article · PLoS neglected tropical diseases
Surveillance conducted between February 2023 and July 2024 at two health facilities in pastoral Kenya evaluated brucellosis among patients presenting with acute fever and compatible symptoms. Laboratory testing combined Rose Bengal Test serology, real-time polymerase chain reaction, and enzyme-linked immunosorbent assays. Among 439 analysed patients, 15.3 percent met the brucellosis case criteria. Disease prevalence differed significantly across locations, reaching 19.4 percent at Laisamis Sub-County Referral Hospital in Marsabit County compared to 3.5 percent at Mailwa Health Centre in Kajiado County. Children aged 5 to 14 years had the highest burden, with an age-specific prevalence of 31.3 percent, representing 38.8 percent of all confirmed cases. Multivariable analysis linked infection to age between 5 and 14 years, fever lasting over seven days, and muscle pain. These observations underline the substantial burden of brucellosis among pastoral children and highlight the need for sharper clinical recognition.
Brucellosis is a debilitating bacterial infection transmitted from livestock, yet facility-level data from pastoral communities remain scarce. Demonstrating that nearly a third of febrile school-aged children in these settings may harbour the disease provides clinicians with vital diagnostic guidance. Recognising symptoms such as protracted fever and muscle ache supports earlier diagnosis and directs public health initiatives toward investigating domestic exposure risks.
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BACKGROUND: Brucellosis remains endemic in pastoral sub-Saharan Africa, but facility-based data on human prevalence and associated factors in these communities are limited. We estimated brucellosis prevalence and associated factors among febrile patients at two pastoral health facilities in Kenya. METHODOLOGY/PRINCIPAL FINDINGS: We conducted prospective facility-based surveillance from February 2023 to July 2024 at Laisamis Sub-County Referral Hospital, Marsabit County, and Mailwa Health Center, Kajiado County. Patients aged ≥1 year with acute febrile illness and brucellosis-compatible symptoms were enrolled consecutively. Blood samples were tested using Rose Bengal Test serology, real-time PCR for Brucella DNA, and indirect ELISA. Cases were classified hierarchically as RBT titer ≥1:8, PCR positivity among low-titer RBT-reactive samples, or low-titer RBT reactivity with ELISA IgG positivity. Modified Poisson regression with robust variance estimated adjusted prevalence ratios (aPR). Of 443 enrolled participants, four lacked sufficient laboratory information, leaving 439 for analysis. Overall, 67 participants met the brucellosis case definition (15.3%; 95% CI: 12.2-18.9%). Prevalence was higher in Laisamis than Mailwa (19.4% vs. 3.5%; p < 0.001). Children aged 5-14 years had the highest age-specific prevalence (31.3%; 95% CI: 22.4-41.9%) and accounted for 38.8% of cases. In multivariable analysis, brucellosis was associated with age 5-14 years (aPR 2.35; 95% CI: 1.51-3.68), prolonged fever >7 days (aPR 1.83; 95% CI: 1.20-2.78), and muscle pain (aPR 2.29; 95% CI: 1.02-5.13). Under a restricted case definition, prevalence decreased to 11.6%, but core associations remained directionally consistent. CONCLUSIONS/SIGNIFICANCE: Brucellosis was common among febrile patients at two Kenyan pastoral health facilities, with highest prevalence among children aged 5-14 years and marked site heterogeneity. Findings support improved clinical recognition of brucellosis in pastoral facilities and further investigation of age-patterned household exposure pathways.
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DOI: 10.1371/journal.pntd.0014129
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