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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An outbreak of Q fever has been registered in Gabrovo, a Bulgarian city. More than 20 people that were initially tested for coronavirus were confirmed positive for Q fever. This was announced at the briefing on SARS-CoV2 pandemic by the Bulgarian national health inspector Prof. Todor Kantardzhiev. The patients are veterinarians and staff of 2 cow farms and one sheep farm. Prof. Kantardzhiev assured that the necessary measures will be taken to limit the infection.
(Shortened and adapted from: ProMED Digest, Vol 95, Issue 74)

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Source: Sofia News Agency/


Q fever outbreak in La Rioja, a Northern province of Spain – Hospitalization of 6 patients

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Q fever outbreak in Ticino Maggia Valley, Switzerland

Several cases of pneumonia have occurred the last few weeks in the Maggia Valley, Switzerland. The people who became ill turned out to be infected by Coxiella burnetti, Q fever pathogen. Q fever is a notifiable disease in Switzerland. "About 50 cases of Q fever have been reported since the beginning of the year and 20 cases were reported from Tessin", Daniel Koch from the Swiss Federal Office of Public Health disclosed upon request. A herd of goats is supposed to be the reason for the illnesses.
In order to reduce the risk of infection for humans, vaccination of the animals was ordered by the Tessin health authority. The federal government had to issue a special permit first, as there hasn't been any permit for using this vaccine so far. Therefore this vaccine can now be imported and applied. In addition the transport of animals from one farm to another was prohibited. The measures taken by the canton of Tessin are meant to put a speedy end to the risk of infection. The most probable reason for the high rate of infection is considered to be the birth of the first kids a few months ago. Besides this the dryness and the wind of the last months may have contributed to the fact that Q fever was able to spread. (Sources: ProMED-mail, 04.06.2019, archive number: 20190604.6502499,;

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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)

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(ProMED Digest, Vol 79, Issue 77 Q – AFG)

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