Table 1 Characteristics of the included studies

Buttigieg [21]

2018

Malta and Serbia

In this comparative case study, a retrospective comparative study was conducted in Malta and Serbia in 2018 on the Brucellosis Control Program during two time periods: 1995–1997 and 2004–2006. The quantitative assessment of its compliance with the One Health approach was done.

It was developed based on the Network for Evaluation of the One Health approach, the framework of which is based on change theory, process evaluation, operational infrastructure, and support and examining the relationship between processes.

In the present study, the researchers identified the results of operations and infrastructures of the One Health approach to the control and eradication of brucellosis through a comprehensive evaluation of these aspects.

The results showed that the context and timing are two key factors in determining how, when, and why to use the One Health approach. Therefore, in order to use this approach in potential health crises, one should not seek to fully-fledge it, because each relevant group must be alert and fulfill its key responsibilities in the early stages before interdisciplinary interventions become necessary. Adopting this approach not only in times of crisis but also in the medium and long term, especially in the areas of disease prevention and control, surveillance programs, health promotion, and health education, has also helped save costs and may add value. Therefore, in order to use this approach and evaluate it, economic evaluations should be done so that they can identify the optimal use of resources in these cases and thus justify the necessary budget and political support.

Fouskis [7]

2018

Greece

The present descriptive study was conducted in Greece based on reviewing and updating statistical data of brucellosis over a period of time from 2012 to 2007. In this study, the epidemiological data of human brucellosis were collected not only by determining the incidence disease but also by examining the relationship between human brucellosis and disease in small mammals and estimating its associated risk factors based on the One Health approach. Known risk factors such as direct contact with animals, recent consumption of dairy products, high-risk occupations, and recent travel history, gender, ethnicity, and age group were analyzed. The correlation between vaccination and disease incidence was evaluated

Results of this study showed that brucellosis will remain a significant public health issue and will subsequently affect the Greek agricultural economy, because updated information on brucellosis in Greece revealed seasonal differences and patterns of transmission. There are still brucellosis zones in Greece, so more effective cooperation among the public health departments involved in this issue should be pursued to effectively control brucellosis. There was a statistically significant difference in the incidence of human brucellosis between eradicated and vaccinated zones.

Godfroid [25]

2013

Uganda

Mongolia

Greece

The present study, a descriptive review, covered topics such as brucellosis control and eradication program, brucellosis serology, mass vaccination against animal brucellosis for human health, various nomadic populations, and brucellosis in animal species and at the animal-human interface.

The researchers concluded that the approach used in brucellosis and other zoonotic diseases should be able to encourage people in medicine, veterinary medicine, wildlife, and sociology to gain a full perception and understanding of the disease. It should also encourage people to engage in professional, scientific, and documentary participation in the formation of collective and effective disease control strategies.

For this reason, authors proposed principles for implementing this approach, which included identifying Brucella species, paying attention to vaccination status, vaccinating animals, and paying attention as well to other species and the source of its transmission to humans. In order to support accurate control measures in the maintenance host, recognizing the biology of Brucella infections and its patterns of transmission in wildlife, as well as between livestock and humans, is of particular importance. Before implementing any control and eradication program, it is necessary to identify Brucella species that infect animals, and the necessary interventions should be integrated into the One Health Program. Infected and non-infected animals (both) need to be vaccinated at the time of mass vaccination. Calves, lambs, and piglets born to infected animals may be infected, regardless of their vaccination status, even if they appear to be healthy. These animals, even when vaccination is implemented, maintain infection in the animal population. The contribution of non-conventional livestock species (yacks and camels) to human brucellosis should also be investigated.

As vaccines interfere with serology, vaccination status should always be considered, especially when studies rely on seroprevalence of disease. The source of human brucellosis cases is mainly related to food (milk and dairy products) or occupation (farmer, butcher, veterinarian, etc.). If human cases are found mainly in certain occupational categories, it indicates that the health measures related to milk and dairy products are effectively done and control should be strengthened in the animal species of the reservoir. If most cases are found in the general population, it indicates that neither health measures nor control measures are being implemented effectively.

Godfroid [10]

2017

Industrialized and low- and middle-income countries (LMICs)

This review study examined the One Health approach for the control of brucellosis in industrialized, low-income, and middle-income countries. The study assessed whether the standard methods and other health interventions were adequate and ethically sound. The results are also showing the knowledge gap about the biology of Brucella infections.

The result of this study showed that understanding the biology of Brucella infections and its transmission patterns in wildlife and between animals and humans is of particular importance, and even before any animal control or eradication program is implemented, more intervention should be performed. Experimenting with the One Health plan empirically, the most important aspect of the program is to show the interdependence of humans, ecosystems, and animals in terms of disease and health. However, even if one considers animals morally valuable, one should consider them to be less valuable than humans. So it is justifiable to put them in the interests of future generations of humans and animals. Conversely, if one concludes that slaughtering is not morally justified, even if it avoids animal suffering, slaughtering would be unacceptable. The One Health approach potentially constitutes a paradigm shift in our worldview, forcing to rethink the understanding of the ethical status of animals, plants, and ecosystems.

Gemechu [22]

2017

Ethiopia

This review study examined how to control brucellosis through the One Health approach in Ethiopia. Various aspects of brucellosis in humans and animals, including epidemiology and etiology, have been examined to shed light on the transmission and risk factors of the disease.

It was concluded that veterinary, medical, and environmental groups should work together in a four-pronged approach to identify the potential risk factors for the disease and design appropriate countermeasures. Unfortunately, in many underdeveloped and developing countries, this type of cooperation is either absent or very weak.

These issues have provided an opportunity for the development of brucellosis, especially in rural areas, and the elimination of this disease is not possible without considering these issues.

Hermesh [19]

2018

Israel

This qualitative study was aimed to design the role of different stakeholders in the fight against brucellosis in the Negev region of Israel. Authors also examined the political and historical aspects of these actors’ understanding of appropriate interventions in disease control. This study conducted twenty in-depth interviews with policy-makers, human, and animal health professionals, local community representatives. Target population interventions and observations, and documentation review were also done as well as stakeholder knowledge (policy-makers, stakeholders, and livestock owners) also gathered. Understanding of appropriate interventions to control brucellosis was also assessed during interviews. Their perceptions of brucellosis, its nature, causes, job or livelihood status, and cooperation with various institutions to tackle the disease were discussed. Participants were observed in decision-making aspects, such as the Israeli parliament, joint ministry meetings, and meetings hosted by the Israeli Veterinary Service. Media and policy-making documents were collected using relevant information from the Google search engine and the websites of the Israeli Ministry of Health. Also, the benefits of developing the One Health approach for ethical cohesion and its social and political aspects in the control of brucellosis were investigated.

The results showed that incorporating historical, political, and biological considerations of public health into developing the One Health approach provides an opportunity to increase the relevance of this approach and expand its scope as a new scientific paradigm.

Because at present, most interventions are based on instrumental efforts to strengthen stakeholder collaboration with specific frontiers in the fields of veterinary, medical, and agricultural sciences, such an approach would require addressing the health discourse and practice of structural inequalities. It was also stated that, although the One Health approach, as an international movement and as a research method, wishes to cross the boundaries between disciplines, nevertheless, due to the over-emphasis on physicians and veterinarians, the capacity of the care program is also known as “reductionist manner.”

Kracalik [9]

2014

Azerbaijan

In a cross-sectional descriptive study conducted in Azerbaijan, authors assessed the annual epidemiological and spatial incidence of human brucellosis using animal care and control program data during the years from 2002 to 2009 from a single health perspective.

The findings showed that the occurrence of human brucellosis has a pattern of re-emergence in Southeast Azerbaijan. It seems the disease was emerging from 1983 to 2009, when a total of 11,233 cases of human brucellosis were reported. Until the mid-1990s, human brucellosis showed a pattern of re-emergence with an average increase of 25% annually. The findings also strengthened the role of animal vaccination in controlling brucellosis and concluded that the One Health approach is needed to address the changing pattern of brucellosis in the Republic of Azerbaijan and elsewhere in the former Soviet Union.

Kaneene [20]

2018

Uganda

This cross-sectional descriptive study was conducted to investigate outbreaks of zoonotic diseases such as brucellosis. The research team consisted of two units (Public Health and Animal Health) that participated in the project implementation. The benefits of using the One Health approach in outbreaks and brucellosis in the human and livestock population in Uganda were recorded and compared with the results of the two units which were working separately.

The main results of the present study included the preparation of a protocol for collecting laboratory samples, the method of transporting them and conducting experiments in the laboratory, the development of training programs for the investigations and research in the field of zoonotic diseases. There was also a program for farmers on how the disease transmits between humans and animals (using the One Health approach) and results and communication were shared between representatives of the Ministry of Health and the Ministry of Agriculture, Animal Industry, Fisheries, and Wildlife.

One of the main results of the research was to reduce tensions with the agricultural sector. Therefore, using the One Health approach in research and studies on outbreaks of zoonotic diseases such as brucellosis has several advantages and is much less expensive than conducting two separate studies (one by the Public Health team and the other by the Animal Health Departments).

Lindahl [26]

2019

India

The study, published in India in 2019, describes the results of a joint workshop to determine the One Health approach priorities in the control of brucellosis. The workshop, organized by the International Institute for Livestock Research, is attended by government experts, national research institutes, universities, and invited various international organizations to a 1-day meeting to set out the priorities of a “hygiene strategy” for controlling brucellosis in India. The priority of these strategies includes cooperation (transboundary and cross-sectoral) gathering more epidemiological evidence in humans, cattle, and small ruminants (neglected in past research), economic impact studies (including the cost-effectiveness of control programs). These include vaccination livestock (including national facilities for vaccines for cows), managing infected animals (prohibiting the slaughter of cattle), laboratory capacity and detection (quality and speed of performance), raising awareness (farmers, healthcare workers), and making the general public aware of the dangers of brucellosis and zoonosis in general.

The results of the workshop showed that although India faces many challenges in the control of brucellosis, the success of this initiative depends on cooperation between institutions, neighboring countries, and international institutions. The results of the workshop provide suggestions for joint strategies for the promotion of brucellosis control with a multi-pronged One Health approach that coordinates their performance in both veterinary and medical fields.

Plum b[23]

2013

USA

This study review, conducted in the USA, examined the challenges and opportunities for the One Health approach. In the present study, seven key factors were considered in the One Health approach, which included factors such as medicine, politics, ecology, science, socioeconomics, education, and management.

The study showed that challenges and opportunities must be identified in the management of brucellosis, which is fundamentally multivariate, multifaceted, and integrated.

Therefore, it is essential that a brucellosis training curriculum in the form of the One Health approach for the veterinary, public health, and wildlife and environmental protection professions will provide a common framework for interactive training among statesmen and administrators. To prioritize and demonstrate the economic benefits of major investments in brucellosis research, diagnosis, surveillance, and management in human and animal health sectors, developing and analyzing its effects are important. Adaptive risk management (AMR) could provide a framework for supporting stakeholders to address complexities and uncertainties and to learn management practices. The integration of the global One Health approach must be implemented to overcome the under-reporting and underestimation of disease.