European Centre for Disease Prevention and Control
Abstract
We investigated a Q fever outbreak with human
patients showing high fever, respiratory tract symptoms, headache and retrosternal pain in southern
Hungary in the spring and summer of 2013. Seventy
human cases were confirmed by analysing their serum
and blood samples with micro-immunofluorescence
test and real-time PCR. The source of infection was a
merino sheep flock of 450 ewes, in which 44.6% (25/56)
seropositivity was detected by enzyme-linked immunosorbent assay. Coxiella burnetii DNA was detected
by real-time PCR in the milk of four of 20 individuals
and in two thirds (41/65) of the manure samples. The
multispacer sequence typing examination of C. burnetii DNA revealed sequence type 18 in one human
sample and two manure samples from the sheep flock.
The multilocus variable-number tandem repeat analysis pattern of the sheep and human strains were also
almost identical, 4/5-9-3-3-0-5 (Ms23-Ms24-Ms27-
Ms28-Ms33-Ms34). It is hypothesised that dried
manure and maternal fluid contaminated with C. burnetii was dispersed by the wind from the sheep farm
towards the local inhabitants. The manure was eliminated in June and the farm was disinfected in July. The
outbreak ended at the end of July 2013