Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Infect Dis. 2017 Aug;61:56-61. doi: 10.1016/j.ijid.2017.06.002. Epub 2017 Jun 7.
Human brucellosis and recurrent brucellosis is an ever-increasing public health concern, especially in endemic areas like Iran. Nevertheless, little is known regarding the epidemiology and determinants of recurrent brucellosis. Therefore, the objective of this study was to investigate epidemiological patterns and potential determinants of recurrent brucellosis in Hamadan Province during the years 2009-2015.
Data on reported cases of new and recurrent brucellosis from 2009 to 2015 were obtained from the provincial Notifiable Diseases Surveillance System at Hamadan University of Medical Sciences. Incidence rates per 100000 were estimated at the county level. Binary logistic regression was used to estimate the effects of background characteristics and recurrent brucellosis. The power of discrimination of the model for recurrent brucellosis was assessed using the area under the curve (AUC).
Among 7318 brucellosis cases, the total frequency (%) of recurrent cases was 472 (6.45%). The rate of recurrent brucellosis was higher in females, people aged 50 years and over, people with a history of consuming unpasteurized dairy products with no history of contact with animals, and in the winter season. Multivariable logistic regression analysis showed that female sex (adjusted odds ratio (AOR) 1.36, 95% confidence interval (CI) 1.13-1.65), age ≥55 years (AOR 4.15, 95% CI 2.32-7.42), consumption of unpasteurized dairy products (AOR 1.16, 95% CI 0.96-1.40), and winter season (AOR 1.32, 95% CI 1.03-1.71) are potential risk factors for recurrent brucellosis. The final model that involved all the determinants showed moderate discrimination (AUC 0.61).
Female sex, older age, and winter months were found to be significant determinants of recurrent human brucellosis. Enhanced surveillance systems with an emphasis on these population characteristics will allow effective preventive and protective measures to be implemented and might alleviate the recurrence of brucellosis in the country.
人类布鲁氏菌病和复发性布鲁氏菌病是一个日益严重的公共卫生问题，尤其是在伊朗等流行地区。然而，对于复发性布鲁氏菌病的流行病学模式和潜在决定因素知之甚少。因此，本研究的目的是调查 2009 年至 2015 年期间在哈马丹省复发性布鲁氏菌病的流行病学模式和潜在决定因素。
从哈马丹医科大学省级传染病监测系统获取 2009 年至 2015 年新发病例和复发病例的数据。以县为单位计算每 10 万人的发病率。采用二元逻辑回归估计背景特征和复发性布鲁氏菌病的影响。采用曲线下面积（AUC）评估模型对复发性布鲁氏菌病的鉴别能力。
在 7318 例布鲁氏菌病病例中，复发病例的总频率（%）为 472（6.45%）。女性、50 岁及以上人群、有食用未经巴氏消毒奶制品而无动物接触史且在冬季人群中复发性布鲁氏菌病的发生率较高。多变量逻辑回归分析显示，女性（调整后的优势比（AOR）1.36，95%置信区间（CI）1.13-1.65）、年龄≥55 岁（AOR 4.15，95%CI 2.32-7.42）、食用未经巴氏消毒奶制品（AOR 1.16，95%CI 0.96-1.40）和冬季（AOR 1.32，95%CI 1.03-1.71）是复发性布鲁氏菌病的潜在危险因素。包含所有决定因素的最终模型显示出中等的鉴别力（AUC 0.61）。
女性、年龄较大和冬季是人类复发性布鲁氏菌病的重要决定因素。加强监测系统，重点关注这些人群特征，将有助于实施有效的预防和保护措施，减轻该国布鲁氏菌病的复发。
