Brucellosis Control in Armenia: A Holistic Approach

Introduction

Brucellosis, a contagious disease caused by Brucella spp., impacts humans and animals globally. The bacterium has various species affecting livestock, with zoonotic implications. Human infection occurs through consuming contaminated products, leading to severe symptoms ranging from flu-like to central nervous system infection. While advanced nations have successfully eliminated brucellosis, developing regions still struggle, with around 500,000 reported human cases annually. This disease poses significant health and economic challenges, necessitating effective control measures.

Brucellosis Control Challenges in Armenia

In the Republic of Armenia, brucellosis is currently controlled through a test-and-slaughter strategy that is considered insufficient to break the chain of transmission. Armenia faces the burden of brucellosis, impacting its economy and public health. Economic losses due to human brucellosis were estimated at millions annually, highlighting the need for effective control strategies and economic assessments in this setting.

Adopting a One Health Approach to Brucellosis

Developed by the World Health Organization, One Health is a comprehensive approach that seeks to harmonise and enhance the well-being of humans, animals, and ecosystems. Acknowledging the interconnectedness of human, animal, and environmental health, is crucial in tackling diseases like brucellosis. Fairly distributing costs between agriculture and public health sectors is essential for sustainable control measures. Studies show that controlling brucellosis in livestock can benefit both sectors economically, emphasising the need for collaboration and shared responsibilities.

Innovative Approaches and Findings

Research by the Advanced One Health course team in Switzerland developed a mathematical-compartmental transmission model for brucellosis in Armenia. By analysing different scenarios over a ten-year period, the study aimed to assess the profitability and cost-effectiveness of the current test-and-slaughter strategy compared to three upgraded control strategies, from the perspectives of society and the public health sector.  From a public health standpoint, the intervention costs $1587 per DALY averted. When factoring in additional patient costs, the overall cost-effectiveness rises to $6727 per DALY averted. These figures suggest that the intervention is more cost-effective within the public health sector compared to the agricultural or societal perspectives. By implementing a cost-sharing approach, involving multiple sectors in combating zoonotic diseases, the intervention can potentially be cost-effective across all sectors. Results indicated that mass vaccination showed profitability, while test-and-slaughter strategies may not be economically viable without proper compensation mechanisms.

Recommendations and Future Directions

The study recommends exploring alternative control strategies, such as integrating vaccination with test-and-slaughter, for improved economic and health outcomes. Fair cost-sharing mechanisms between sectors can enhance disease control effectiveness. Future research should involve local data for more accurate predictions and assess stakeholders’ willingness to contribute to control measures. By embracing a One Health perspective and innovative strategies, Armenia can enhance its brucellosis control efforts, benefiting both its economy and public health.