PAs, there was at least one positive animal.  The three out of 32 camel herds and 2 of the 4 sampled PAs and 12 in 34 goat herds in all 4 sampled PAs were seropositive. Out of 98 RBPT negative camel sera 12.0% was positive for ELISA. Univariable analysis of RBPT showed that goats and older animals were at higher risk of infection (OR=7.3, 95% CI, 2.8-19.1) and (OR=1.7 95% CI, 0.9-2.9), respectively. 


























Table 1 Associations with risk factors for brucellosis seropositivity

Risk factorsNumber of test negative Number test positive (%)Univariable 
OR (95% CI) SpeciesCattle85012 (1.4)1Camel4544 (0.9)0.7 (0.2-2.1)Goat46248 (9.6)7.3(2.8-19.1)***Age class1a2954 (1.2)12b77232 (3.8)1.4 (0.9-2.2)3c69928 (4.0)1.7(0.9-2.9) *SexFemale140863 (4.0)1Male3581 (0.3)0.3(0.2-0.4)**** p<0.05; *** p<0.001
a Age categories,  for cattle and goats <=1 years, and camels <=2 years,  b for cattle and goats 1-<=3 years, and  for camels 2-<=4 years,   c  for cattle and goats >3 years,   and for camels  >4 years.














Q-fever sero-prevalence For Q-fever, a total of 368 sera were tested for cattle, camels and goats for antibodies against Q-fever, where by the median of samples tested per herd was 3 for all species. The seroprevalences was 31.6% (95% CI, 24.7-39.5%), 90.0% (95% CI, 81.8-94.7%) and 54.2% (95% CI, 46.1-62.1%) in cattle, camels and goats, respectively (table 2). We found positive animals in all tested PAs for all animal species. Being camel and older animal was risk factor for infection (OR=19.0, 95% CI, 8.9-41.2) and (OR=3.6, 95% CI, 2.0-6.6), respectively.












































Table 2 Associations with risk factors for Q-fever seropositivity

Risk factorsNumber  test negative  Number test positive (%)Univariable 
OR (95% CI) SpeciesCattle12357 (31.6)1Camel981 (90.0)19.0(8.9-41.2)Goat4454 (54.2)2.7(1.7-4.2)***Age class1a4317 (30.8)12b7777 (49.6)2.2 (1.3-3.9)**3c5698 (62.7)3.6(2.0-6.6)***SexFemale140170 (55.1)1Male3622 (39.5)0.6(0.4-1.1) ** p<0.01; *** p<0.001
a Age categories,  for cattle and goats <=1 years, and camels <=2 years,  b for cattle and goats 1-<=3 years, and  for camels 2-<=4 years,   c  for cattle and goats >3 years,   and for camels  >4 years.














Discussions
Seroprevalence of brucellosis The RBPT seroprevalence result of the present study is lower than many of the earlier reports. Seroprevalences as high as 38.7% and 22% have been reported from western and north-eastern parts of Ethiopia  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"27pf4a5ljg","properties":{"formattedCitation":"[24]","plainCitation":"[24]"},"citationItems":[{"id":340,"uris":["http://zotero.org/users/60721/items/I2TA5GQH"],"uri":["http://zotero.org/users/60721/items/I2TA5GQH"],"itemData":{"id":340,"type":"paper-conference","title":"Reproductive wastage in cattle due to bovine brucellosis","container-title":"Livestock Improvement Conference","publisher":"Ethiopian Institute of Agricultural Research","publisher-place":"Addis Ababa, Ethiopia","page":"270-272","volume":"4","event":"4th Livestock Improvement Conference 13-15 November 1991","event-place":"Addis Ababa, Ethiopia","author":[{"family":"Rashid","given":"M"}],"issued":{"date-parts":[[1993]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [24] and  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1es60hrfu0","properties":{"formattedCitation":"[25]","plainCitation":"[25]"},"citationItems":[{"id":405,"uris":["http://zotero.org/users/60721/items/FU68QBZN"],"uri":["http://zotero.org/users/60721/items/FU68QBZN"],"itemData":{"id":405,"type":"thesis","title":"The impact of brucellosis on productivity in an improved dairy herd of Chaffa state farm, Ethiopia","publisher":"Free University of Berlin","publisher-place":"Berlin, Germany.","genre":"Master of Science thesis","event-place":"Berlin, Germany.","author":[{"family":"Sintaro","given":"T"}],"issued":{"date-parts":[[1994]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [25], respectively. Slightly higher individual serological prevalences of 5.6%, 5.9%, 6.5%, 6.6%, 9.9% and 15.8% have also been recorded in Eritrea ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7r9lpqud7","properties":{"formattedCitation":"[26]","plainCitation":"[26]"},"citationItems":[{"id":1228,"uris":["http://zotero.org/users/60721/items/5GJI7JGA"],"uri":["http://zotero.org/users/60721/items/5GJI7JGA"],"itemData":{"id":1228,"type":"article-journal","title":"Prevalence of Antibodies to Brucella spp. in Cattle, Sheep, Goats, Horses and Camels in the State of Eritrea; Influence of Husbandry Systems","container-title":"Epidemiology and Infection","page":"447-453","volume":"125","issue":"2","source":"JSTOR","abstract":"Samples from 2427 cattle, 661 goats, 104 sheep, 98 camels and 82 horses were screened for brucella infections by the Rose Bengal Test and positive reactors confirmed by the complement fixation test. In cattle, the highest individual seroprevalence was in dairy herds kept under the intensive husbandry system, with an individual prevalence of 8�2% and unit (herd) seroprevalence of 35�9%. This was followed by the pastoral husbandry system in the Western Lowlands with 5�0% individual but a higher unit (vaccination site) prevalence of 46�1%. The lowest was in the mixed crop-livestock system in the Southern Highlands with individual 0�3% and unit (village) prevalence of 2�4%. In sheep and goats, no positive animals were detected in the mixed crop-livestock areas. In the Eastern Lowlands individual prevalences of 3�8% (goats) and 1�4% (sheep) and unit prevalence of 33�3% (goats) and 16�7% were found, while 14�3% of individual goats and 56�3% of the units in the Western Lowlands were positive. No positive horses were found. The present study documents the first serological evidence of Brucella spp. infection in camels (3�1%) in Eritrea.","ISSN":"09502688","note":"ArticleType: research-article / Full publication date: Oct., 2000 / Copyright � 2000 Cambridge University Press","author":[{"family":"Omer","given":"M. K."},{"family":"Skjerve","given":"E."},{"family":"Holstad","given":"G."},{"family":"Woldehiwet","given":"Z."},{"family":"MacMillan","given":"A. P."}],"issued":{"date-parts":[["2000",10,1]]},"accessed":{"date-parts":[[2011,2,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [26], Tanzania, Sudan, Chad, Kenya and Uganda, respectively  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2iibb5ks63","properties":{"formattedCitation":"{\\rtf [18,27\\uc0\\u8211{}29]}","plainCitation":"[18,27�29]"},"citationItems":[{"id":394,"uris":["http://zotero.org/users/60721/items/J76X4H56"],"uri":["http://zotero.org/users/60721/items/J76X4H56"],"itemData":{"id":394,"type":"article-journal","title":"A survey of the prevalence of bovine brucellosis in East Africa","container-title":"Bulletin of animimal Health and Production for  Africa","page":"224-229","volume":"26","issue":"3","author":[{"family":"Kagumba","given":"M"},{"family":"Nandokha","given":"E"}],"issued":{"date-parts":[[1978]]}},"label":"page"},{"id":393,"uris":["http://zotero.org/users/60721/items/HJATH6AT"],"uri":["http://zotero.org/users/60721/items/HJATH6AT"],"itemData":{"id":393,"type":"article-journal","title":"Bovine brucellosis among two different cattle populations in Bahr el Ghazal Province of Southern Sudan","container-title":"Tropical Medical parasitology","page":"123-126.","volume":"35","issue":"2","author":[{"family":"Hellman","given":"E"},{"family":"Staak","given":"C"},{"family":"Baumann","given":"M"}],"issued":{"date-parts":[[1984]]}},"label":"page"},{"id":782,"uris":["http://zotero.org/users/60721/items/9EBUS6F6"],"uri":["http://zotero.org/users/60721/items/9EBUS6F6"],"itemData":{"id":782,"type":"article-journal","title":"Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad","container-title":"Preventive Veterinary Medicine","page":"279-293","volume":"61","issue":"4","source":"ScienceDirect","abstract":"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals.\r\nQ-fever-seropositive blood samples were taken from 11 Arab camel and 4 Arab cattle breeders (seroprevalence 1%). Being a camel breeder was associated with Q-fever seropositivity in humans (OR=9). Camels had the highest Q-fever seroprevalence (80%) among livestock species.\r\nAlthough there was high-risk human behaviour for the acquisition of brucellosis and Q-fever from livestock through raw-milk consumption (98%) and contact with placentas of livestock (62%), we concluded that seroprevalences in humans were relatively low (likely due to limited active foci in livestock).","DOI":"10.1016/j.prevetmed.2003.08.004","ISSN":"0167-5877","author":[{"family":"Schelling","given":"E."},{"family":"Diguimbaye","given":"C."},{"family":"Daoud","given":"S."},{"family":"Nicolet","given":"J."},{"family":"Boerlin","given":"P."},{"family":"Tanner","given":"M."},{"family":"Zinsstag","given":"J."}],"issued":{"date-parts":[["2003",12,12]]},"accessed":{"date-parts":[[2009,12,27]]}},"label":"page"},{"id":392,"uris":["http://zotero.org/users/60721/items/MNKXVI4Z"],"uri":["http://zotero.org/users/60721/items/MNKXVI4Z"],"itemData":{"id":392,"type":"article-journal","title":"Tuberculosis and brucellosis prevalence survey on dairy cattle in Mbarara milk basin (Uganda)","container-title":"Preventive veterinary Medicine","page":"267-281.","volume":"67","issue":"4","author":[{"family":"Faye","given":"B"},{"family":"Castel","given":"V"},{"family":"Lesnoff","given":"M"},{"family":"Rutabinda","given":"D"},{"family":"Dhalwa","given":"S"}],"issued":{"date-parts":[[2005]]}},"label":"page"}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [18,27�29]. Differences in the seroprevalence observed in this study, as opposed to those recorded by previous researchers, may be due to differences in herd size, different management systems and  the presence or absence of infectious foci, such as Brucella-infected herds, which could spread the disease among contact herds. 
The seroprevalence of 9.6% of goats brucellosis in this study is inline with report of   ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"91fl9df47","properties":{"formattedCitation":"[30]","plainCitation":"[30]"},"citationItems":[{"id":682,"uris":["http://zotero.org/users/60721/items/A5GH5WWW"],"uri":["http://zotero.org/users/60721/items/A5GH5WWW"],"itemData":{"id":682,"type":"article-journal","title":"Distribution of brucellosis among small ruminants in the pastoral region of Afar, eastern Ethiopia","container-title":"Revue Scientifique Et Technique (International Office of Epizootics)","page":"731-739","volume":"26","issue":"3","source":"NCBI PubMed","abstract":"A cross-sectional study was conducted in the pastoral region of Afar, in eastern and central Ethiopia, to determine the distribution of brucellosis in small ruminants. Between December 2005 and June 2006, 1,568 serum samples were taken: 563 samples from sheep and 1,005 from goats. One hundred and forty-seven of these (9.4%) tested positive using the Rose Bengal plate test (RBPT), and 76 (4.8%) also tested positive by the complement fixation test (CFT). Brucellosis was detected in all five administrative zones of the region. The difference in prevalence (P) among the zones was not statistically significant (P > 0.05). The seroprevalence of Brucella infection was found to be 5.8% (n = 58) in goats and 3.2% (n = 18) in sheep. A prevalence rate of 5.3% was observed in adult animals and 1.6% in younger sheep and goats. Caprine species (chi2 = 5.56) and adult goats and sheep (chi2 = 4.84) were found to be at higher risk of Brucella infection (P < 0.05). No statistically significant difference was found between males and females (chi2 = 2.57, P > 0.05). The study showed that small-ruminant brucellosis is a widely distributed disease in Afar. The authors recommend the implementation of well-organised disease control and prevention methods to mitigate the economic losses and public health hazard caused by the disease.","ISSN":"0253-1933","note":"PMID: 18293621","journalAbbreviation":"Rev. - Off. Int. Epizoot","author":[{"family":"Ashenafi","given":"F"},{"family":"Teshale","given":"S"},{"family":"Ejeta","given":"G"},{"family":"Fikru","given":"R"},{"family":"Laikemariam","given":"Y"}],"issued":{"date-parts":[["2007",12]]},"accessed":{"date-parts":[[2009,12,26]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [30] however, higher than the results of   ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2kuh3hjhh0","properties":{"formattedCitation":"[31]","plainCitation":"[31]"},"citationItems":[{"id":403,"uris":["http://zotero.org/users/60721/items/6D79TQBW"],"uri":["http://zotero.org/users/60721/items/6D79TQBW"],"itemData":{"id":403,"type":"article-journal","title":"The prevalence of brucellosis in small ruminants in central Ethiopia","container-title":"Bulletin of Animal Health and Production for Africa","page":"97-98.","issue":"37","author":[{"family":"Teklye","given":"B"},{"family":"Kasali","given":"O"}],"issued":{"date-parts":[[1989]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [31] from central Ethiopia,  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"4amu7c7gq","properties":{"formattedCitation":"[32]","plainCitation":"[32]"},"citationItems":[{"id":395,"uris":["http://zotero.org/users/60721/items/F5W4HVQ3"],"uri":["http://zotero.org/users/60721/items/F5W4HVQ3"],"itemData":{"id":395,"type":"article-journal","title":"Seroprevalence of small ruminant brucellosis in selected districts of Afar and Somali pastoral areas of eastern Ethiopia: the impact of husbandry practice","container-title":"Revue M�dicine v�teterinaiane","page":"557-563","volume":"157","issue":"11","author":[{"family":"Teshale","given":"S"},{"family":"Yibeltal","given":"M"},{"family":"Abaineh","given":"D"},{"family":"Awoke","given":"K"}],"issued":{"date-parts":[[2006]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [32] from Somali region,  and  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1566fhfoug","properties":{"formattedCitation":"[12]","plainCitation":"[12]"},"citationItems":[{"id":1204,"uris":["http://zotero.org/users/60721/items/8MQXT6SR"],"uri":["http://zotero.org/users/60721/items/8MQXT6SR"],"itemData":{"id":1204,"type":"article-journal","title":"Seroprevalence of brucellosis and its contribution to abortion in cattle, camel, and goat kept under pastoral management in Borana, Ethiopia","container-title":"Tropical Animal Health and Production","page":"651-656","volume":"43","issue":"3","source":"CrossRef","DOI":"10.1007/s11250-010-9748-2","ISSN":"0049-4747","journalAbbreviation":"Trop Anim Health Prod","author":[{"family":"Megersa","given":"Bekele"},{"family":"Biffa","given":"Demelash"},{"family":"Abunna","given":"Fufa"},{"family":"Regassa","given":"Alemayehu"},{"family":"Godfroid","given":"Jacques"},{"family":"Skjerve","given":"Eystein"}],"issued":{"date-parts":[[2010,11]]},"accessed":{"date-parts":[[2011,2,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [12] from Borena pastoralist. Management could be a factor for lower prevalence reported by Teklye and Kasali since they studied goats under small holder mixed crop-livestock systems of central Ethiopia.  Zero seroprevalence was reported in goats from Chad  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"l24lukiep","properties":{"formattedCitation":"[18]","plainCitation":"[18]"},"citationItems":[{"id":782,"uris":["http://zotero.org/users/60721/items/9EBUS6F6"],"uri":["http://zotero.org/users/60721/items/9EBUS6F6"],"itemData":{"id":782,"type":"article-journal","title":"Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad","container-title":"Preventive Veterinary Medicine","page":"279-293","volume":"61","issue":"4","source":"ScienceDirect","abstract":"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals.\r\nQ-fever-seropositive blood samples were taken from 11 Arab camel and 4 Arab cattle breeders (seroprevalence 1%). Being a camel breeder was associated with Q-fever seropositivity in humans (OR=9). Camels had the highest Q-fever seroprevalence (80%) among livestock species.\r\nAlthough there was high-risk human behaviour for the acquisition of brucellosis and Q-fever from livestock through raw-milk consumption (98%) and contact with placentas of livestock (62%), we concluded that seroprevalences in humans were relatively low (likely due to limited active foci in livestock).","DOI":"10.1016/j.prevetmed.2003.08.004","ISSN":"0167-5877","author":[{"family":"Schelling","given":"E."},{"family":"Diguimbaye","given":"C."},{"family":"Daoud","given":"S."},{"family":"Nicolet","given":"J."},{"family":"Boerlin","given":"P."},{"family":"Tanner","given":"M."},{"family":"Zinsstag","given":"J."}],"issued":{"date-parts":[["2003",12,12]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [18] and Zambia  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1vmal3h438","properties":{"formattedCitation":"[33]","plainCitation":"[33]"},"citationItems":[{"id":427,"uris":["http://zotero.org/users/60721/items/I8KKWC4A"],"uri":["http://zotero.org/users/60721/items/I8KKWC4A"],"itemData":{"id":427,"type":"article-journal","title":"Prevalence of antibodies to Brucella spp. and individual risk factors of infection in traditional cattle, goats and sheep reared in livestock-wildlife interface areas of Zambia","container-title":"Tropical Animal Health and Production","page":"195-206","volume":"38","issue":"3","source":"NCBI PubMed","abstract":"A cross-sectional study was performed in the livestock-wildlife interface areas of Lochinvar and Blue Lagoon National Parks and the non-interface area of Kazungula to determine the prevalence of antibodies to Brucella spp. in domestic ruminants and identify individual animal risk factors of infection. A total of 1245 cattle from 124 herds and 280 goats and sheep from 29 flocks were tested sequentially for Brucella antibodies using the Rose Bengal test (RBT) and competitive ELISA. In cattle, individual seroprevalence ranged from 14.1% to 28.1%, while herd sero-prevalence ranged from 46.2% to 74.0% in the three study areas. No goat or sheep tested positive for Brucella antibodies. Three types of cattle grazing strategies were encountered: locally grazed herds (LGH), transhumantly grazed herds (TGH) and river flood plain grazed herds (FGH). Brucella seroprevalence was seen to vary according to area and grazing strategy: Lochinvar and transhumant grazed herds recorded the highest figures, respectively. Age, sex and history of abortion were found to have independent effects on individual seroprevalence. This study establishes that brucellosis is endemic in domestic animals in the livestock-wildlife interface areas of Blue Lagoon and Lochinvar national parks and the disease is also present in Kazungula. We observed that type of grazing strategy had significant impact on cattle Brucella seroprevalence and that transhumant herds were at high risk of being infected.","ISSN":"0049-4747","note":"PMID: 16986767","journalAbbreviation":"Trop Anim Health Prod","author":[{"family":"Muma","given":"J B"},{"family":"Samui","given":"K L"},{"family":"Siamudaala","given":"V M"},{"family":"Oloya","given":"J"},{"family":"Matop","given":"G"},{"family":"Omer","given":"M K"},{"family":"Munyeme","given":"M"},{"family":"Mubita","given":"C"},{"family":"Skjerve","given":"E"}],"issued":{"date-parts":[["2006",4]]},"accessed":{"date-parts":[[2011,4,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [33]. Difference in management system in different countries or absence of infected goat herds may attribute to such variations. In addition, brucellosis transmission is favored by a more humid climate, which prolongs the survival of the bacteria in the environment. However, our study sites were in  arid  and semi-arid  region. 
The seroprevalence of < 1% in camel is lower than previous reports from Borena pastoralists  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hp249aolc","properties":{"formattedCitation":"[12,34]","plainCitation":"[12,34]"},"citationItems":[{"id":1254,"uris":["http://zotero.org/users/60721/items/ZHV7X77H"],"uri":["http://zotero.org/users/60721/items/ZHV7X77H"],"itemData":{"id":1254,"type":"webpage","title":"Seroprevalence of brucellosis in camels ( Camelus dromedarius ) in Borena Lowland, Southern Ethiopia  Seroprevalence de la brucellose chez les dromadaires ( Camelus dromedarius ) dans la plaine de Borena au Sud de l'Ethiopie","genre":"Text.Serial.Journal","URL":"http://www.ajol.info/index.php/bahpa/article/view/32718","note":"A cross-sectional study was undertaken from August 2003 to January 2004 to estimate the seroprevalence of camel brucellosis and associated risk factors in two districts of Borena lowland, southern Ethiopia. The two districts were selected purposively whereas pastoral associations and animals in a herd in the two districts were selected randomly using cluster sampling. Blood samples were collected from a total of 3218 camels that were two years of age and above. All serum samples were initially screened by the Rose Bengal Plate Test (RBPT). Positive serum samples were further tested by the Complement Fixation Test (CFT) for confirmation. Brucella antibodies were detected in 1.8% (58/3218) of the camels tested. Sixteen percent of the herds (40/250) had one or more animals positive for brucellosis. The effect of sex was observed to be significant for seroprevalence (p   R�sum�   Une �tude transversale a �t� men�e d'ao�t 2003 � janvier 2004, afin d'�valuer la s�ropr�valence de la brucellose cameline et les facteurs de risque y aff�rents dans deux districts de la plaine de Borena au sud de l'Ethiopie. Les deux districts �taient choisis � dessein, tandis que des associations de pasteurs et des animaux d'un troupeau dans les deux districts �taient s�lectionn�s au hasard gr�ce � un �chantillonnage de groupe. On a pr�lev� du sang � 3.218 dromadaires �g�s de deux ans et plus. Tous les �chantillons de s�rum �taient examin�s � l'aide du Test d'agglutination sur lame au Rose Bengal (RBPT). Les �chantillons de s�rum positifs �taient ensuite analys�s avec le Test de fixation du compl�ment (CFT) pour confirmation. Des anticorps anti-Brucella �taient d�tect�s chez 1,8% des dromadaires examin�s (58/3.218). Seize pour cent des troupeaux (40/250) avaient un animal (ou plus) positif pour la brucellose. L'effet du sexe a �t� constat� comme �tant important pour la s�ropr�valence (p   Bulletin of Animal Health and Production Journal  Vol. 53(4) 2005: 252-257","author":[{"family":"Megersa","given":"B"},{"family":"Molla","given":"B"},{"family":"Yigezu","given":"L"}],"issued":{"date-parts":[[2006,4,24]]},"accessed":{"date-parts":[[2011,2,15]]}},"label":"page"},{"id":1204,"uris":["http://zotero.org/users/60721/items/8MQXT6SR"],"uri":["http://zotero.org/users/60721/items/8MQXT6SR"],"itemData":{"id":1204,"type":"article-journal","title":"Seroprevalence of brucellosis and its contribution to abortion in cattle, camel, and goat kept under pastoral management in Borana, Ethiopia","container-title":"Tropical Animal Health and Production","page":"651-656","volume":"43","issue":"3","source":"CrossRef","DOI":"10.1007/s11250-010-9748-2","ISSN":"0049-4747","journalAbbreviation":"Trop Anim Health Prod","author":[{"family":"Megersa","given":"Bekele"},{"family":"Biffa","given":"Demelash"},{"family":"Abunna","given":"Fufa"},{"family":"Regassa","given":"Alemayehu"},{"family":"Godfroid","given":"Jacques"},{"family":"Skjerve","given":"Eystein"}],"issued":{"date-parts":[[2010,11]]},"accessed":{"date-parts":[[2011,2,12]]}},"label":"page"}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [12,34] and Jordan  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pdlcf3148","properties":{"formattedCitation":"[35]","plainCitation":"[35]"},"citationItems":[{"id":429,"uris":["http://zotero.org/users/60721/items/3MEZH9FF"],"uri":["http://zotero.org/users/60721/items/3MEZH9FF"],"itemData":{"id":429,"type":"article-journal","title":"Risk factors associated with camel brucellosis in Jordan","container-title":"Tropical Animal Health and Production","page":"193-200","volume":"40","issue":"3","source":"NCBI PubMed","abstract":"During the period between February, 2004 and December, 2006, a cross-sectional study was performed to investigate some epidemiological aspects related to camel brucellosis in Jordan. Four hundred twelve camel sera from 37 herds were randomly collected and analyzed using Rose Bengal plate test and complement fixation test. A structured pre-tested questionnaire was administered to collect information on camel herd health and management. A multivariable logistic regression model was constructed to investigate risk factors associated with seropositivity to Brucella antigens. Moreover, the incidence of Brucella-specific abortion was investigated in 7 camel herds located in different locations in Southern Jordan. The true prevalence of Brucella-seropositive in camels was 12.1%. Thirteen (35.1%) herds had at least one positive camel. The seroprevalence ofbrucellosis in camels was significantly higher in the southern part of Jordan than that in central or northern Jordan. The multivariable logistic regression model on both individual and herd levels revealed large herds and contact with small ruminants as risk factors for Brucella seropositivity. On the other hand, using disinfectants was identified as a protective factor (OR = 0.8; 95% CI: 0.1, 0.9) only on the camel herd level. The incidence of Brucella-caused abortion was 1.9%. Brucella melitensis biotype 3 was isolated from 4 aborted camel fetuses.","ISSN":"0049-4747","note":"PMID: 18484121","journalAbbreviation":"Trop Anim Health Prod","author":[{"family":"Al-Majali","given":"Ahmad M"},{"family":"Al-Qudah","given":"Khaled M"},{"family":"Al-Tarazi","given":"Yasser H"},{"family":"Al-Rawashdeh","given":"Odea F"}],"issued":{"date-parts":[["2008",4]]},"accessed":{"date-parts":[[2011,4,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [35].  Comparable report was from Chad  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1rj3iv0vtc","properties":{"formattedCitation":"[18]","plainCitation":"[18]"},"citationItems":[{"id":782,"uris":["http://zotero.org/users/60721/items/9EBUS6F6"],"uri":["http://zotero.org/users/60721/items/9EBUS6F6"],"itemData":{"id":782,"type":"article-journal","title":"Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad","container-title":"Preventive Veterinary Medicine","page":"279-293","volume":"61","issue":"4","source":"ScienceDirect","abstract":"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals.\r\nQ-fever-seropositive blood samples were taken from 11 Arab camel and 4 Arab cattle breeders (seroprevalence 1%). Being a camel breeder was associated with Q-fever seropositivity in humans (OR=9). Camels had the highest Q-fever seroprevalence (80%) among livestock species.\r\nAlthough there was high-risk human behaviour for the acquisition of brucellosis and Q-fever from livestock through raw-milk consumption (98%) and contact with placentas of livestock (62%), we concluded that seroprevalences in humans were relatively low (likely due to limited active foci in livestock).","DOI":"10.1016/j.prevetmed.2003.08.004","ISSN":"0167-5877","author":[{"family":"Schelling","given":"E."},{"family":"Diguimbaye","given":"C."},{"family":"Daoud","given":"S."},{"family":"Nicolet","given":"J."},{"family":"Boerlin","given":"P."},{"family":"Tanner","given":"M."},{"family":"Zinsstag","given":"J."}],"issued":{"date-parts":[["2003",12,12]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [18]. Inter-study variation may be due to difference in camel husbandry practices in different communities.
In our study ELISA found to be more sensitive than RBPT to detect positive camels. This observation needs further evaluation of both tests to validate for diagnostic uses in camels. 
The seroprevalence of brucellosis was higher in goats than in other two species of animals studied. It could be due to the highly contagious nature of the diseases in goats. The higher pathogenicity of B. melitensis and the close contact caused by the high density of the herds of goats, the intermixing of herds of different owners and heavy exposure in housing during the night can also contribute to this higher prevalence. The seroprevalence was also higher in females and older animals than in males and younger counterparts. This is in consent with the previous works  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"o0ULZBoQ","properties":{"formattedCitation":"[36]","plainCitation":"[36]"},"citationItems":[{"id":962,"uris":["http://zotero.org/users/60721/items/DJRB5PIM"],"uri":["http://zotero.org/users/60721/items/DJRB5PIM"],"itemData":{"id":962,"type":"article-journal","title":"Prevalence of Bovine Brucellosis and Risk Factors Assessment in Cattle Herds in Jigawa State","container-title":"ISRN Veterinary Science","page":"1-4","volume":"2011","source":"CrossRef","DOI":"10.5402/2011/132897","ISSN":"2090-4452, 2090-4460","author":[{"family":"Mohammed","given":"Farouk U."},{"family":"Ibrahim","given":"Salisu"},{"family":"Ajogi","given":"Ikwe"},{"family":"Olaniyi","given":"Bale J. O."}],"issued":{"date-parts":[[2011]]},"accessed":{"date-parts":[[2012,8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [36]. It has already been shown that susceptibility to brucellosis is greater in sexually mature animals. Young animals are often resistant, although it should be noted that latent infections can occur and such animals may present a hazard when mature  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gpfqtrn98","properties":{"formattedCitation":"[37]","plainCitation":"[37]"},"citationItems":[{"id":385,"uris":["http://zotero.org/users/60721/items/GTTHN75M"],"uri":["http://zotero.org/users/60721/items/GTTHN75M"],"itemData":{"id":385,"type":"article-magazine","title":"Brucellosis in humans and animals","container-title":"World Health Organisation, Geneva, Switzerland.","author":[{"family":"Corbel","given":"M.J"}],"issued":{"date-parts":[[2006]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [37].
Seroprevalence of Q-fever The seroprevalence of Q-fever found in this study is high in all the three animals species studied. The higher prevalence in camels is in agreement with previous reports from Chad  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2n0774j248","properties":{"formattedCitation":"[18]","plainCitation":"[18]"},"citationItems":[{"id":782,"uris":["http://zotero.org/users/60721/items/9EBUS6F6"],"uri":["http://zotero.org/users/60721/items/9EBUS6F6"],"itemData":{"id":782,"type":"article-journal","title":"Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad","container-title":"Preventive Veterinary Medicine","page":"279-293","volume":"61","issue":"4","source":"ScienceDirect","abstract":"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals.\r\nQ-fever-seropositive blood samples were taken from 11 Arab camel and 4 Arab cattle breeders (seroprevalence 1%). Being a camel breeder was associated with Q-fever seropositivity in humans (OR=9). Camels had the highest Q-fever seroprevalence (80%) among livestock species.\r\nAlthough there was high-risk human behaviour for the acquisition of brucellosis and Q-fever from livestock through raw-milk consumption (98%) and contact with placentas of livestock (62%), we concluded that seroprevalences in humans were relatively low (likely due to limited active foci in livestock).","DOI":"10.1016/j.prevetmed.2003.08.004","ISSN":"0167-5877","author":[{"family":"Schelling","given":"E."},{"family":"Diguimbaye","given":"C."},{"family":"Daoud","given":"S."},{"family":"Nicolet","given":"J."},{"family":"Boerlin","given":"P."},{"family":"Tanner","given":"M."},{"family":"Zinsstag","given":"J."}],"issued":{"date-parts":[["2003",12,12]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [18]. But the seroprevalence in sera from cattle and goats are higher than previous report from Central African Republic  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1idpjoncup","properties":{"formattedCitation":"[38]","plainCitation":"[38]"},"citationItems":[{"id":779,"uris":["http://zotero.org/users/60721/items/B5IFEJKJ"],"uri":["http://zotero.org/users/60721/items/B5IFEJKJ"],"itemData":{"id":779,"type":"article-journal","title":"Serological surveillance of brucellosis and Q fever in cattle in the Central African Republic","container-title":"Acta Tropica","page":"147-151","volume":"92","issue":"2","source":"ScienceDirect","abstract":"No data are available concerning the seroprevalence of brucellosis in Central African Republic (CAR) and the last report concerning the seroprevalence of Q fever in CAR is from 1995. The aim of our study was to determine the prevalence of these diseases in CAR, especially in Zebu cattle. We used the Rose Bengal Plate Test to test 2032 bovine serum samples for antibodies to Brucella spp. and an indirect immunofluorescence assay to test 784 bovine serum samples for antibodies to Coxiella burnetii (the species responsible for Q fever). The mean seroprevalences of antibodies to Brucella and Coxiella were 3.3 and 14.3%, respectively. Significant differences were found between regions and herds for both diseases. However, relation with differences of climate or vegetation were not evident. Therefore, further data are necessary to better understand the epidemiology of these diseases in CAR and evaluate losses to the farmers.","DOI":"10.1016/j.actatropica.2004.06.007","ISSN":"0001-706X","author":[{"family":"Nakoun�","given":"E."},{"family":"Debaere","given":"O."},{"family":"Koumanda-Kotogne","given":"F."},{"family":"Selekon","given":"B."},{"family":"Samory","given":"F."},{"family":"Talarmin","given":"A."}],"issued":{"date-parts":[["2004",10]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [38] and Chad  ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rep854l7g","properties":{"formattedCitation":"[18]","plainCitation":"[18]"},"citationItems":[{"id":782,"uris":["http://zotero.org/users/60721/items/9EBUS6F6"],"uri":["http://zotero.org/users/60721/items/9EBUS6F6"],"itemData":{"id":782,"type":"article-journal","title":"Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad","container-title":"Preventive Veterinary Medicine","page":"279-293","volume":"61","issue":"4","source":"ScienceDirect","abstract":"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals.\r\nQ-fever-seropositive blood samples were taken from 11 Arab camel and 4 Arab cattle breeders (seroprevalence 1%). Being a camel breeder was associated with Q-fever seropositivity in humans (OR=9). Camels had the highest Q-fever seroprevalence (80%) among livestock species.\r\nAlthough there was high-risk human behaviour for the acquisition of brucellosis and Q-fever from livestock through raw-milk consumption (98%) and contact with placentas of livestock (62%), we concluded that seroprevalences in humans were relatively low (likely due to limited active foci in livestock).","DOI":"10.1016/j.prevetmed.2003.08.004","ISSN":"0167-5877","author":[{"family":"Schelling","given":"E."},{"family":"Diguimbaye","given":"C."},{"family":"Daoud","given":"S."},{"family":"Nicolet","given":"J."},{"family":"Boerlin","given":"P."},{"family":"Tanner","given":"M."},{"family":"Zinsstag","given":"J."}],"issued":{"date-parts":[["2003",12,12]]},"accessed":{"date-parts":[[2009,12,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [18]. The highest seroprevalence observed in camels may be due to genetic susceptibility of camels to C. burnetii or host preference of tick vectors to camel. The high seroprevalence of anti Q-fever antibody in the present study may be due to ELISA kit used in our study is hyper-sensitivity to cross-react with related genera and species. However it needs further validation. 
The high seroprevalence of Q-fever in all animal species studied and the higher prevalence of brucellosis in goats is particularly important finding that pinpoint the hazard to the health of the pastoralists. The importance of these zoonotic diseases in impairing the health of the community needs to be further studied in the future. 

Acknowledgement 
We would like to thank the Wellcome Trust Fund Program on Bovine Tuberculosis in Ethiopia and the Armauer Hansen Research Institute for their financial support to the research work. The National Centre of Competence in Research North-South is acknowledged for its co-founding to field work supervision.
Reference:

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Youez - 2016 - github.com/yon3zu
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