Q Fever Guidance Document NASPHV/NASAHO
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1 Q Fever Guidance Document NASPHV/NASAHO
2 Q Fever Committee
3 Q Fever Committee Formed in January 2012 Joint leadership of the National Association of State Public Health Veterinarians (NASPHV) and the National Assembly of State Animal Health Officials (NASAHO)
4 Membership Alicia Anderson, Centers for Disease Control and Prevention Tom Boyer, American Goat Federation Ann Garvey*, NASPHV Katherine Marshall, USDA Paula Menzies, University of Guelph Julia Murphy, NASPHV Paul Plummer, Iowa State University Gatz Riddel, American Association of Bovine Practitioners Paul Rodgers, American Sheep Industry Joni Scheftel, NASPHV Tahnee Szymanski*, NASAHO
5 Goal To provide recommendations for a coordinated public and animal health response to a Q fever outbreak in response to the 2011 multi-state outbreak in the northwest US and the recent outbreak in the Netherlands.
6 2011 Multi-state Q Fever Outbreak Washington, Montana, Oregon
7 May 2011 Q fever was diagnosed in humans in both Washington and Montana All human cases linked to contact with goats that had originated from a single farm in Washington. Earlier in 2011 this farm had experienced an abortion storm in it s goat herd (14 of 50 pregnant goats/28%). Goat placental samples submitted for diagnostics were found to be C. burnetii-positive 20 farms with epidemiological link 16 Washington farms 3 Montana farms 1 Oregon farm
8 Joint Investigation CDC USDA State public health officials State animal health officials Local public health authorities
9 MT Farm B Abortions, weak kids, and ewe loss 33/55 goats ELISA positive 25/27 vaginal swabs PCR positive All milk samples PCR positive Genome equivalents per swab ranged from 544 2,018,400
10 Issues Identified During Investigation Quarantine Under what conditions would quarantine be released? All animals ELISA negative? All animals PCR negative?
11 Issues Identified During Investigation Animal product risk Raw milk consumption Sale of goat s milk soap
12 Issues Identified During Investigation Environmental contamination Birthing stall: 1,405,496 genomes/gram Living room floor following carpet removal and bleach treatment: 692,099 genomes/gram
13 Prevention and Control of Coxiella burnetii infection among Humans and Animals Guidance for a Coordinated Public & Animal Health Response, 2013
14 Available on NASPHV website /Documents/Q_Fever _2013.pdf
15 Content Background information on C. burnetii infection in humans and animals Epidemiology Clinical presentation Testing methods and interpretation Treatment and monitoring Controlling transmission Joint public health and animal health investigation and response Recommendation for future action Appendices
16 Public Health Response 1. Interview human Q fever cases for illness and exposure history. 2. Identify people in contact with or potentially exposed, through aerosol transmission, to animals with suspected or confirmed coxiellosis. 3. Discuss with animal owners/caretakers Risks Routes of transmission How to prevent additional human exposure Need for medical attention should symptoms develop
17 Public Health Response 4. Alert health care providers and medical clinics in surrounding areas. 5. Provide guidance to healthcare providers on diagnostic testing options, test results interpretation, and treatment. 6. In partnership with animal health officials, provide outbreak information to media outlets and stakeholders as appropriate. 7. Perform epidemiological analysis to characterize case demographics and to identify risk factors associated with human illness.
18 Animal Health Response 1. Perform on-site investigation. Collect: Species and number of animals on premises Animal management practices 2. Contact herd/flock veterinarian. Diagnostic testing Treatment considerations
19 Animal Health Response 3. Discuss with the animal owner and herd/flock veterinarian: Human and animal illness Persons at higher risk for complications Routes of transmission Measures to prevent human exposure Need to seek medical attention should symptoms develop.
20 Animal Health Response 4. Alert veterinarians in surrounding areas. 5. In partnership with public health officials, provide outbreak information to media outlets and stakeholders as appropriate. 6. Perform epidemiological analysis to characterize outbreak animal health demographics and to identify risk factors associated with the identification of coxiellosis in animals in a premises.
21 Recommendations Availability of a commercially available veterinary vaccine to respond to a Q fever outbreak.
22 Appendices Q Fever Interview Template Q Fever Factsheet PPE for Animal Owners and Caretakers Human Case Definition Healthcare Provider and Veterinary Alerts Coxiellosis Diagnostics and Interpretation for Veterinarians Manure Management and Carcass Disposal Considerations
23 Thank-you! Tahnee Szymanski Asst.State Veterinarian MT Dept of Livestock
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