A human Q fever cluster linked to a sheep farm in Lavaux, Switzerland
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GRF 2nd One Health Summit 2013: Presentation by Ioannis Magouras, University of Bern
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A human Q fever cluster linked to a sheep farm in Lavaux, Switzerland
- 1. A human Q fever cluster linked to a sheep farm in Lavaux, Switzerland Ioannis Magouras, DVM, PhD
- 2. Q fever (Coxiella burnetii) • 1935: Australia Slaughterhouse workers • Q Fieber = Query fever=unknown fever • Global distribution (New Zealand +Norway) • «re-emerging disease» 2
- 3. Coxiella burnetii 3 Proteobacteria Francisella tularensis Coxiella burnetii Legionella pneumophila * Escherichia coli Pseudomonas aeruginosa Characteristics • Gram-negative pleomorphic rods • Obligate intracellularmonocytes, macrophages • Extreme environmental resistance *Modified from: Maurin et al:. 1999, van Woerden et al, 2004
- 5. Manifestations in ruminants http://www.sheepandgoat.com/zoonosis.html http://www.drostproject.org 5
- 6. Manifestations in ruminants Shedding by asymptomatic animals! 6
- 8. Clinical signs-Humans IP ~2-3 weeks 9 asymptomatic 60% Acute Q fever 38% “flu-like” 2% Hepatitis, Pneumonia, etc. 1-5% Chronιc Q fever Endocarditis other
- 10. Outbreak Lavaux 2012-clinical signs N=14 February-May 2012 Unusually high number of hospitalised cases with febrile ilness up to 2 weeks, asthenia + hepatitis 2 x biopsy-proven granulomatous hepatitis 1 x vertebral osteomyelitis 13
- 11. Table 2. Frequency of some clinical features at the moment of diagnosis among the 14 human Outbreak Lavaux 2012-clinical signs cases documented during the outbreak Symptoms Frequency % in this series of 14 cases Persistent Fever (> 14 days) 14 100% Fatigue 12 86% Liver enzyme elevation 12 86% Profuse night sweat 10 71% Inappetence 10 71% Severe headache 8 57% Myalgia 8 57% Diffuse arthralgia 6 43% Nausea 6 43% 14
- 12. Outbreak Lavaux 2012-communication flow Physicians Cantonal public health office Meeting: -information exchange -further investigations -measures 15 Cantonal veterinary office VPHI, University of Bern & FVO
- 13. Outbreak Lavaux 2012-environmental samples No abortion history! 6 x manure- and 5 x dust samples from the farm strong positive (PCR) 16
- 14. Outbreak Lavaux 2012-sheep samples 15 von 50 sera positive 7x Ab+/DNA+ Q 22 of 52 vaginal swabs PCR positive 17
- 15. Outbreak Lavaux 2012-follow-up and measures • Official communicationmedia • Information of local physiciansvoluntary report of new cases • 1345 blood donors tested (PCR) negative • Vaginal swabs repeated: 42 of 50 positiv • Environmental samples again positive (2 x samplings) Measures • Vaccination • Transport restrictions • Hygiene measures • Lambing in closed compartments 18
- 16. „Take home message“ 19 Q fever is a very obvious example of a disease that should be monitored and controlled through an „one health approach“ . 18/11/13
- 17. Acknowledgements • • Veterinary becteriology (BE, ZH) & -virology (BE) • Ruminant- and horse clinics • Federal veterinary office • Cantonal Veterinary and Public health offices Vaud • Institute Galli-Valerio • Ioannis.magouras@vetsuisse.unibe.ch VPHI Colleagues: Anna, Bart, Patrick Physicians
Hinweis der Redaktion
- Coxiellaburnetii:coloured transmission electron micrograph (TEM).