Q fever and Australia's veterinary workforce: research to inform vaccine policy.

Q fever is a zoonotic disease of worldwide importance, causing significant and prolonged morbidity, low mortality, and burdening health systems with an enhanced requirement for diagnostics and disease surveillance. Most infections are attributed to livestock, though other species may harbour the causative pathogen, Coxiella burnetii. Australia is currently the only country with a licensed Q fever vaccine, where it is recommended for workers considered to have a high risk for C. burnetii exposure. Veterinarians are routinely vaccinated, usually at the commencement of university studies. However, veterinary support staff including nurses and kennel hands are not, and recent outbreaks in small animal clinics in Sydney highlighted potential under-vaccination of these workers. The need for a greater understanding of Q fever epidemiology among Australia’s veterinary personnel was also evident, as this unique population is inadequately described in the existing body of knowledge. This research investigated the knowledge, attitudes, and practices of Australian veterinary personnel regarding Q fever disease and vaccination, and quantified Q fever vaccine uptake while identifying barriers to and drivers of vaccine uptake. Coxiella burnetii seroprevalence was determined in Australia’s unvaccinated veterinary workforce as an indicator of exposure risks, while the presence of markers of immunity among vaccinated veterinary workers were also studied post-vaccination. Adverse events following Q fever vaccination were also investigated in veterinary students to provide a greater representation of younger adults and females, who predominate the demographic entering the veterinary workforce yet remain under-represented in adverse events data to date. While this research is intended to provide veterinary specific insights for the continued improvement of workplace health and safety practices in Australia, the findings have implications for the wider community both within Australia and abroad

Q Fever Knowledge, Attitudes and Vaccination Status of Australia’s Veterinary Workforce in 2014

Q fever, caused by Coxiella burnetii, is a serious zoonotic disease in humans with a worldwide distribution. Many species of animals are capable of transmitting C. burnetii, and consequently all veterinary workers are at risk for this disease. An effective Q fever vaccine has been readily available and used in Australia for many years in at-risk groups, and the European Centre for Disease Prevention and Control has recently also called for the use of this vaccine among at-risk groups in Europe. Little is known about attitudes towards this vaccine and vaccine uptake in veterinary workers. This study aimed to determine the Q fever vaccination status of veterinarians and veterinary nurses in Australia and to assess and compare the knowledge and attitudes towards Q fever disease and vaccination of each cohort. An online cross-sectional survey performed in 2014 targeted all veterinarians and veterinary nurses in Australia. Responses from 890 veterinarians and 852 veterinary nurses were obtained. Binary, ordinal and multinomial logistic regression were used to make comparisons between the two cohorts. The results showed that 74% of veterinarians had sought vaccination compared to only 29% of veterinary nurses. Barriers to vaccination among those not vaccinated did not differ between cohorts, and included a lack of perceived risk, financial expense, time constraints, and difficulty in finding a vaccine provider. Poor knowledge and awareness of Q fever disease and vaccination were additional and notable barriers for the veterinary nursing cohort, suggesting veterinary clinics and veterinarians may not be meeting their legal responsibility to educate staff about risks and risk prevention. Further evaluation is needed to identify the drivers behind seeking and recommending vaccination so that recommendations can be made to improve vaccine uptake

Adverse Events Following Q Fever Immunisation in Young Adults

The study is part of Frequency of Adverse Events Following Q Fever Immunisation in Young Adults project which collected Q fever vaccine (Q-VAX®) adverse events following immunisation (AEFI) data in veterinary and animal science students at Australian universities. Students were enrolled at the time of vaccination and were emailed a link to an online AEFI survey one week later. Of the 60% (499/827) that responded, 85% were female and the median age was 18 years. Local injection site reactions (ISRs) occurred in 98% (95%; CI 96–99%) of respondents. Systemic AEFI occurred in 60% (95%; CI 55–64%) of respondents within the seven days following immunisation. Medical attention was sought by 19/499 (3.8%) respondents, of whom one sought treatment at a hospital emergency department. This dataset is an excel file of data obtained from a survey of young adults following Q fever immunisation. The survey contained questions pertaining to local and systemic adverse events following immunisation; frequency, size and onset of local reactions, and the presence of systemic events within the seven days following vaccination. The data headings can be interpreted with the data dictionary provided within the excel file

Frequency of adverse events following Q fever immunisation in young adults

Q fever is a zoonosis of concern in many countries. Vaccination is the most effective means of prevention, and since 1989, Australia has had a licensed Q fever vaccine, Q-VAX((R)). This vaccine was also used in the Netherlands in 2011 following the largest recorded Q fever outbreak globally. There is a paucity of available data regarding adverse events following immunisation (AEFI) for young adult females. Such data are important for informing future vaccination recommendations both within Australia and internationally. This study collected Q fever vaccine (Q-VAX((R))) AEFI data in veterinary and animal science students at Australian universities. Students were enrolled at the time of vaccination and were emailed a link to an online AEFI survey one week later. Of the 60% (499/827) that responded, 85% were female and the median age was 18 years. Local injection site reactions (ISRs) occurred in 98% (95%; CI 96-99%) of respondents, of which 30% (95% CI 24-32%) were severe. Systemic AEFI occurred in 60% (95%; CI 55-64%) of respondents within the seven days following immunisation. Medical attention was sought by 19/499 (3.8%) respondents, of whom one sought treatment at a hospital emergency department. Females were more likely than males to experience any local ISR (odds ratio [OR] 9.3; 95% CI 2.5-33.8; p < 0.001), ISRs of greater severity (OR 2.5; 95% CI 1.5-4.2; p < 0.001), and any systemic AEFI (OR 1.9; 95% CI 1.1-3.1; p = 0.016). These safety data suggest that a high frequency of adverse events following immunisation should be expected in young adults, particularly females. However, the consequences of Q fever disease are potentially far more debilitating

Survey data relating to Q fever knowledge, attitudes and vaccination status of Australia’s veterinary workforce in 2014

This data collection is associated with the accepted publication ‘Q fever knowledge, attitudes and vaccination status of Australia’s veterinary workforce in 2014’v| |v Publication abstract: Q fever, caused by Coxiella burnetii, is a serious zoonotic disease in humans with a worldwide distribution. Many species of animals are capable of transmitting C. burnetii, and consequently all veterinary workers are at risk for this disease. An effective Q fever vaccine has been readily available and used in Australia for many years in at-risk groups and the European Centre for Disease Prevention and Control has recently called for the use of this vaccine among at-risk groups in Europe. Little is known about attitudes towards this vaccine and vaccine uptake in veterinary workers. This study aimed to determine the Q fever vaccination status of veterinarians and veterinary nurses in Australia and to assess and compare the knowledge and attitudes towards Q fever disease and vaccination of each cohort. An online cross-sectional survey performed in 2014 targeted all veterinarians and veterinary nurses in Australia. Responses from 890 veterinarians and 852 veterinary nurses were obtained. Binary, ordinal and multinomial logistic regression were used to make comparisons between the two cohorts. The results showed that 74% of veterinarians had sought vaccination compared to only 29% of veterinary nurses. Barriers to vaccination among those not vaccinated did not differ between cohorts, and included a lack of perceived risk, financial expense, time constraints, and difficulty in finding a vaccine provider. Poor knowledge and awareness of Q fever disease and vaccination were additional and notable barriers for the veterinary nursing cohort, suggesting veterinary clinics and veterinarians may not be meeting their legal responsibility to educate staff about risks and risk prevention. Further evaluation is needed to identify the drivers behind seeking and recommending vaccination so that recommendations can be made to improve vaccine uptake

Willingness of veterinarians in Australia to recommend Q fever vaccination in veterinary personnel: Implications for workplace health and safety compliance

<div><p>Q fever vaccine uptake among veterinary nurses in Australia is low, suggesting veterinarians are not recommending the vaccination to veterinary personnel. This study aimed to determine the willingness of veterinarians to recommend Q fever vaccination to veterinary personnel and to identify factors influencing Q fever vaccine uptake by veterinary nurses in Australia. An online cross sectional survey targeted veterinarians and veterinary nurses in Australia in 2014. Responses were analysed using multivariable logistic regression. Factors significantly (p<0.05) associated with a willingness to recommend the vaccination, expressed by 35% (95% CI 31–38%) of veterinarians (n = 828), were (1) being very concerned for colleagues regarding <i>Coxiella burnetii</i> (OR 4.73), (2) disagreeing the vaccine is harmful (OR 3.80), (3) high Q fever knowledge (OR 2.27), (4) working within small animal practice (OR 1.67), (5) disagreeing the vaccine is expensive (OR 1.55), and (6) age, with veterinarians under 39 years most likely to recommend vaccination. Of the veterinary nursing cohort who reported a known Q fever vaccination status (n = 688), 29% (95% CI 26–33%) had sought vaccination. This was significantly (p<0.05) associated with (1) agreeing the vaccine is important (OR 8.34), (2) moderate/high Q fever knowledge (OR 5.51), (3) working in Queensland (OR 4.00), (4) working within livestock/mixed animal practice (OR 3.24), (5) disagreeing the vaccine is expensive (OR 1.86), (6) strong reliance on work culture for biosecurity information (OR 2.5), (7) perceiving personal exposure to <i>Coxiella burnetii</i> to be at least low/moderate (OR 2.14), and (8) both agreeing the vaccine is safe and working within a corporate practice structure (OR 4.28). The study identified the need for veterinarians to take greater responsibility for workplace health and safety promotion, and calls for better education of veterinary personnel to raise awareness of the potential for occupational exposure to <i>C</i>. <i>burnetii</i> and improve the perception of the Q fever vaccine as being important, safe and cost-effective.</p></div

Final multivariable model parameter estimates and odds ratios of factors significantly associated with Q fever vaccination status of veterinary nurses in Australia in 2014.

<p>Final multivariable model parameter estimates and odds ratios of factors significantly associated with Q fever vaccination status of veterinary nurses in Australia in 2014.</p

Final multivariable model parameter estimates and odds ratios of factors associated with a willingness to recommend Q fever vaccination among veterinarians surveyed in Australia in 2014.

<p>Final multivariable model parameter estimates and odds ratios of factors associated with a willingness to recommend Q fever vaccination among veterinarians surveyed in Australia in 2014.</p

Boxplot of self-rated Q fever knowledge among veterinarians and veterinary nurses.

<p>Boxplot of self-rated Q fever knowledge among veterinarians and veterinary nurses.</p

Perceived exposure risk of veterinarians and veterinary nurses to <i>C</i>. <i>burnetii</i> across different practice types.

<p>Perceived exposure risk of veterinarians and veterinary nurses to <i>C</i>. <i>burnetii</i> across different practice types.</p