An outbreak of Q fever in Staffordshire

Brown, Ginevra; Colwell, D. C.; Hooper, W. L.

doi:10.1017/s0022172400028382

Cited by 15 publications

(6 citation statements)

References 12 publications

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“…However, suspected milk-borne outbreaks are rare in the UK. Unpasteurised cow's milk purchased by a patient was thought to be responsible for an outbreak of Q fever in a hospital in London in 1950 (Marmion and Harvey 1956) and it was concluded that raw milk was responsible for an outbreak of Q fever in a boys' detention centre in Staffordshire in April 1967 (Brown et al 1968). Although these studies are highly suggestive of the consumption of unpasteurised milk being the source of the outbreak, there is still uncertainty associated with this link (EFSA 2010).…”

Section: Consumption Of Unpasteurised Milk and Milk Productsmentioning

confidence: 99%

Q fever through consumption of unpasteurised milk and milk products - a risk profile and exposure assessment

et al. 2015

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Summary Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii which is endemic in cattle, sheep and goats in much of the world, including the United Kingdom (UK). There is some epidemiological evidence that a small proportion of cases in the developed world may arise from consumption of unpasteurised milk with less evidence for milk products such as cheese. Long maturation at low pH may give some inactivation in hard cheese, and viable C. burnetii are rarely detected in unpasteurised cheese compared to unpasteurised milk. Simulations presented here predict that the probability of exposure per person to one or more C. burnetii through the daily cumulative consumption of raw milk in the UK is 0·4203. For those positive exposures, the average level of exposure predicted is high at 1266 guinea pig intraperitoneal infectious dose 50% units (GP_IP_ID50) per person per day. However, in the absence of human dose–response data, the case is made that the GP_IP_ID50 unit represents a very low risk through the oral route. The available evidence suggests that the risks from C. burnetii through consumption of unpasteurised milk and milk products (including cheese) are not negligible but they are lower in comparison to transmission via inhalation of aerosols from parturient products and livestock contact.

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Section: Consumption Of Unpasteurised Milk and Milk Productsmentioning

confidence: 99%

Q fever through consumption of unpasteurised milk and milk products - a risk profile and exposure assessment

et al. 2015

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“…7 % among non-exposed people. Other authors used the same argument on the basis of observations in England [4,17,56] and in other countries [18,19,25,[57][58][59][60]. Nevertheless several reports mentioned the oral route as possible but infrequent, circumstantial, or needing a very high dose [15,33,44,[61][62][63].…”

Section: Transmission Of Q Fever To Peoplementioning

confidence: 99%

Coxiella burnetii and milk pasteurization: an early application of the precautionary principle?

Cerf

Condron

2006

Epidemiol. Infect.

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Stringency of milk pasteurization has been established on requirements for Coxiella burnetii as being the most heat-resistant organisms of public heath significance. This paper discusses the estimation of the efficiency of pasteurization time/temperature combinations as required in regulations for food safety. Epidemiological studies have been interpreted as C. burnetii being a significant pathogen causing clinical disease through ingestion of milk. The paper examines the evidence and challenges the designation of C. burnetii as a foodborne pathogen. Consequently it questions the need for pasteurization parameters to be established on its heat resistance characteristics.

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“…The significance of infection acquired via the oral route remains a subject of discussion (Lorenz et al, 1998) and the role of drinking unpasteurized milk in C. burnetii infection remains controversial. Epidemiologic studies suggest that the consumption of contaminated unpasteurized milk has been a mode of exposure to C burnetii for humans (Christie, 1980;Fishbein and Raoult, 1992;Benson et al, 1963;Brown et al, 1968;Connolly et al 1990;Hatchette et al, 2001). Benson et al, (1963) reported that 42 of 120 persons who were routinely drinking unpasteurized milk tested positive for C. burnetii in at least one immunological test during the reference period.…”

Section: Milk and Dairy Products As A Source Of C Burnetii For The Cmentioning

confidence: 99%

Scientific Opinion on Q fever

More¹,

Stegeman²,

Rodolakis³

et al. 2010

EFSA Journal

127

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Following a request from the European Commission, a scientific opinion was prepared by EFSA's Animal Health and Welfare Panel to determine the magnitude, distribution, impact and significance of infection and disease in domestic ruminants and humans, risk factors for the maintenance (in domestic ruminant populations) and spillover (from these populations to humans) of Coxiella burnetii (the causative agent of Q fever), and control options in domestic ruminant populations. A range of approaches were used, including an assessment of monitoring/surveillance data, the development of a simple conceptual model, a critical review of available literature, and several country case studies. Control options for C. burnetii infection in small ruminants were qualitatively assessed. Infection is endemic in domestic ruminants in most, if not all, EU member states, however, disease is rare and impact is limited. In the EU, Q fever is a zoonotic disease with limited public health impact, except under certain epidemiological circumstances and for particular risk groups. Human cases are often associated with proximity to small ruminants (particularly at parturition or during abortions) and dry, windy weather. Currently, there is no clear evidence of an association between bacterial genotypes/isolates and virulence. A number of longer-term options to control C. burnetii infection in domestic ruminants were identified; these should be considered in those situations where the public health risk is considered unacceptable. Some additional options were not considered sustainable for long-term control, but may have a role in the face of an outbreak. Persistent environmental contamination may confound animal-based control efforts. Vaccination should be considered a longterm control option, noting that effectiveness may not be observed in the short-term. Antibiotic treatment of animals is not recommended. There is no conclusive evidence that the consumption of milk and milk products containing C. burnetii has resulted in clinical Q fever in humans. (ECDC) and the EFSA staff members Ana Afonso, Milen Georgiev and Jane Richardson for the support provided to this EFSA scientific output. Thank you also for the valuable information made available by the Zoonoses task force, the EFSA Animal Health and Welfare network, Prof. S. Martinov and I. Yordanov.This opinion was the result of a fruitful collaboration with ECDC in relation to public health aspects. The BIOHAZ Panel wishes to thank the EFSA staff member Bart Goossens for the support provided to Chapter 4 of this EFSA scientific output. Q fever 2 EFSA Journal 2010; 8 (5):1595 SUMMARYThe recent developments in the EU, especially the increase in confirmed human cases of Q fever in the Netherlands, call for special consideration as regards the risks posed by Q fever for humans and animals. The European Commission requested further scientific advice and risk assessment, as regards Q fever in animals. The mandate posed three questions:to assess the significance of the occurrence of Q fever in the ...

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An outbreak of Q fever in Staffordshire

Cited by 15 publications

References 12 publications

Q fever through consumption of unpasteurised milk and milk products - a risk profile and exposure assessment

Q fever through consumption of unpasteurised milk and milk products - a risk profile and exposure assessment

Coxiella burnetii and milk pasteurization: an early application of the precautionary principle?

Scientific Opinion on Q fever

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