Jacqueline Dawson, PhD Public Health Epidemiologist Chelan,
Douglas, Grant, Kittitas and Okanogan Counties 509-886-6428
[email protected] Jeff Ketchel, MA, RS; Lois Swenson,
RN & Amber McCoy, RS Grant County Health District Ben Smith,
DVM Washington State Department of Agriculture Slide 2 History 1935
Queensland, Australia Montana 2012 Worldwide Outbreaks Military
troops Cities and towns Downwind from farms Next to roads traveled
by animals www.cfsph.iastate.edu Slide 3 The Organism Coxiella
burnetii Bacteria Grows inside cells Spore-like Stable and
resistant- Category B bioterrorism agent: long-term environmental
stability =weeks to years resistance to heat and drying extremely
low infectious dose (1 bacteria) aerosol infectious route Killed by
pasteurization Slide 4 Transmission Aerosol Placenta and birth
fluids Urine, feces, milk Direct contact Surfaces Ingestion Ticks
Human-to-human extremely rare Ingestion (mainly drinking raw milk)
is probably a minor factor in the transmission of C. burnetii and a
point of controversy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88923/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88923/ Slide 5 Animal
Disease Sheep, cattle, goats, cats, dogs, some wild animals
(including rodents), birds and ticks. Localizes in: mammary glands
supramammary lymph nodes placenta uterus, from which it may be shed
in subsequent parturitions and lactations May be asymptomatic
Reproductive failure Abortions Stillbirths Retained placenta
Infertility Weak newborns Low birth weights Carrier state Slide 6
Acute Infection The bacteria can cause a sudden onset of: High
fever (104 F) with shaking chills (night sweats) Vomiting,
diarrhea, abdominal pain and chest pain Muscle and joint pains
Severe headache (often behind the eyes) Extreme fatigue Flu-like
symptoms that usually last for 2-6 weeks Pneumonia (30 to 50%)
Hepatitis (33%)= liver inflammation Skin rash (10%) Other signs
(< 1%) Myocarditis, meningoencephalitis, pericarditis Death: 1
to 2% Slide 7 Chronic Disease 1 to 5% of those infected Prior heart
disease pregnant women Immunocompromised (ex: Cancer therapy)
Endocarditis (infection of a heart valve) Poor liver function Bone
infection 50% relapse rate after antibiotic therapy Slide 8 Risk to
Pregnant Women Most asymptomatic Transplacental transmission
Reported complications In-utero death Premature birth Low birth
weight Slide 9 Where is it? The true incidence is unknown in the
Pacific Northwest. WSU is currently conducting a study to determine
the geographic distribution and goat herd prevalence. Slide 10
Epidemiology Occupational and environmental hazard Farmers
Livestock producers Veterinarians and technicians Meat processors/
abattoir workers Laboratory workers Slide 11 Treatment GOATS
Treatment: Oral tetracycline at the therapeutic dose may be given
for 2- 4 wk. In known infected herds administering tetracycline (8
mg/kg/day) prophylactically in the water supply prior to
parturition may reduce spread of the organism. Merck Veterinary
Manual HUMANS Treatment Doxycycline Chronic disease long course 2
to 3 years of medication Immunity Long lasting (possibly lifelong)
Slide 12 Lab testing for Q fever Serology = CF or ELISA Detects
antibodies produced against bacteria LIVE bugs?= Culture at CDC
Risk to laboratory personnel PCR = polymerase chain reaction
Detects and amplifies the bacteria (LIVE or DEAD) Slide 13
Polymerase Chain Reaction = PCR Slide 14 Phase I vs II Antibodies
During the course of the infection, the outer membrane of the
organism undergoes changes in its lipopolysaccharide structure,
called phase variation. Acute: Higher Phase II antibody titers Not
very infectious Chronic: Higher Phase I antibody titers Highly
infectious http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88923/ Slide
15 Q fever in Washington, 2011 Producer wanted to know the source
of abortions in goat herd Placenta sent to WSU by local Vet
Producer assisted with tracing herd sales in WA, OR and MT Coxiella
burnetii organisms (red) within infected placenta cells (blue)
Slide 16 Washington State Study Humans: 61 samples were collected
from Producers/family and Agriculture personnel Goats were tested
from 13 farms in 7 counties: Adams, Chelan, Clark, Franklin, Grant
(N=6), Pend Oreille & Thurston Samples were collected by WSDA
& USDA Vets: 326 Blood samples 312 Vaginal swabs 108 Fecal
swabs 37 Milk samples Environmental samples were taken from a few
farms Slide 17 Results From All Washington Farms PEOPLE: 11 / 61
(18%) had positive serum samples 7 / 11 (64%) people were sick 4 /
11 (36%) people were not sick All Vets and Extension service
personnel were negative Most Producers were negative, even on goat
positive farms 5 / 11 Grant County: 4+ (3 ill) in a family with
meat goats since 2007 All goats PCR negative (including goat from
Farm A); 9% ELISA + 1 + recently moved to WA: raised goats, sheep
and cattle whole life Bought dog from Farm A; goats and sheep from
other farms GOATS: 8% goats were ELISA + 10% fecal swabs (males)
were PCR + 31% of vaginal swabs were PCR + All whole blood samples
were PCR negative All 19 + milk samples were from one non-milk
producing farm Slide 18 Animal Tracing ? 3 positive does on one
farm were not from Farm A One positive had never been off of the
farm Does bred at Farm A were ELISA and PCR negative Q fever is
ubiquitous, so positive animals should be found throughout the
state WSU conducting study of goats around WA Farm AFarm X Slide 19
2011 Environmental Results CDC isolated live Coxiella burnetii from
the WA goat placenta and a vaginal swab taken from a Montana goat.
The 2 isolates and a WA environmental sample are in the same
genetic group (sequence type 8). Type 8 was previously seen in a
chronic human Q fever case in Washington State with no connection
to goats. Type 8 has also been found in several other goats and
chronic human cases in the US. Slide 20 Presence of Coxiella
burnetii DNA in the Environment of the United States, 2006 to 2008
http://aem.asm.org/content/76/13/4469.full.pdf+html
http://aem.asm.org/content/76/13/4469.full.pdf+html CDC found Q
fever bacteria in environmental samples from post offices, stores,
schools, farms, dairies and fairgrounds Rocky Mountains- 45% South
Central 36% Upper Midwest 25% Deep South 16% West Coast 14% East
Coast 6% Some areas had up to 50% positive samples Slide 21 Best
Practices to Control Q Fever National seroprevalence: 41.6% of
sheep 16.5% of goats 3.4% of cattle
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/52000.htm
Slide 22 Prevention and Control Eradication not practical Too many
reservoirs Constant exposure Stability of agent in environment
WSDA: Best Practices to Control Q Fever
http://agr.wa.gov/FoodAnimal/AnimalHealth/Diseases/QFeverManagementPractices.pdf
Slide 23 When is the most risk ? 2 weeks prior to one month after
birth Lactation Abortions Placentas Birth fluids
Kidding/lambing/calving barns Slide 24 Where is the most risk?
Highest risk is due to contact with birth products such as
placentas, birth fluids, etc. Use disposable gloves Barn only
clothes Mask to reduce airborne bacteria in dust Remove any dead
fetuses and placentas as soon as you can in plastic bags and burn
or bury at least 3 feet Compost and spread on fields Risk of
selling manure Immediately clean birthing areas then apply 10%
Bleach, 5% Hydrogen Peroxide, or 1% Lysol 30 minute contact time
Keep down dust Slide 25 Farm Biosecurity Limit access for visitors
People with high risk to contract it are immune compromised,
pregnant women, and heart valve patients Wash hands and arms after
animal contact Keep barn clothes out of the house Clean and
disinfect boots Slide 26 Farm Biosecurity Maintain good records of
animal movements If your animal aborts, contact local veterinarian
and save everything you can, especially placenta, for diagnostic
evaluation Culling of animals based on blood tests is not
recommended and wont ensure a negative herd. Slide 27 2 Kidding
Seasons C. burnetii infection in goats seems to be limited to two
kidding seasons. Natural History of Q Fever in Goats Todd Hatchette
The Department of Medicine, Dalhousie University, Halifax, Nova
Scotia Nancy Campbell, Robert Hudson, Didier Raoult, Thomas J.
Marrie March 2003, Vol. 3, No. 1, Pages 11-15 Posted online on July
9, 2004. Slide 28 Conclusion Q fever is everywhere. Individual
antibody test of little value. Q fever can not be traced to any one
source with any reliability. All farms had multiple sources of
animals or bred animals at multiple farms. The number of antibody
positive animals in this investigation (8%) was lower than that of
previous studies. Slide 29 Resources Many links on our website
www.agr.wa.govwww.agr.wa.gov Sublinks to CDC and university
websites on: Composting Manure and animals Disinfection Basics of
different products and what they will work on Boot cleaning Hand
washing Slide 30 Acknowledgements Centers for Disease Control and
Prevention Center for Food Security and Public Health at Iowa State
University USDA- veterinarians and laboratorians WSU- Field Disease
Investigative Unit, Extension Service and Lab Local county health
jurisdictions Slide 31
