Jacqueline Dawson, PhD
Public Health Epidemiologist
Chelan, Douglas, Grant, Kittitas and Okanogan Counties
509-886-6428
Jacqueline.Dawson@cdhd.wa.gov
Jeff Ketchel, MA, RS; Lois Swenson, RN & Amber McCoy, RS
Grant County Health District
Ben Smith, DVM
Washington State Department of Agriculture
History
 1935
 Queensland, Australia
 Montana
 2012
 Worldwide
 Outbreaks
 Military troops
 Cities and towns
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Downwind from farms
Next to roads traveled by animals
www.cfsph.iastate.edu
The Organism
 Coxiella burnetii
 Bacteria
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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
Transmission
 Aerosol
 Placenta and birth fluids
 Urine, feces, milk
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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/
Animal Disease
 Sheep, cattle, goats, cats, dogs, some wild animals
(including rodents), birds and ticks.
 Localizes in:
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mammary glands
supramammary lymph nodes
placenta
uterus, from which it may be shed in subsequent
parturitions and lactations
May be asymptomatic
 Reproductive failure
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Abortions
Stillbirths
Retained placenta
Infertility
Weak newborns
Low birth weights
 Carrier state
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%
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
Risk to Pregnant Women
 Most asymptomatic
 Transplacental transmission
 Reported complications
 In-utero death
 Premature birth
 Low birth weight
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.
Epidemiology
 Occupational and environmental hazard
 Farmers
 Livestock producers
 Veterinarians and technicians
 Meat processors/ abattoir workers
 Laboratory workers
Treatment
GOATS
 Treatment: Oral tetracycline at the therapeutic dose may be given for 24 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)
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)
Polymerase Chain Reaction = PCR
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/
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)
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
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:
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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:
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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
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 A
Farm X
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.
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
 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
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
Prevention and Control
 Eradication not practical
 Too many reservoirs
 Constant exposure
 Stability of agent in environment
 WSDA: Best Practices to Control Q Fever
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http://agr.wa.gov/FoodAnimal/AnimalHealth/Diseases/QFeverManagementPractices.pdf
When is the most risk ?
 2 weeks prior to one month after birth
 Lactation
 Abortions
 Placentas
 Birth fluids
 Kidding/lambing/calving barns
Where is the most risk?
• Highest risk is due to contact with birth products such as
placentas, birth fluids, etc.
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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
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
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 won’t ensure a negative herd.
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.
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.
Resources
 Many links on our website www.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
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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