A human Q fever cluster was linked to a sheep farm in Lavaux, Switzerland. In early 2012, an unusually high number of patients were hospitalized with febrile illness lasting up to two weeks and hepatitis. Environmental and animal samples from the farm tested strongly positive for Coxiella burnetii by PCR. Fifteen of 50 sheep sera and 22 of 52 vaginal swabs from sheep were also PCR positive. Measures were taken including vaccinating the sheep, restricting transport, improving hygiene, and lambing in closed compartments. The outbreak highlighted the need for a "one health" approach to monitor and control Q fever.

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 intracellularmonocytes, macrophages
• Extreme environmental resistance
*Modified from: Maurin et al:. 1999,
van Woerden et al, 2004

4. Epidemiology
4

5. Manifestations in ruminants
http://www.sheepandgoat.com/zoonosis.html
http://www.drostproject.org
5

6. Manifestations in ruminants
Shedding by asymptomatic animals!
6

7. Transmission-Humans
8
INHALATION!
US geological survey,
Occupational exposure!
?

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

9. Outbreak Lavaux 2012
12

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 communicationmedia
• Information of local physiciansvoluntary 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

18. Questions?
21
Ioannis.magouras@vetsuisse.unibe.ch