As many are infected by a bacteria in China, doctors advise caution and advocate screening of travellers
While the nation continues to fight the COVID-19 pandemic and the socio-economic problems that have come along with it, health experts and scientists are now worried about a new zoonotic bacterial disease Brucellosis, that surfaced in China in December last year and has already infected more than 3,000 people. While some feel that as the disease is already present in India, it won't be as severe as COVID-19, others are of the opinion that it might snowball into a pandemic and become more severe than the current one.
Authorities of Lanzhou city in Gansu province have confirmed that 3,245 people have tested positive for Brucellosis – a zoonotic disease – which is usually spread through contact with infected farm animals such as cows, goats and pigs. The outbreak started with a leak at the Lanzhou Veterinary Research Institute in central China, which infected 96 laboratory staff on December 7, 2019.
Speaking to mid-day, Dr Seyed E Hasnain, professor of Molecular Medicine, vice chancellor of Jamia Hamdarad and Hon. professor at IIT-Delhi, said, "Recent evidence suggests that Brucellosis is getting associated with returning travellers and is a serious concern in countries with low and middle-income group people. It is transmitted to humans from farm animals either through direct contact or by using unpasteurised animal products. We have to be careful as symptoms of COVID-19 and Brucellosis might overlap."
No association
Dr Hasnain added, "So far there has been no association of Brucellosis with COVID-19 but the similarities include: spread through inhalation of air containing the bacteria, initial infection due to movement of travellers, symptoms like fever, chills, headache, body ache, general weakness, fatigue, etc, infection can affect most parts of the body including liver, inflammation of the testicles leading to infertility in men, inflammation of the meninges and CVDs. While about 2 per cent of the infected people die, so far no deaths have been reported from China. Brucellosis can be treated with antibiotics like rifampin doxycycline and streptomycin."
Swab samples being collected at an antigen testing camp at Chunabhatti, Dahisar. Pic/Satej Shinde
Professor Dr Sarman Singh, director of All India Institute of Medical Sciences (AIIMS), Bhopal, and an expert in clinical microbiology and molecular medicine said, "The outbreak of Brucellosis in China is a matter of concern. An advisory on the disease is welcome, but Brucellosis is still treatable but COVID-19 is not."
He added, "Also, COVID-19 has long-term effects as it affects multiple organs. Recovered patients do complain of weight loss, fatigue, neurological and psychological issues etc, which is not the case with Brucellosis. Moreover, there is a significant difference between the two – viruses like SARS-CoV2 can cause pandemics, whereas bacteria do not usually lead to the same. And even if it does, we can easily make molecular modifications to treat a bacterial attack. At this moment, we should continue our fight against COVID-19 while keeping our eyes and ears open for future possible outbreaks of Brucellosis."
'Already present in India'
Dr Wiqar Shaikh, senior allergy and asthma specialist said, "Is the world looking at the beginning of a new pandemic? The recent episodes of Brucellosis cases multiplying in North West China cannot be taken sitting low, because like COVID-19, this may spread to neighbouring countries as well."
Dr Shaikh further said, "Unlike COVID-19, which was a new disease for this country, the incidence of Brucellosis in India is approximately 1 lakh cases per year, with a mortality of approximately 2 per cent. Unfortunately, a disease that already exists in the country, can turn into a pandemic faster and become more severe. So doctors should test patients with high fever both for COVID-19 and brucellosis. Just the way swab samples are taken for Coronavirus, blood culture and IgM antibodies test should be done for the bacterial disease. Currently, no effective vaccine is available for Brucellosis, as is also the case with COVID-19."
Echoing similar concerns, Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle, USA, said, "This sends out a strong message to all countries to scale-up vigilance at their apex centres for disease control. Scientists have been talking about the 21st century being the 'century of pandemics' and while the world is still struggling to deal with the health and socio-economic effects of COVID-19, a new zoonotic bacterial disease's outbreak has been reported in northwest China."
Dr Hira added, "Brucellosis spreads from person to another only under exceptional conditions. Breastfeeding moms with brucellosis may pass the bacteria on to their babies. It may also be spread through sexual contact, through a cut or scratch on the skin, by breathing contaminated air and eating or drinking something contaminated with the bacteria, such as unpasteurised milk or undercooked meat."
Dr Shaikh added, "The presenting symptoms of both the diseases are fairly similar. However, a difference is that in case of brucellosis, arthritis (joint swelling) spondylitis (swelling of back bone) and swelling of the testicles are common symptoms as well. The other major difference is that although no treatment is available for COVID-19, there are multiple antibiotics available for treating brucellosis."
Dr Ketan Vagholkar, professor of surgery, DY Patil medical college said, "The COVID-19 pandemic should serve as an eye-opener for health authorities across the world. Research laboratories from far East countries are involved in biological engineering of zoonotic organisms. COVID-19 is a concrete example of this. Most of these laboratories are involved in research of organisms. The focus should be on identifying organisms, both viruses and bacteria, which otherwise are found in animals of various species and can be transmitted to human beings."
Dr Vagholkar added, "A rough strategy to identify and treat such potential organisms should be developed. This might also help in knowing about breakouts in advance and otherwise uncommon diseases such as brucellosis. All health care workers should be trained to create, awareness about such potential modified organisms, which can lead to not only epidemics, but a serious pandemic."
Different view
Dr T Jacob John, known globally for his extensive work in the fields of virology and paediatrics, who headed the ICMR Centre of Advanced Research in Virology and the National HIV/AIDS Reference Centre at the Christian Medical College, Vellore, where he set up the country's first diagnostic virology laboratory, has a different view. He says, "Brucellosis is a most unlikely candidate for a pandemic as it is already prevalent in many countries and in India too. Its original names were Malta fever and Mediterranean fever. In this case human-to-human transmission is extremely rare and not a problem. It can be easily diagnosed and treated with antibiotics. Also, the mortality rate is very low.
When asked if our health experts need to be alert, Dr Jacob stated, "We often miss brucellosis when it comes to diagnosis and antibiotics are given without a specific/proper/lab-based diagnosis, but patients recover."
'COVID-19 has long-term effects as it affects multiple organs. Recovered patients do complain of weight loss, fatigue, neurological and psychological issues etc, which is not the case with Brucellosis. Moreover, there is a significant difference between the two – viruses like SARS-CoV2 can cause pandemics, whereas bacteria do not usually lead to the same'
– Dr Sarman Singh, director of AIIMS Bhopal
'Unlike COVID-19, which was a new disease for this country, the incidence of Brucellosis in India is approximately 1 lakh cases per year, with a mortality of approximately of 2 per cent. Unfortunately, a disease that already exists in the country, can turn into a pandemic faster and become more severe. So doctors should test patients with high fever both for COVID-19 and Brucellosis'
– Dr Wiqar Shaikh, senior allergy and asthma specialist
'Recent evidence suggests that Brucellosis is getting associated with returning travellers and is a serious concern in countries with low- and middle-income group people. It is transmitted to humans from farm animals either through direct contact or by using unpasteurised animal products. We have to be careful as symptoms of COVID-19 and Brucellosis might overlap'
– Dr Seyed E Hasnain, professor of Molecular Medicine
3,245
No. of people who have been infected in China's Lanzhou city
Expert Virologist differ's in his view
Dr T Jacob John, known globally for his extensive work in the fields of virology and paediatrics, who headed the ICMR Centre of Advanced Research in Virology and the National HIV/AIDS Reference Centre, at the Christian Medical College, Vellore, where he set up the country's first diagnostic virology laboratory, tells has a different view - Brucellosis is a most unlikely candidate for a pandemic as it is already prevalent in many countries and in India in almost all States. Its original names were Malta fever and Mediterranean fever.
Cattle, sheep, goats and pigs are the natural hosts. Man is accidental victim but human-to-human transmission is extremely rare and not a problem. It is easily diagnosed (by laboratory) once it is suspected, and easily treated with antibiotics.
Laboratory staff getting infected is sad and bad; that indicates sloppy lab discipline.
All over India farm animals have infection and a lot of people get infected, many without major symptoms, some with fever and fatigue. Death rate is very lo
When asked if our health experts need to be alert, so that they do not miss out on signs of Brucellosis, while they are in the midst of treating Covid 19 pandemic, Dr Jacob stated, "Yes. Brucellosis if often a missed diagnosis and missed when antibiotics are given without a specific/proper/lab-based diagnosis -- patients recover. Typhoid, malaria, dengue, chikungunya and leptospirosis are remembered by doctors in Fever Cases, but brucellosis often forgotten.
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