Investigation of a Q fever outbreak in a Scottish co-located slaughterhouse and cutting plant

Outbreaks of Q fever are rare in the UK. In 2006, the largest outbreak of Q fever in Scotland occurred at a co-located slaughterhouse and cutting plant with 110 cases. Preliminary investigations pointed to the sheep lairage being the potential source of exposure to the infective agent. A retrospective cohort study was carried out among workers along with environmental sampling to guide public health interventions. A total of 179 individuals were interviewed of whom 66 (37%) were migrant workers. Seventy-five (41.9%) were serologically confirmed cases. Passing through a walkway situated next to the sheep lairage, a nearby stores area, and being male were independently associated with being serologically positive for Q fever. The large proportion of migrant workers infected presented a significant logistical problem during outbreak investigation and follow up. The topic of vaccination against Q fever for slaughterhouse workers is contentious out with Australasia, but this outbreak highlights important occupational health issues

An Outbreak of Q fever in a prison in Italy

We observed an outbreak of Q fever in a prison population. Overall, 65 of the 600 prison inmates developed the disease. The location of the prison cells had no apparent effect on the risk of infection. The outbreak was probably due to exposure to dust contaminated by a passing flock of sheep, which at the time of the outbreak was engaged in lambing. These findings highlight the possible emergence of Q fever in settings and populations not normally thought of as being at risk of exposure to the infection

Q Fever

Q fever was first identified in Iowa, in both man and animal, in 1957. Subsequently the disease was demonstrated to occur enzootic ally among Iowa dairy cattle and, perhaps more important, constitute an occupational hazard of some degree for farmers and certain industrial groups in the state

Chronic Q fever associated with systemic sclerosis

Contains fulltext : 205462.pdf (publisher's version ) (Open Access)BACKGROUND: After the Q fever outbreak in the Netherlands between 2007 and 2010, more than 300 patients with chronic Q fever have been identified. Some patients were also diagnosed with systemic sclerosis, a rare immune-mediated disease. We aimed to increase awareness of concomitant chronic Q fever infection and systemic sclerosis and to give insight into the course of systemic sclerosis during persistent Q fever infection. MATERIALS AND METHODS: Chronic Q fever patients were identified after the Dutch Q fever outbreak in 2007-2010. Systemic sclerosis was diagnosed by a scleroderma expert and patients fulfilled the 2013 Classification Criteria for Systemic Sclerosis. RESULTS: Four cases presented with chronic Q fever, persistent Coxiella burnetii infection, shortly preceded or followed by the diagnosis of limited cutaneous systemic sclerosis. The three male patients of 60 years or older developed a relatively mild systemic sclerosis, which did not require immunosuppressive therapy during adequate treatment of the chronic Q fever infection. The 58-year-old female patient used immunosuppressives for her newly diagnosed systemic sclerosis at the time she likely developed a chronic Q fever infection. CONCLUSIONS: In this case series, chronic Q fever preceding systemic sclerosis was associated with a mild course of systemic sclerosis without the necessity of immunosuppressive drugs, while chronic Q fever development due to immunocompromised state was associated with a more deteriorating course of systemic sclerosis

Q fever in Bulgaria and Slovakia.

As a result of dramatic political and economic changes in the beginning of the 1990s, Q-fever epidemiology in Bulgaria has changed. The number of goats almost tripled; contact between goat owners (and their families) and goats, as well as goats and other animals, increased; consumption of raw goat milk and its products increased; and goats replaced cattle and sheep as the main source of human Coxiella burnetii infections. Hundreds of overt, serologically confirmed human cases of acute Q fever have occurred. Chronic forms of Q fever manifesting as endocarditis were also observed. In contrast, in Slovakia, Q fever does not pose a serious public health problem, and the chronic form of infection has not been found either in follow-ups of a Q-fever epidemic connected with goats imported from Bulgaria and other previous Q-fever outbreaks or in a serologic survey. Serologic diagnosis as well as control and prevention of Q fever are discussed

One-year follow-up of patients of the ongoing Dutch Q fever outbreak: clinical, serological and echocardiographic findings

Contains fulltext : 89915.pdf (publisher's version ) (Open Access)PURPOSE: In 2007, a large goat-farming-associated Q fever outbreak occurred in the Netherlands. Data on the clinical outcome of Dutch Q fever patients are lacking. The current advocated follow-up strategy includes serological follow-up to detect evolution to chronic disease and cardiac screening at baseline to identify and prophylactically treat Q fever patients in case of valvulopathy. However, serological follow-up using commercially available tests is complicated by the lack of validated cut-off values. Furthermore, cardiac screening in the setting of a large outbreak has not been implemented previously. Therefore, we report here the clinical outcome, serological follow-up and cardiac screening data of the Q fever patients of the current ongoing outbreak. METHODS: The implementation of a protocol including clinical and serological follow-up at baseline and 3, 6 and 12 months after acute Q fever and screening echocardiography at baseline. RESULTS: Eighty-five patients with acute Q fever were identified (male 62%, female 38%). An aspecific, flu-like illness was the most common clinical presentation. Persistent symptoms after acute Q fever were reported by 59% of patients at 6 months and 30% at 12 months follow-up. We observed a typical serological response to Coxiella burnetii infection in both anti-phase I and anti-phase II IgG antibodies, with an increase in antibody titres up to 3 months and a subsequent decrease in the following 9 months. Screening echocardiography was available for 66 (78%) out of 85 Q fever patients. Cardiac valvulopathy was present in 39 (59%) patients. None of the 85 patients developed chronic Q fever. CONCLUSIONS: Clinical, serological and echocardiographic data of the current ongoing Dutch Q fever outbreak cohort are presented. Screening echocardiography is no longer part of the standard work-up of Q fever patients in the Netherlands.1 december 201

PAT-5 Update: Q Fever in Indonesia

Q Fever is zoonotic disease caused by Coxiella burnetii, an intracellular obligate and negative Gram bacterium with pleomorphic shape (Kaplan and Bertagna 1955). Centers for Disease Control and Prevention (CDC) classify Coxiella burnetii as potential bioterrorism agent within B rank for its ability and characteristics (CDC 2013).The main reservoir animals for Q fever are ruminants (Maurin and Raoult 1999). Q fever infection whether in animal or human generally occur through inhalation, vector bites, or through oral ingestion—the last two routes are considered as secondary routes (Angelakis and Raoult 2010). Clinical symptoms of Q fever in both animal and human generally asymptomatic. Q fever can cause abortion in the third trimester of pregnancy and pneumonia in ruminants. Whether in human, acute Q fever can cause flu like syndrome and can develop into hepatitis, endocarditis, and for some severe chronic case, it caused death (Fournier et al. 1998). Office international des epizooties (OIE) classify Q fever into a re-emerging disease group (OIE 2010). Based on OIE data in 2012, the distribution of Q fever in animals occur in almost all country in the world including ASEAN (OIE 2012).Q fever was first discovered in Australia in 1935 (Kaplan and Bertagna 1955). Q fever disease transmission in animal occurs almost in every country in the world. Based on OIE data, Indonesia was classified as no information region (OIE 2012). World Health Organization (WHO) reported that Q fever was first found in cow serologically in Indonesia in 1953 (Kaplan and Bertagna 1955). Q fever in ruminants was again reported by Indonesian researcher between 2006 to 2015 in Bali, West Java, Jakarta, and Medan (Mahatmi et al. 2007; Setiyono et al. 2008; Nasution et al. 2015).Positive Q fever result was obtained especially from ex imported cows, thus it was suspected that cows from abroad might play main role of transmission of Q fever in Indonesia. However, there was also report of positive result in local ruminants, such as Bali cattle, goat, and sheep (Mahatmi et al. 2007). Researches in various country also stated of potential local ruminant as reservoir animal,  among them are Tibet sheep in China, Alpine and Saanen goat in Italia, camel (Camelus dromedaries) in Saudi Arabia, or Swedish dairy cattle in Swedia (Mohammed et al. 2014). Based on the historical study of Q fever in Indonesia, this research was performed by taken sample from both ex-import cattle and local ruminants in several region in East Java (Malang, Surabaya, Madura), Central Java (Boyolali), and West Java (Bogor, Bandung, Depok) which are known as regions with high population of ruminants in Indonesia.  So far, surveillance data of Q fever has not been recorded from these regions

Q Fever in France, 1985–2009

To assess Q fever in France, we analyzed data for 1985–2009 from the French National Reference Center. A total of 179,794 serum samples were analyzed; 3,723 patients (one third female patients) had acute Q fever. Yearly distribution of acute Q fever showed a continuous increase. Periodic variations were observed in monthly distribution during January 2000–December 2009; cases peaked during April–September. Q fever was diagnosed more often in patients in southeastern France, where our laboratory is situated, than in other areas. Reevaluation of the current positive predictive value of serologic analysis for endocarditis was performed. We propose a change in the phase I (virulent bacteria) immunoglobulin G cutoff titer to >1,600. Annual incidences of acute Q fever and endocarditis were 2.5/100,000 persons and 0.1/100,000 persons, respectively. Cases and outbreaks of Q fever have increased in France

Reduction of Coxiella burnetii prevalence by vaccination of goats and sheep, the Netherlands

Recently, the number of human Q fever cases in the Netherlands increased dramatically. In response to this increase, dairy goats and dairy sheep were vaccinated against Coxiella burnetii. All pregnant dairy goats and dairy sheep in herds positive for Q fever were culled. We identified the effect of vaccination on bacterial shedding by small ruminants. On the day of culling, samples of uterine fluid, vaginal mucus, and milk were obtained from 957 pregnant animals in 13 herds. Prevalence and bacterial load were reduced in vaccinated animals compared with unvaccinated animals. These effects were most pronounced in animals during their first pregnancy. Results indicate that vaccination may reduce bacterial load in the environment and human exposure to C. burnetii