SUMMARYA systematic review of studies providing frequency estimates of brucellosis in humans and ruminants and risk factors for Brucella spp. seropositivity in humans in the Middle East was conducted to collate current knowledge of brucellosis in this region. Eight databases were searched for peer-reviewed original Arabic, English, French and Persian journal articles; the search was conducted on June 2014. Two reviewers evaluated articles for inclusion based on pre-defined criteria. Of 451 research articles, only 87 articles passed the screening process and provided bacteriological and serological evidence for brucellosis in all Middle Eastern countries. Brucella melitensis and B. abortus have been identified in most countries in the Middle East, supporting the notion of widespread presence of Brucella spp. especially B. melitensis across the region. Of the 87 articles, 49 were used to provide evidence of the presence of Brucella spp. but only 11 provided new knowledge on the frequency of brucellosis in humans and ruminants or on human risk factors for seropositivity and were deemed of sufficient quality. Small ruminant populations in the region show seroprevalence values that are among the highest worldwide. Human cases are likely to arise from subpopulations occupationally exposed to ruminants or from the consumption of unpasteurized dairy products. The Middle East is in need of well-designed observational studies that could generate reliable frequency estimates needed to assess the burden of disease and to inform disease control policies.

We evaluated livestock owners' knowledge, attitudes, and practices regarding brucellosis in Jordan. A questionnaire was administered and biological samples were examined to verify the serological status of animals. Seroprevalence estimates indicated that 18.1% (95% CI: 11–25.3) of cattle herds and 34.3% (95% CI: 28.4–40.4) of small ruminant flocks were seropositive. The results showed that 100% of the interviewed livestock keepers were aware of brucellosis: 87% indicated a high risk of infection if unpasteurized milk is consumed and 75% indicated a high risk if unpasteurized dairy products are consumed. Awareness of the risk of infection through direct contact with fetal membranes or via physical contact with infected livestock is considerably lower, 19% and 13%, respectively. These knowledge gaps manifest in a high frequency of high-risk practices such as assisting in animal parturition (62%), disposing aborted fetuses without protective gloves (71.2%) or masks (65%), and not boiling milk before preparation of dairy products (60%). When brucellosis is suspected, basic hygiene practices are often disregarded and suspect animals are freely traded. Public health education should be enhanced as the disease is likely to remain endemic in the ruminant reservoir as long as a suitable compensation program is not established and trust on available vaccines is regained.

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