title: How human brucellosis incidence in urban Kampala can be reduced most efficiently? A stochastic risk assessment of informally-marketed milk.
abstract: BACKGROUND
  In Kampala, Uganda, studies have shown a significant incidence of human brucellosis. A stochastic risk assessment involving two field surveys (cattle farms and milk shops) and a medical record survey was conducted to assess the risk of human brucellosis infection through consumption of informally marketed raw milk potentially infected with Brucella abortus in Kampala and to identify the best control options.
  
  
  RESULTS
  In the cattle farm survey, sera of 425 cows in 177 herds in the Kampala economic zone were sampled and tested for brucellosis using a competitive enzyme-linked immunosorbent assay (CELISA). Farmers were interviewed for dairy information. In the milk shop surveys, 135 milk sellers in the urban areas were interviewed and 117 milk samples were collected and tested using an indirect enzyme-linked immunosorbent assay (IELISA). A medical record survey was conducted in Mulago National Referral Hospital for serological test results. A risk model was developed synthesizing data from these three surveys. Possible control options were prepared based on the model and the reduction of risk was simulated for each scenario. Overall, 12.6% (6.8-18.9: 90%CI) of informally marketed milk in urban Kampala was contaminated with B.abortus at purchase and the annual incidence rate was estimated to be 5.8 (90% CI: 5.3-6.2) per 10,000 people. The best control option would be the construction of a milk boiling centre either in Mbarara, the largest source of milk, or in peri-urban Kampala and to ensure that milk traders always sell milk to the boiling centre; 90% success in enforcing these two options would reduce risk by 47.4% (21.6-70.1: 90%CI) and 82.0% (71.0-89.0: 90%CI), respectively.
  
  
  CONCLUSIONS
  This study quantifies the risk of human brucellosis infection through informally marketed milk and estimates the incidence rate in Kampala for the first time; risk-based mitigation strategies are outlined to assist in developing policy.
authors.affiliation: Centre for Infectious Diseases, Division of Pathway Medicine, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom. kmakita@rakuno.ac.jp
authors.forename: Kohei
authors.initials: K
authors.lastname: Makita
authors.forename: Eric M
authors.initials: EM
authors.lastname: Fèvre
authors.forename: Charles
authors.initials: C
authors.lastname: Waiswa
authors.forename: Mark C
authors.initials: MC
authors.lastname: Eisler
authors.forename: Susan C
authors.initials: SC
authors.lastname: Welburn
mesh_terms: D000818:Animals; D002003:Brucella abortus / Q000378:metabolism*; D002006:Brucellosis / Q000175:diagnosis / Q000453:epidemiology*; D002007:Brucellosis, Bovine / Q000382:microbiology / Q000635:transmission; D002417:Cattle; D003611:Dairy Products; D004797:Enzyme-Linked Immunosorbent Assay; D005506:Food Contamination; D005516:Food Microbiology; D006801:Humans; D008892:Milk / Q000378:metabolism*; D009010:Monte Carlo Method; D018570:Risk Assessment; D013269:Stochastic Processes