COMMUNICABLE DISEASE MANUAL POLICIES / PROCEDURES
Q Fever
OBJECTIVE:
Control and management of Q Fever.
DESCRIPTION:
Q Fever is caused by Coxiella burnetii, which is unique among Rickettsiae
because it undergoes a host-dependent phase. The disease is transmitted by
domestic farm animals especially sheep, goats and cows, but also cats, dogs,
rodents, marsupials, other mammalian species and some wild and domestic
bird species. Human disease is uncommon and may be asymptomatic or
unrecognized. Persons who work with animals, including farmers, ranchers,
research laboratory workers, veterinarians, and others who work with birthing of
animals are at greatest risk of disease. The disease has been transmitted to
humans by inhalation of aerosols spontaneously generated from infected
material, such as placental tissue from infected cats or farm animals and by
exposure to infected animals or tissues on farms or ranches or in research
facilities. Milk has not been proved to transmit organism.
The incubation period varies from 9 to 39 days, but usually is between 14 and
22 days. Chronic Q Fever can develop years to decades after initial infection.
EQUIPMENT:
MDSS User Manual and Disease specific form found in MDSS. MDCH Web
site at www.michigan.gov/mdch, www.michigan.gov/cdinfo and CDC Web
site at www.cdc.gov/diseasesconditions/az/a.html.
POLICY:
Legal Responsibility: Michigan's communicable disease rules of Act No. 368 of
the Public Acts of 1978, as amended, being 333.5111 of the Michigan
Compiled Laws. Follow-up within 24 hours post referral and enter into
MDSS within 24 hours of receipt of referral; report routinely.
PROCEDURE:
A.
Case Investigation:
1.
2.
3.
B.
Clinical Case Definition:
1.
C.
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Referral received per phone call, laboratory results, or
automatically through MDSS.
Document all case investigation proceedings.
Contact MD and/or client to start process of completing disease
specific form in MDSS.
Acute Q Fever usually is characterized by abrupt onset of fever,
chills, weakness, headache, and anorexia, as well as other
nonspecific systemic symptoms. The illness lasts 1 to 4 weeks
and then resolves gradually. Chronic Q Fever occurs in
approximately 1% of acutely infected patients with hepatitis,
endocarditis and fever of undetermined origin as common
manifestations.
Lab Criteria for Diagnosis:
1.
D.
E.
Control Measures:
1.
Tetracycline or doxycycline is the drug of choice and
chloramphenicol is an alternative. Tetracyclines should not be
given to children younger than 8 years of age unless the benefit
is greater than the risk of dental staining. Therapy should be
initiated promptly and continued until the patient has been
afebrile and clinically improved for 10 to 14 days. In chronic Q
Fever, relapses can occur necessitating repeated courses of
antimicrobial therapy. The organism can remain latent in tissues
for years; treatment of chronic disease is extremely difficult.
2.
Experimental vaccines for domestic animals and laboratory
workers are promising, but not available in the United States.
3.
Strict adherence to proper hygiene when handling parturient
animals can help decrease risk of infection in the farm setting.
MDSS Case Reporting:
1.
2.
3.
RESOURCES:
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Isolation of C. burnetii from blood is usually not attempted
because of the hazard to laboratory workers. (Refer to Redbook
for additional information.)
Complete case investigation using disease specific form in
MDSS.
Notify CD Supervisor that the case report is ready for review.
PHN will be notified if corrections are needed prior to closing
case in MDSS.
CD Supervisor reviews case for completeness and closes MDSS
case report.
Current Red Book
Current Control of Communicable Diseases Manual
Current disease specific “Fact Sheet”
Websites: www.cdc.gov/diseasesconditions/az/a.html
www.michigan.gov/cdinfo