Prevalence and factors associated with Erysipelothrix rhusiopathiae infection among raw pork handlers in Kamuli district, Eastern Uganda

Introduction: Erysipelothrix rhusiopathiae (ER) is a zoonotic, ubiquitous gram-positive bacterium, which causes erysipelas in swine, mammals, birds and erysipeloid in humans. The study was conducted in Kamuli district because farmers had reported signs of disease in their pigs which was reported at a prevalence of 67%. Therefore this study determined the prevalence and factors associated with ER infection among raw pork handlers in Kamuli district, Eastern Uganda. Methods: A cross-sectional community based study was done which employed quantitative and qualitative methods for data collection between January and March 2016. The study was conducted in Namwendwa, Bugulumbya and Kitayunjwa sub counties in Kamuli District because the farmers reported signs of the disease in their pigs. A total of 302 participants (butchers, abattoir workers and cooks) were enrolled consecutively for quantitative data collection. Participants for qualitative data collection were sampled purposively. E. rhusiopathiae infection among the handlers was determined by collecting whole blood which was used for culture and isolating the bacteria. The infection was confirmed the infection using biochemical tests and gram staining of the resulting isolates. Results: The prevalence of E.rhusiopathiae infection was 9.9 % (95% CI: 7.35 -12.52). Type of raw pork handler and alcohol consumption increased the risk of acquiring the infection. Working in the abattoir and butchery increased the risk of the infection at (aOR= 26.13 95% CI: 5.29 129.10) and (aOR= 8.37 95%CI: 1.79 -39.10) respectively. Alcohol consumption was associated with E.rhusiopathiae infection (aOR= 4.02 95%CI: 1.07 -15.03). Conclusion: The overall prevalence of E. rhusiopathiae infection was low compared to those from previous studies. Abattoir worker and butchers were highly infected with E. rhusiopathiae. Alcohol consumption, working in the abattoir and being male increased the risk of acquiring the infection. The main causes of E. rhusiopathiae were poor hygiene of the personnel especially the abattoir workers and butchers. Increased alcohol consumption among participant was associated developing the infection. Recommendations: Abattoir workers, butchers and cooks/pork buyers should be sensitized on the risk of being infected with E.rhusiopathiae infection and how to prevent it while carrying on with their duties. Raw pork handlers should avoid working under the influence of alcohol as this would impair their sense for judgment and increase their exposure to E. rhusiopathiae infection

Erysipelothrix rhusiopathiae infection in pigs, pork and raw pork handlers in Kamuli District, Eastern Uganda

Erysipelothrix rhusiopathiae is a zoonotic ubiquitous gram-positive bacterium, which causes erysipelas in swine, mammals, birds and erysipeloid in humans. People in contact with animals, animal products or animal wastes are at greatest risk. From June 2013 to December 2015, a multidisciplinary risk assessment was conducted to identify the risks associated with E. rhusiopathiae along the pig value chain in Kamuli District, Eastern Uganda. Quantitative and qualitative methods of data collection were employed. Serum from 460 pigs and 100 fresh pork samples and human EDTA blood was gathered from 302 raw pork handlers (butchers, abattoir workers and housewives), for microbiology cultures and serology. Six focus group discussions were conducted with 26 butchers/abattoir workers and with 26 housewives. Three key informant interviews were conducted with a health assistant, veterinary officer and a nursing officer. Overall, 308/460 (67%) of the pig sera carried antibodies against E. rhusiopathiae. Forty-five percent (45/100, 45%) of the fresh pork samples were contaminated with E. rhusiopathiae and 30/302 (9.9%) of the raw pork handlers were positive for infection with E. rhusiopathiae. The mean age of the raw pork handlers was 38 years, 21/30 (70%) of men were infected compared to 9/30(30%) of the women. The main risk factor for the infection was the type of raw pork handler. Of the abattoir workers 14/38 (47%) were positive, 9/59 (30%) of the butchers and 7/205 (23.3%) of the housewives were infected with E.rhusiopathiae. This is the first ever report of E. rhusiopathiae in pigs and humans in Uganda and East Africa. Previously, the acute form of swine erysipelas may have been confused for other diseases in pigs reported in Uganda which are characterized acute symptoms such as sudden death (for example, African swine fever). We recommend increasing awareness of the disease among animal and human practitioners as treatment is easy and available and vaccination is possible. However, the disease is still unknown to local veterinarians, clinical doctors, meat inspectors, butchers and laboratory personnel. Proper hygiene, regular pork inspection, use of protective wear among people working/ in contact with animals should be promoted. The study was conducted under the Safe Food, Fair Food project led by the International Livestock Research Institute and carried out with the financial support of the Federal Ministry for Economic Cooperation and Development, Germany, and the CGIAR Research Program on Agriculture for Nutrition and Health, led by the International Food Policy Research Institute

Detection of Erysipelothrix rhusiopathiae in naturally infected pigs in Kamuli District, Uganda

Swine erysipelas is an economically significant disease affecting all stages of pork production. The biggest losses may occur in growers-finishers because of sudden death or acute septicemia. Survivors often suffer from chronic lameness, arthritis and endocarditis leading to poor body growth. The causative agent is the ubiquitous bacterium Erysipelothrix (E.) rhusiopathiae, which is also able to enter the skin of people handling infected animals and meat and cause infection. In order to show the presence of E. rhusiopathiae in pigs, serum samples from 426 randomly selected pigs were collected in four subcounties (Bugulumbya, Butansi, Kitayunwa and Namwendwa) in Kamuli District in Uganda, as part of a multipathogen survey conducted by the International Livestock Research Institute in 2013. Subsequently, 100 samples of fresh pork were collected from all 67-pork slaughterhouses operating in the same subcounties for isolation and bacterial culture. Overall, 308/460 (67%) of the pig sera carried antibodies against E. rhusiopathiae and 45/100 (45%) of the fresh pork samples were contaminated with E. rhusiopathiae. This is the first ever report of E. rhusiopathiae in pigs and pork in Uganda

High prevalence of Erysipelothrix rhusiopathiae infection among abattoir workers in Kamuli District, Eastern Uganda

Introduction: Erysipelothrix (E.) rhusiopathiae is a ubiquitous gram-positive bacterium, which causes erysipelas in swine, mammals, birds and erysipeloid in humans. A previous study conducted in Kamuli district, identified serotypes 1 and 2 in pigs thus a follow up study in humans aimed at establishing prevalence and factors associated with E. rhusiopathiae infection. Methods: We conducted a cross-sectional community-based epidemiological study using quantitative methods of data collection. The study enrolled 302 raw pork handlers (butchers, abattoir workers and cooks) in Kamuli district, Eastern Uganda. Erysipelothrix rhusiopathiae infection among the handlers was determined by collecting whole blood for culture. Bacteria were isolated and infection confirmed using biochemical tests and gram staining. In addition, a semi-structured questionnaire was administered to establish the risk factors of E. rhusiopathiae infection. Results: The overall prevalence of E. rhusiopathiae infection was 9.9 % (95% CI: 7.4-13). Being a raw pork handler and self-reported alcohol consumption increased the risk of acquiring the infection. Among butchers, the prevalence was 15% (95% CI: 5.9 - 25), abattoir workers 37% (95% CI: 21 - 52) and cooks 3.4% (95% CI: 1.0 - 5.9). Working in the abattoir and butchery made infection 26 times (OR = 26; 95% CI: 5.3 - 129) and 8 times (OR = 8.4; 95% CI: 1.8 - 39) more likely, respectively. Alcohol consumption was associated with E. rhusiopathiae infection (OR = 4.0; 95% CI: 1.1 - 15). Conclusion: E. rhusiopathiae infections exist in Kamuli district, Eastern Uganda affecting all categories of raw pork handlers. We recommend that the isolates be serotyped to identify the circulating serotypes and inform the appropriate control measures for the disease in humans

Diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending an urban public health facility in Kampala, Uganda

<div><p>Background</p><p>The prevalence of HIV in Uganda is 7.3%, and yet nearly 40% of people living with HIV are unaware of their status. The current HIV testing policy which is strictly blood-based poses several challenges including: a need for high level laboratory skills, stringent waste disposal needs, and painful sample collection. It is envisaged that introduction of a rapid, painless HIV oral fluid test as a potential alternative is likely to increase the number of people testing. The aim of this study was to determine the diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending Kisenyi Health Centre IV in Kampala.</p><p>Methods and findings</p><p>We conducted a cross-sectional study among 440 adults recruited consecutively at Kisenyi Health Centre IV from January to March 2016. The diagnostic accuracy of the HIV oral test was assessed by comparing to the national HIV serial testing algorithm. We also assessed for acceptability among patients and health care workers (HCWs) by triangulating responses from a structured questionnaire, three focus group discussions and seven key informant interviews. Acceptability was defined as willingness to take the test at the time of the study and intention for future use of the test if it was availed.</p><p>The prevalence of HIV infection among study participants was 14.8%. The HIV oral fluid test was highly accurate with sensitivity of 100% (95% CI; 94.5–100.0), specificity of 100% (95% CI; 99.0–100.0), positive predictive value (PPV) of 100% (95% CI; 94.5–100.0) and negative predictive value (NPV) of 100% (95% CI; 99.0–100.0). Acceptability of HIV oral testing was also high at 87.0% (95% CI; 83.6–89.9). Participants preferred HIV oral testing because it was: pain free (91%, n = 399) and did not require blood draw (82%, n = 360).</p><p>Conclusion</p><p>The HIV oral fluid test has high diagnostic accuracy and acceptability. HIV oral testing is a suitable addition to the national HIV testing strategies with the potential of increasing access to HIV testing services in Uganda.</p></div

Diagnostic accuracy of OraQuick® Rapid HIV-1 antibody test compared to HIV infected¹, N = 440.

<p>Diagnostic accuracy of OraQuick® Rapid HIV-1 antibody test compared to HIV infected<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182050#t004fn001" target="_blank">¹</a>, N = 440.</p

Socio-demographic characteristics of study participants at Kisenyi Health Centre IV, January to March 2016.

<p>Socio-demographic characteristics of study participants at Kisenyi Health Centre IV, January to March 2016.</p

Reasons for acceptability of HIV oral testing among adults at Kisenyi Health Centre IV from January to March, 2016.

<p>Reasons for acceptability of HIV oral testing among adults at Kisenyi Health Centre IV from January to March, 2016.</p

Acceptability of HIV oral testing among adults at Kisenyi Health Centre IV from January to March, 2016.

<p>Acceptability of HIV oral testing among adults at Kisenyi Health Centre IV from January to March, 2016.</p

HIV risky behaviors among study participants at Kisenyi Health Centre IV, January to March 2016.

<p>HIV risky behaviors among study participants at Kisenyi Health Centre IV, January to March 2016.</p