Coxiella burnetii Infection in a Community Operating a Large-Scale Cow and Goat Dairy, Missouri, 2013

Abstract

Abstract. Coxiella burnetii is a zoonotic pathogen that causes Q fever in humans and is transmitted primarily from infected goats, sheep, or cows. Q fever typically presents as an acute febrile illness; however, individuals with certain predisposing conditions, including cardiac valvulopathy, are at risk for chronic Q fever, a serious manifestation that may present as endocarditis. In response to a cluster of Q fever cases detected by public health surveillance, we evaluated C. burnetii infection in a community that operates a large-scale cow and goat dairy. A case was defined as an individual linked to the community with a C. burnetii phase II IgG titer ≥ 128. Of 135 participants, 47 (35%) cases were identified. Contact with or close proximity to cows, goats, and their excreta was associated with being a case (relative risk 2.7, 95% confidence interval 1.3-5.3). Cases were also identified among individuals without cow or goat contact and could be related to windborne spread or tracking of C. burnetii on fomites within the community. A history of injection drug use was reported by 26/130 (20%) participants; follow-up for the presence of valvulopathy and monitoring for development of chronic Q fever may be especially important among this population.

Is a One Health Approach Utilized for Q Fever Control? A Comprehensive Literature Review

“…Of the remaining 72 cases with available results, 42 (58%) had positive Q fever serology [ 24 ]. In another outbreak in the USA, 81/135 (60%) persons had positive Q fever serology [ 29 , 30 ]. Contrary to the high seroprevalence among these occupational groups, the seroprevalence in a Kenyan community ( n = 2049) was 2.5% [ 21 ].…”

“…High seroprevalence among occupational groups in this review is similar to that of goat farmers in the Netherlands [41] and may indicate that Q fever prevention should target occupational contacts. Unlike this, low population seroprevalence is consistent with the Netherlands and USA national rates that makes the general population a less appropriate target for interventions [21,30,41]. In contrast, as animals are asymptomatic carriers [42], their serology can identify species that have previously been infected and can have some role in identifying flocks or herds where C. burnetii is endemic.…”

A systematic knowledge synthesis on the spatial dimensions of Q fever epidemics

“…Q fever outbreaks have occurred in many countries worldwide. Studies on these epidemics mainly used ad hoc investigations (affected area/suspected cases sampling; Bond et al, ; Gilsdorf et al, ; Gyuranecz et al, ; Lyytikäinen et al, ; Medic et al, ; Wallensten et al, ) or classical epidemiological study designs, including cross‐sectional studies (Biggs et al, ; Jorm et al, ; King et al, ; Martinov, ; Porten et al, ) and case–control studies (Manfredi Selvaggi et al, ; O'Connor et al, ; Porten et al, ; Tissot‐Dupont, Torres, Nezri, & Raoult, ) to identify associated risk factors.…”

“…Numerous studies suggested the role of the wind, particularly when either cases without contact with ruminants were observed and/or C. burnetii infections on a nearby farm were detected, but in depth analyses were lacking (Biggs et al, ; Bond et al, ; Brouqui et al, ; Gyuranecz et al, ; Jorm et al, ; King et al, ; Lyytikäinen et al, ; O'Connor et al, ; Tissot‐Dupont et al, ). Tissot‐Dupont, Amadei, Nezri, and Raoult () went into further detail with respect to the effect of wind in relation to a cluster of Q fever cases in France.…”

“…Health effects include mild respiratory symptoms, pneumonia, hepatitis, endocarditis and fatigue (Dijkstra et al, ). Besides the epidemic in the Netherlands, outbreaks have occurred worldwide, including other European countries (Brouqui, Badiaga, & Raoult, ; Gilsdorf et al, ; Gyuranecz et al, ; Jorm, Lightfoot, & Morgan, ; King et al, ; Lyytikäinen et al, ; Manfredi Selvaggi et al, ; Martinov, ; Medic et al, ; Porten et al, ; Tissot‐Dupont, Amadei, Nezri, & Raoult, ; Wallensten et al, ), the United States (Biggs et al, ) and Australia (Bond et al, ; O'Connor, Tribe, & Givney, ).…”