Q fever outbreak at Charité in Berlin:

 According to a news story published by "Berliner Morgenpost" staff members were affected by a q fever outbreak at Charité in Mid-July 2021 after animal experiments with pregnant sheep. 20 staff members of the „Forschungseinrichtung für experimentelle Medizin" at the Virchow Clinique were infected with Coxiella burnetii when carrying out the animal experiments.

The trigger for the q fever specific diagnostics among staff members was obviously the detection of the pathogen in one of the experimental animals at the beginning of August 2021. At that time, it was possible to detect antibodies in staff members of the Charité, which indicated an acute q fever infection. Upon request by "Berliner Morgenpost" the Charité pointed out that all individuals who became ill have recovered in the meantime.

In addition, a Charité spokesman stated that the experimental animals came from breeding facilities in Brandenburg, where no q fever has been detected so far. Clinical signs have been absent in the sheep and there hasn't been any suspicion that the animals had been infected in the first place. Immediately after a first suspected infection within the Charité the holding of the research facilities was quarantined. Yet another consequence from the q fever outbreak is that stricter quality criteria regarding hygiene in the animal stock, supply chain and risk assessment will be paid attention to in future when purchasing animals, in order to reduce the risk of introducing zoonotic diseases. There hasn't been any obligation to check for the agent of q fever in farm animals regularly, so far.

Remarks:
Fortunately, institutions from the Q-GAPS research project (National Reference Laboratories for q fever, human and veterinary medicine, Lower State Office for Consumer Protection and Food Safety, Food and Veterinary Institute Braunschweig/Hannover, (LAVES)) also contributed to the analysis of the q fever outbreak described above. Based on the experience and knowledge of the Q-GAPS partners a guideline is being drawn up which contains information including recommendations for action concerning the overall topic q fever. The article about the outbreak in an establishment for animal use cited here shows an example of the necessity and importance of such a professional gathering of information and consulting. Therefore, it should be taken into account as to whether further protective measurements have to be taken or procedures for risk mitigation have to be considered, if necessary, not only in holdings of origin but also in research projects along these lines using experimental animals. For example, a regular q fever monitoring in as well as in experimental animals would be advisable, especially, as q fever infections can often be asymptomatic.

Image Sheep: © Stiftung Tierärztliche Hochschule Hannover

Sources:
Berliner Morgenpost: Tierseuchen-Ausbruch an der Charité (in German, for a fee)

BZ: Q-Fieber! 20 Charité-Mitarbeiter mit Tier-Seuche infiziert

High Prevalence and New Genotype of Coxiella burnetii in Ticks Infesting Camels in Somalia:

 Coxiella burnetii is the causative agent of Q fever. It can infect animals, humans, and birds, as well as ticks, and it has a worldwide geographical distribution. To better understand the epidemiology of C. burnetii in Somalia, ticks infesting camels were collected from five different regions, including Bari, Nugaal, Mudug, Sool, and Sanaag, between January and March 2018.

Collected ticks were tested for C. burnetii and Coxiella-like endosymbiont DNA by using IS1111, icd, and Com1-target PCR assays. Moreover, sequencing of the 16S-rRNA was conducted. Molecular characterization and typing were done by adaA-gene analysis and plasmid-type identification. Further typing was carried out by 14-marker Multi-Locus Variable-Number Tandem Repeats (MLVA/VNTR) analysis. The investigated ticks (n = 237) were identified as Hyalomma spp. (n = 227, 95.8%), Amblyomma spp. (n = 8, 3.4%), and Ripicephalus spp. (n = 2, 0.8%), and 59.1% (140/237) of them were positive for Coxiella spp. While Sanger sequencing and plasmid-type identification revealed a C. burnetii that harbours the QpRS-plasmid, MLVA/VNTR genotyping showed a new genotype which was initially named D21. In conclusion, this is the first report of C. burnetii in ticks in Somalia. The findings denote the possibility that C. burnetii is endemic in Somalia. Further epidemiological studies investigating samples from humans, animals, and ticks within the context of “One Health” are warranted.

 Abstract taken from Dimitrios Frangoulidis; Claudia Kahlhofer; Ahmed Shire Said; Abdinasir Yusuf Osman; Lidia Chitimia-Dobler; Yassir Adam Shuaib
Pathogens 2021, Volume 10, Issue 6, 741

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A Straightforward Hypoxic Cell Culture Method Suitable for Standard Incubators:

 We present a new and straightforward method by which standard cell culture plates can be sealed off from ambient air and be placed under controlled hypoxic cell culture conditions without costly or highly specialized materials. The method was established on a murine cell culture system using the dendritic cell line JAWS II but can be readily adapted to other cell cultures. The procedure was designed to be easy to implement in cell culture laboratories with standard incubators and requires only readily available materials, resources, and consumables, such as six-well plates, degassed culture medium, CoCl2, a vacuum sealer, etc., and no further complicated laboratory equipment. The simple hypoxic cell culture method presented here is technically reliable and experimentally safe. As it can be performed in any standard incubator, it is suitable for use at both low and higher biosafety levels.

Abstract taken from Svea Matthiesen, Rico Jahnke, Michael R. Knittler, Methods Protoc. 2021, 4(2), 25; https://doi.org/10.3390/mps4020025

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The Prevalence of Coxiella burnetii in Hard Ticks in Europe and Their Role in Q Fever Transmission Revisited - A Systematic Review

The zoonosis Q fever is caused by the obligate intracellular bacterium Coxiella burnetii. Besides the main transmission route via inhalation of contaminated aerosols, ticks are discussed as vectors since the first isolation of the pathogen from a Dermacentor andersonii tick. The rare detection of C. burnetii in ticks and the difficult differentiation of C. burnetii from Coxiella-like endosymbionts (CLEs) are questioning the relevance of ticks in the epidemiology of Q fever.

In this review, literature databases were systematically searched for recent prevalence studies concerning C. burnetii in ticks in Europe and experimental studies evaluating the vector competence of tick species. A total of 72 prevalence studies were included and evaluated regarding DNA detection methods and collection methods, country, and tested tick species. Specimens of more than 25 different tick species were collected in 23 European countries. Overall, an average prevalence of 4.8% was determined. However, in half of the studies, no Coxiella-DNA was detected. In Southern European countries, a significantly higher prevalence was observed, possibly related to the abundance of different tick species here, namely Hyalomma spp. and Rhipicephalus spp. In comparison, a similar proportion of studies used ticks sampled by flagging and dragging or tick collection from animals, under 30% of the total tick samples derived from the latter. There was no significant difference in the various target genes used for the molecular test. In most of the studies, no distinction was made between C. burnetii and CLEs. The application of specific detection methods and the confirmation of positive results are crucial to determine the role of ticks in Q fever transmission. Only two studies were available, which assessed the vector competence of ticks for C. burnetii in the last 20 years, demonstrating the need for further research.

Abstract taken from: Sophia Körner, Gustavo R Makert, Sebastian Ulbert, Martin Pfeffer, Katja Mertens-Scholz, The Prevalence of Coxiella burnetii in Hard Ticks in Europe and Their Role in Q Fever Transmission Revisited - A Systematic Review, Front Vet Sci. 2021 Apr 26; 8: 655715

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Humoral immune response to Q fever vaccination of three sheep flocks naturally pre-infected with Coxiella burnetii:

 Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii; Coxiella-infected ruminants are the main reservoir shedding the pathogen during abortion or parturition through birth products. Germany has a long history of small-scale Q fever epidemics in the human population mostly associated with lambing sheep. Therefore, fast and efficient control measures are essentially required to prevent transmission from infected sheep flocks to humans.

In our present study, three sheep flocks were vaccinated with an inactivated C. burnetii phase I vaccine after a field infection with C. burnetii was diagnosed. Serum samples and vaginal swabs were collected at different time points to evaluate the extent of the outbreak and the consequences of the vaccination. The serum samples were examined by phase-specific IgG phase I and phase II ELISAs and a commercial ELISA, simultaneously detecting both phase variations. Moreover, vaginal swabs were analysed by qPCR. The fourth flock with no Q fever history and non-vaccinated animals were used as a control group to evaluate the phase-specific ELISAs.

The inactivated C. burnetii phase I vaccine induced an IgG phase II response and boosted the humoral immune reaction against natural preinfections. Furthermore, the longevity of vaccine-induced antibodies seems to depend on previous infections. Around 16 months after primary vaccination, mainly IgG phase I antibodies were detectable. Vaccination did not prevent shedding at the next lambing season. Most interestingly, the phasespecific ELISAs revealed more C. burnetii positive animals than the blended ELISA-Assay. Taken together, phase-specific ELISAs are suitable tools to provide insights into natural- or vaccine-induced humoral immune responses to C. burnetii in sheep.

Original Abstract, © 2021 Elsevier Ltd. All rights reserved.

Source: Benjamin U. Bauer, Michael R. Knittler, T. Louise Prüfer, Annika Wolf, Svea Matthiesen, Martin Runge, Martin Ganter (2021) Humoral immune response to Q fever vaccination of three sheep flocks naturally pre-infected with Coxiella burnetii. Vaccine, Volume 39, Issue 10, 5 March 2021, Pages 1499-1507, https://doi.org/10.1016/j.vaccine.2021.01.062

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Concept of an Active Surveillance System for Q Fever in German Small Ruminants - Conflicts Between Best Practices and Feasibility

Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii. Inhalation of contaminated dust particles or aerosols originating from animals (esp. small ruminants) is the main source of human infection. Hence, an active early warning system for Q fever in German small ruminant livestock was conceptualized to prevent human infections.

First, we describe the best practice for establishing this system before evaluating its feasibility, as the combination of both evokes conflicts. Vaginal swabs from all husbandry systems with a focus on reproductive females should pooled and investigated by PCR to detect C. burnetii-shedding animals. Multistage risk-based sampling shall be carried out at the flock level and within-flock level. At the flock level, all flocks that are at risk to transmit the pathogen to the public must be sampled. At the within-flock level, all primi- and multiparous females after lambing must be tested in order to increase the probability of identifying a positive herd. Sampling should be performed during the main lambing period and before migration in residential areas.

Furthermore, individual animals should be tested before migration or exhibition to ensure a negative status. If a flock tests positive in at least one individual sample, then flock-specific preventive measures should be implemented. This approach implies huge financial costs (sample testing, action/control measures). Hence, taking the step to develop more feasible and affordable preventive measures, e.g., vaccinating small ruminant flocks, should replace testing wherever justifiable.

Abstract taken from: Winter F, Schoneberg C, Wolf A, Bauer BU, Prüfer TL, Fischer SF, Gerdes U, Runge M, Ganter M and Campe A (2021) Concept of an Active Surveillance System for Q Fever in German Small Ruminants — Conflicts Between Best Practices and Feasibility. Front. Vet. Sci. 8:623786. doi: 10.3389/fvets.2021.623786

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Mortality from Q fever outbreak from 2007-2010 in the Netherlands adjusted upwards: 95 people died

During the Q fever outbreak from 2007-2010 in the Netherlands an unprecedented number of people became infected with the Q fever bacterium Coxiella burnetii. (Remark: Besides the 4000 cases diagnosed a 10-fold number of unrecorded cases is assumed (see Kampschreur et al. Epidemiol. Infect. 2013). Some of them developed chronic Q fever, in which vessel walls and heart valves become infected. About half of them developed complications, such as heart failure or a ruptured aorta. The prognosis is often unfavorable. Of all patients who die of chronic Q fever, 55 percent died within one year of diagnosis. The data from patients with chronic Q fever are collected in the National Chronic Q Fever Database, a collaboration between University Medical Center (UMC) Utrecht, Radboudumc in Nijmegen and Jeroen Bosch Hospital in 's Hertogenbosch.
In 2016, this database contained data from 439 patients. In that year, it appeared that 65 patients had died of the effects of chronic Q fever since the outbreak. With the 9 patients who had died due to acute Q fever, the total number of patients who had died as a result of Q fever in 2016 was 74.
The database was updated again in 2018. Currently 519 chronic Q fever patients are registered. The increase is almost entirely due to patients who have been diagnosed with chronic Q fever after 2016. In 2018, 86 patients were registered who died from the consequences of chronic Q fever, 21 more than in 2016. The total number of patients who died as a result of Q fever (acute and chronic) was therefore 95.
(Shortened version of the article)

News from February 14, 2019
Source: https://ncoh.nl/news/

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