Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis

Brucellosis is a commonly neglected zoonosis but remains a serious public health concern globally. The epidemiological evolution of human brucellosis has changed considerably over the past decades, and the epidemic geography is continuously expanding. Human brucellosis is increasingly emerging and re-emerging, imported from areas in which it is endemic due to travel, immigration, and international trade. The disease continues to be rampant in Asia and Africa, including West Asia, Central Asia, North Africa, and East Africa, with the highest incidences in Syria, Kyrgyzstan, Mongolia, Iran, Algeria, and Kenya. Re-emerging cases are frequently recorded in places where brucellosis has achieved control, such as Bosnia and Herzegovina, Azerbaijan, and USA. In countries with a high disease burden, control and eradication of the disease has been extremely difficult due to livestock farming as the only source of livelihood, unique religious beliefs regarding animals, a nomadic lifestyle, and low socioeconomic levels. Interventions focused on protecting livestock keepers are needed, particularly for those assisting with goat and sheep births and consumption of raw dairy products.⁣ Strikingly, in the majority of countries with a high disease burden, each period of several years with a low incidence rate was followed by a subsequent increase in cases, highlighting that continuous investment and surveillance are necessary. In addition, advocacy for the inclusion of brucellosis as a globally mandated reported disease, strict restrictions on animal movement, mandated consumption of pasteurized milk, and health education are needed. The present study will help in forming an evidence-based strategy for international organizations to curb the future spread of brucellosis.