GRF 2nd One Health Summit 2013: Presentation by Hendrik-Jan Roest, Central Veterinary Institute, part of Wageningen UR

1. The Dutch Q fever situation
lessons learned?
November 19, 2013
One Health Summit 2013
Hendrik-Jan Roest, CVI, Lelystad, NL
Kitty Maassen, RIVM, Bilthoven, NL
Arjen van de Giessen, RIVM, Bilthoven, NL
Fred van Zijderveld, CVI, Lelystad, NL
Davos, Switzerland

2. Let’s talk about
 Intro Coxiella
 Summary of the Q fever Outbreak
 Lessons learned

3. Coxiella burnetii
 Intracellular, Gram
negative bacterium
 Can infect
● Humans
● Flu like symptoms
● Chronic disease
● Animals
● Nearly all species
● Abortion (small)
ruminants
 Low infectious dose
McCaul et al 1981, Voth et al 2009, Moos et al 1987

4. The Dutch Q fever outbreak
Dutch population: +/- 16.5 million people
Information from RIVM

5. Onset of the Dutch Q fever outbreak
Animals
 2005
 Dairy goats/dairy
sheep
 Southern part of NL
 In spring
Humans
 2007
 Males, age around 50
 Southern part of NL
 In spring

6. Q-fever in dairy goats and dairy sheep
Farms with abortions due to Q fever
Roest et al, E&I, 2011

7. Roest et al, E&I, 2011

8. Human cases 2009
dairy goat/sheep farms 2005-2009
Roest et al, E&I, 2011

10. Assumption
Dairy goats are the most probable source of the Dutch
human Q fever outbreak because:
 Overlapping area
 Succession in time
 No other possible source
 Confirmed by genotyping
 Other probable causes were excluded by genotyping

11. Measures to control the human outbreak
 In the veterinary field  dairy goats
● Notification of abortions and positive farms
● Improved hygiene
● Manure control
● Visitors ban
● Transport ban
● Stop excretion
● Breeding ban
● Vaccination
● Eliminate risk animals
● Culling of pregnant goats on positive farms

12. http://rivm.nl/Onderwerpen/Ziekten_Aandoeningen/Q/Q_koorts

13. Lessons to be learned
 An endemic disease can emerge to an outbreak
 Genotyping can confirm epidemiological findings
 Share information
● In the human medicine chain
● In the veterinary chain
● Human  veterinary
 One health approach
● Practitioners, policy makers and researchers
● Attention from the media
 One health is the approach to fight zoonosis

14. See also:
Poster:
PB02
Presentation: WED1.2
Hendrik-Jan Roest, DVM, PhD
Central Veterinary Institute
 : +31 320 238026
: hendrikjan.roest@wur.nl
: www.cvi.wur.nl