Q Fever in North Central Washington, 2011

1. Q Fever in North Central Washington, 2011 Washington State Department of Agriculture Washington State UniversityGrant County Health District

2. Q Fever • Q fever is a rare bacterial infection in people around the world caused by Coxiellaburnetii • Q fever spills over to people, from infected animals/ environment, through inhalation • The bacteria can cause a sudden onset of: • high fever • often with night sweats • headache and • flu-like symptoms that usually last for at least a week

3. Q fever in Washington, 2011 • Discovered because Producer wanted to know the source of abortions in goat herd (April 2011) • Q fever diagnosed because placenta was sent to WSU by local Veterinarian • Producer assisted with tracing herd sales in WA and MT • Grant County Health District sent an alert to medical providers

4. 2011 Washington State Study • Goats were tested from 13 farms in 7 counties: • Adams, Chelan, Clark, Franklin, Grant, Pend Oreille & Thurston • The following samples were collected by WSDA, USDA and CDC veterinarians: • 326 Blood samples • 312 Vaginal swabs • 108 Fecal swabs • 37 Milk samples • Environmental samples were taken from a few farms • Humans: 61 samples were collected from Producers and Agriculture personnel

5. Lab testing for Q fever • Serology – CF or ELISA • Detects antibodies produced against bacteria • LIVE bugs?- grow the bacteria (culture) at CDC • PCR = polymerase chain reaction • Detects and amplifies the bacteria (LIVE or DEAD)

6. 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 • GOATS: • All whole blood samples were PCR negative • Only 8% of 326 goats were ELISA positive • Only 10% of 108 fecal swabs (males) were PCR positive • 31% of 312 vaginal swabs were PCR positive • All 19 positive milk samples were from one non-milk producing farm

7. Farm Links • 3 positive does on one farm were not from Farm A • One of those positives 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

8. Environmental Results • Environmental testing was based on a quantitative PCR assay targeted to a specific gene (IS1111).  • PCR assay does not determine viability • Positive scale in genomes / gram: • Low:  <= 10 (normal background) • Moderate:  >10 – 1,000 • Strong:  > 1,000 – 100,000 • Extremely strong:  >100,000 • The farms with the highest level of shedding among their goats had the highest genomes/gram in the environment

9. Environmental Results • CDC isolated liveCoxiellaburnetii 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). • Sequence type 8 was previously seen in a chronic human Q fever case in Washington State with no connection to goats. • Sequence type 8 has also been found in several other goats and chronic human cases in the US.

10. Presence of CoxiellaburnetiiDNA 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

11. Best Practices to Control Q Fever • National seroprevalence: • 10% in cattle • 15-20% in sheep • 25-35% in goats • No real good numbers.

12. When/where is the most risk ? • 2 weeks prior to one month after birth • Lactation • Abortions • Placentas • Birth fluids • Kidding/lambing/calving barns

13. When/where is the most risk? • The highest risk is due to contact with birth products such as placentas, birth fluids, etc. • 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

14. 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

15. 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.

16. 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

17. Conclusion • Q fever is everywhere. • Individual animal serum 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.

18. 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 and Lab • All local county health jurisdictions

19. Questions?