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Q Fever in a Family
Carol Gilliam, RN, MSN, CIC– Community Health Nurse
Khrist Roy, MPH– Epidemiologist
Gene Arvin, RS– Environmentalist
Madison County Health Department Staff
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Q Fever in a Family
Chasing the elusive case-defining test
And
What do you do when you know?
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What Is Q Fever
Zoonotic disease caused by Coxiella brunetii - You get it from animals
Cattle, sheep and goats are primary reservoirs
It is endemic to these animals – Assume that they have it. Most animals show no symptoms
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Coxiella burnetiibacteria
Found all over the world Resistant to heat, drying and many
common disinfectants Lives for long periods in soil
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How is Q Fever spread?
Breathing in the organisms from air and dust contaminated by
– Dried placental material
– birth fluids
– excreta of infected herd animals
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How is Q Fever spread?(continued)
Other modes of transmission possible but not common
– Tick bites– Ingestion of contaminated
unpasteurized milk
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Human to Human transmission is
very rare
Q Fever
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Incubation Period
Most patients become ill within 2-3 weeks after exposure
Those who recover fully from infection may possess lifelong immunity against re-infection
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Clinical Types How does it look?
No symptoms – 60% Flu-like illness Liver problems – most common Respiratory or lung problems May involve nervous system Chronic Q Fever Endocarditis Miscellaneous complications:
– Inflammation of cartilage or bone, abortion, brucellosis like illness
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Our cue to get involved
The State Office of Epidemiology faxed us a copy of a positive lab report they had received directly from LabCorps
Note: Resulted from computer flag at reference lab that automatically kicks out a report to the state for reportable diseases
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Q Fever in a Family Cluster
Father – 48 years old – First + Lab test
Mother – 44 years old
Son – 15
Son - 11
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Q Fever in a Family Cluster Father, mother, and older son helped in
birthing of goat on April 27, 04 Father became ill on May 16 and was
hospitalized on May 20 Mother became ill on May 20, treated for
bronchitis by PCP and was not hospitalized Older son became ill on May 22 and was not
hospitalized Younger son was not present in birthing area
and did not get ill
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Father
Fever of Unknown Origin (complicated by past history of UTI, proctitis, prostatitis)
Hospitalized for 7 days in May, 04
In hospital, Infectious Disease Spec– Ruled out Lyme Disease, Ehrlicosis– Diagnosed Q Fever based on clinical
presentation and positive test for Q fever antibody titer
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Mother Early – Fever, cough, slight chest pain
treated for bronchitis
Later – “Drop Down” attacksreferred to Neurologist
– MRI, nerve conduction tests, etc negative– Q Fever antibody titer +
Referrred to Infectious Disease Specialist– Second titer >fourfold increase
CONFIRMED CASE – Meets CDC criteria
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Older Son
Flu Like illness Short duration Fever, body aches Cough and stuffy nose, mild chills Did not see doctor, but went for
testing at our suggestion 8 weeks after birthing of goat
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Environmental Conditions
No dust conditions at present time Barn enclosed Dirt floor covered with hay Environmental disinfectant not present House within 100 yards of birthing area No more than 3 homes within ½ mile radius Tarred or gravel roads leading to farm No goats on nearby farms, some cattle Does not sell milk and has not sold or eaten the
goat meat yet
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Environmental Assessment
Q Fever epidemic unlikely this year Whole family most likely immune Farmer now using appropriate
personal protective equipment– Shoulder length gloves– Mask
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Impact on Family
Personal – Significant morbidity– Illness, fear, inconvenience
– Father felt he nearly died Economic –
– Father was not able to go to his “Day Job” for 2 months
– Expensive hospitalization, referral to specialists, MRI, etc.
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How can it be prevented?
Education on sources of infection Personal protection during birthing Proper disposal of birthing materials Use only pasteurized milk and milk
products Holding areas for sheep, cattle & goats
located away from populated areas
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What we did:
Community Education
Info to family - verbal and written
E-mail notification to health care facilities
Memo to Veterinarians
Supplied info to County Extension Agent for weekly newspaper column
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What we did:(continued)
Assessed environment
Discussed at Nurses Work Group– An inter-county coalition of hospital
infection control nurses, members of MCHD epidemiology team, physician office staff and EOC staff
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What went well
Good support to circulate educational materials locally
Accessability to KY State Epidemiology team for discussion
Able to talk to vet at CDC for technical question
Enhanced relationships with local physicians
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Challenges
Difficulty getting good history from family members
Difficulty convincing practitioners for second test in 3-4 weeks (nearly did not succeed)
Maintaining privacy of family Hesitation to do environmental assessment
until case confirmed Lack of specific guidance on “proper
disposal of birthing materials”
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…provides replacement income for tobacco.
We are likely to see more of it
…and possibly more Q Fever
Goat farming in Kentucky
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But it’s not just the goats…
It’s the cows
It’s the sheep
And Q Fever is on some lists as a minor agent of bioterrorism