Análise epidemiológica dos casos notificados de tuberculose em região de produção leiteira

Abstract

Tuberculosis is a disease caused by different agents of the complex Mycobaceterium tuberculosis, with a complex epidemiology involving different hosts, presence of comorbidities and other risk factors. One Health approach could aid the TB control process in humans, especially dairy cattle producer regions, because raw milk and dairy products is the main source of infection in bovine-human transmission. The objective of this study was to analyze risk factors for human TB and its relationship with cases of bovine tuberculosis in a region with higher dairy production in Brazil. Cross-sectional study involving all cases of TB reported to the Brazilian Notifiable Diseases Surveillance System (Sistema de Informações de Agravo de Notificação - SINAN) in Brazil between 2011 and 2015. Sociodemographic and clinical characteristics of patients with exclusively PTB and exclusively EPTB were compared. Following analysis with Pearson’s chi-square test, variables with p < 0.05 were included in a hierarchical regression model. Variables with p < 0.05 in the corresponding level were kept in the model. It was selected 1,483 cases of tuberculosis in humans were selected in the areas analyzed, being 314 extrapulmonary TB and 1189 TB of the pulmonary. By means of hierarchical regression analysis, it is possible to show that the low level of schooling for the pulmonary form is a risk factor for extrapulmonary HIV infection was prominent. The information about positive bovine the official intradermal tests were obtained from the Instituo Mineiro de Agropecuária, responsible for receiving the notification reports, between 2011 and 2017. For the analysis of carcass condemnation for suspicious lesions of bovine tuberculosis were the daily slaughter of three slaughterhouses was analyzed in the study area, where the age of the animal was analyzed, carcass destination after condemnation. Through linear regression there was a decreasing tendency in the reports of positive and inconclusive reagents. On the other hand, the carcass condemnation data were stationary, with bigger condemned females, and lesions characteristic of the disease generalization process. Disagreement between notification and slaughtering data, and the absence of slaughtered animals accompanied by a positive attestation stating the animal's health status, exposes all persons involved in the handling, transportation and slaughter of these animals to risk. Although tuberculosis is present with moderate prevalence in the properties of the studied region, the differential diagnosis for M. bovis in cases of human tuberculosis is not performed, resulting in underreporting or negligence with TB by M. bovis. The obligation of communication between animal and public health services has not been fulfilled, the present results bring to the attention the lack of connectivity between the TB surveillance areas, which requires the Veterinary Medicine professional to have One Health approach with education in health, monitoring of slaughter or euthanasia of positive reactive bovine, guidance of human health services for investigation of suspected cases, protection of ecosystem health.