Washington State Departments of Agriculture and Health
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Transcript Washington State Departments of Agriculture and Health
Jacqueline Dawson, PhD
Public Health Epidemiologist
Chelan, Douglas, Grant, Kittitas and Okanogan Counties
509-886-6428
[email protected]
Jeff Ketchel, MA, RS; Lois Swenson, RN & Amber McCoy, RS
Grant County Health District
Ben Smith, DVM
Washington State Department of Agriculture
History
1935
Queensland, Australia
Montana
2012
Worldwide
Outbreaks
Military troops
Cities and towns
Downwind from farms
Next to roads traveled by animals
www.cfsph.iastate.edu
The Organism
Coxiella burnetii
Bacteria
Grows inside cells
Spore-like
Stable and resistant
Category B bioterrorism agent:
long-term environmental stability =weeks to years
resistance to heat and drying
extremely low infectious dose (1 bacteria)
aerosol infectious route
Killed by pasteurization
Transmission
Aerosol
Placenta and birth fluids
Urine, feces, milk
Direct contact
Surfaces
Ingestion
Ticks
Human-to-human extremely rare
Ingestion (mainly drinking raw milk) is probably a minor factor
in the transmission of C. burnetii and a point of controversy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88923/
Animal Disease
Sheep, cattle, goats, cats, dogs, some wild animals
(including rodents), birds and ticks.
Localizes in:
mammary glands
supramammary lymph nodes
placenta
uterus, from which it may be shed in subsequent
parturitions and lactations
May be asymptomatic
Reproductive failure
Abortions
Stillbirths
Retained placenta
Infertility
Weak newborns
Low birth weights
Carrier state
Acute Infection
The bacteria can cause a sudden onset of:
High fever (104 F) with shaking chills (night sweats)
Vomiting, diarrhea, abdominal pain and chest pain
Muscle and joint pains
Severe headache (often behind the eyes)
Extreme fatigue
Flu-like symptoms that usually last for 2-6 weeks
Pneumonia (30 to 50%)
Hepatitis (33%)= liver inflammation
Skin rash (10%)
Other signs (< 1%)
Myocarditis, meningoencephalitis, pericarditis
Death: 1 to 2%
Chronic Disease
1 to 5% of those infected
Prior heart disease
pregnant women
Immunocompromised (ex: Cancer therapy)
Endocarditis (infection of a heart valve)
Poor liver function
Bone infection
50% relapse rate after antibiotic therapy
Risk to Pregnant Women
Most asymptomatic
Transplacental transmission
Reported complications
In-utero death
Premature birth
Low birth weight
Where is it?
The true incidence is
unknown in the Pacific
Northwest.
WSU is currently
conducting a study to
determine the geographic
distribution and goat herd
prevalence.
Epidemiology
Occupational and environmental hazard
Farmers
Livestock producers
Veterinarians and technicians
Meat processors/ abattoir workers
Laboratory workers
Treatment
GOATS
Treatment: Oral tetracycline at the therapeutic dose may be given for 24 wk.
In known infected herds administering tetracycline (8 mg/kg/day)
prophylactically in the water supply prior to parturition may reduce
spread of the organism. Merck Veterinary Manual
HUMANS
Treatment
Doxycycline
Chronic disease – long course
2 to 3 years of medication
Immunity
Long lasting (possibly lifelong)
Lab testing for Q fever
Serology = CF or ELISA
Detects antibodies produced against bacteria
LIVE bugs?= Culture at CDC
Risk to laboratory personnel
PCR = polymerase chain reaction
Detects and amplifies the bacteria (LIVE or DEAD)
Polymerase Chain Reaction = PCR
Phase I vs II Antibodies
During the course of the infection, the
outer membrane of the organism
undergoes changes in its
lipopolysaccharide structure, called phase
variation.
Acute: Higher Phase II antibody titers
Not very infectious
Chronic: Higher Phase I antibody titers
Highly infectious
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88923/
Q fever in Washington, 2011
Producer wanted to know the source of
abortions in goat herd
Placenta sent to WSU by local Vet
Producer assisted with tracing herd
sales in WA, OR and MT
Coxiella burnetii organisms
(red) within infected placenta
cells (blue)
Washington State Study
Humans: 61 samples were collected from
Producers/family and Agriculture
personnel
Goats were tested from 13 farms in 7
counties:
Adams, Chelan, Clark, Franklin,
Grant (N=6), Pend Oreille &
Thurston
Samples were collected by WSDA &
USDA Vets:
326 Blood samples
312 Vaginal swabs
108 Fecal swabs
37 Milk samples
Environmental samples were taken
from a few farms
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
All Vets and Extension service personnel were negative
Most Producers were negative, even on goat positive farms
5 / 11 Grant County:
4+ (3 ill) in a family with meat goats since 2007
All goats PCR negative (including goat from Farm A); 9% ELISA +
1 + recently moved to WA: raised goats, sheep and cattle whole life
Bought dog from Farm A; goats and sheep from other farms
GOATS:
8% goats were ELISA +
10% fecal swabs (males) were PCR +
31% of vaginal swabs were PCR +
All whole blood samples were PCR negative
All 19 + milk samples were from one non-milk producing farm
Animal Tracing ?
3 positive does on one farm were not from Farm A
One positive 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
Farm A
Farm X
2011 Environmental Results
CDC isolated live Coxiella burnetii 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).
Type 8 was previously seen in a chronic human Q fever
case in Washington State with no connection to goats.
Type 8 has also been found in several other goats and
chronic human cases in the US.
Presence of Coxiella burnetii DNA 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
Best Practices to Control Q Fever
National seroprevalence:
41.6% of sheep
16.5% of goats
3.4% of cattle
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/52000.htm
Prevention and Control
Eradication not practical
Too many reservoirs
Constant exposure
Stability of agent in environment
WSDA: Best Practices to Control Q Fever
http://agr.wa.gov/FoodAnimal/AnimalHealth/Diseases/QFeverManagementPractices.pdf
When is the most risk ?
2 weeks prior to one month after birth
Lactation
Abortions
Placentas
Birth fluids
Kidding/lambing/calving barns
Where is the most risk?
• 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
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
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.
2 Kidding Seasons
C. burnetii infection in goats seems to be limited to
two kidding seasons.
Natural History of Q Fever in Goats
Todd Hatchette
The Department of Medicine, Dalhousie University, Halifax, Nova Scotia
Nancy Campbell, Robert Hudson, Didier Raoult, Thomas J. Marrie
March 2003, Vol. 3, No. 1, Pages 11-15 Posted online on July 9, 2004.
Conclusion
Q fever is everywhere.
Individual antibody 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.
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
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, Extension
Service and Lab
Local county health jurisdictions