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Taking the query out of Q Fever

8 Apr 2024

In the 1930s, a mysterious outbreak of illness among Brisbane abattoir workers was dubbed ‘query fever’ because of its unknown cause. 90 years later, Q Fever can still mystify and mislead with its non-specific flu-like acute symptoms. As two experts explain, the trick is in querying animal contact to create opportunities to vaccinate or instigate timely antibiotic treatment.

Clin­i­cal Nurse Con­sul­tant & Clin­i­cal Lead Com­mu­ni­ca­ble Dis­eases, Hunter New Eng­land Pop­u­la­tion Health, Peter Massey

Who is at risk?

Q Fever is caused by the bac­teri­um Cox­iel­la bur­netii. A per­son can become infect­ed if they breathe in the bac­te­ria or come into con­tact with infect­ed ani­mal tis­sue or flu­ids. Any­one in con­tact with ani­mals, par­tic­u­lar­ly live­stock, is at risk, explains Clin­i­cal Nurse Con­sul­tant & Clin­i­cal Lead Com­mu­ni­ca­ble Dis­eases, Hunter New Eng­land Pop­u­la­tion Health, Peter Massey.

Pulling calves is one of the high­est risk activ­i­ties – where the calf is phys­i­cal­ly pulled out of the moth­er,” Peter says. As is shear­ing or even rouse­about work, where you’ve got your head down close to the shears or fleece and you can breathe in the dust.”

The calv­ing and shear­ing sea­sons’ are more influ­en­tial than the weath­er, even though drought can increase air­borne dust.

Dur­ing drought, you end up hand-feed­ing your ani­mals, bring­ing you clos­er – but after a while peo­ple de-stock and end up with less livestock.”

Once it rains, farm­ers often get lots of new live­stock in – which is relat­ed to increas­ing risk of Q Fever,” Peter says.

Although expo­sure usu­al­ly occurs through a person’s occu­pa­tion, this isn’t always the case.

You can cer­tain­ly get Q Fever from chas­ing a few kan­ga­roos or mow­ing the lawns – if you’ve got kan­ga­roo drop­pings on the lawn and you breathe it in,” Peter says.

Scott Donkin – stock​.adobe​.com

Symp­toms

Although many cas­es are asymp­to­matic, those who become sick with Q Fever often have a severe flu-like ill­ness and may also devel­op hepati­tis and pneu­mo­nia. Occa­sion­al­ly, a chron­ic infec­tion may occur, poten­tial­ly result­ing in endo­cardi­tis and oth­er health prob­lems. 10 to 20% of peo­ple who become sick with acute Q Fever devel­op chron­ic fatigue.

Nurse Prac­ti­tion­er Cather­ine Keil

Lim­it­ing the risk

The vac­cine is esti­mat­ed to be 83 to 100% effec­tive and is the most fool­proof pre­ven­ta­tive approach, says Nurse Prac­ti­tion­er Cather­ine Keil (pic­tured right), who deliv­ers the vac­cine via her clin­ic in SA.

Ide­al­ly any­body liv­ing in a coun­try area where there are ani­mals should have the Q Fever vaccination.”

I most­ly vac­ci­nate vets, vet stu­dents, abat­toir work­ers, and farm­ers who are inter­act­ing with ani­mals, “ Cather­ine says.

The process comes to about $250, so the major­i­ty are peo­ple whose employ­ers are pay­ing for it, or they have to do it for a course.”

The fee can lim­it access, as can the fact that not all clin­ics keep the vac­cine in stock to deliv­er ad hoc and the pre-vac­ci­na­tion test­ing process, which is nec­es­sary giv­en the vac­cine is con­traindi­cat­ed for those pre­vi­ous­ly vac­ci­nat­ed or infected.

On day zero, you’ve got to give the skin test and blood test. On day sev­en, you’ve got to read the results – it’s a two-appoint­ment con­sult,” Cather­ine says.

Cather­ine says that she vol­un­tar­i­ly records vac­ci­na­tions on the Q Fever Reg­istry (qfever​.org) for her clients, which assists users to deter­mine the immune sta­tus of an indi­vid­ual, pre­vent unnec­es­sary test­ing, and reduce risk in workplaces.

William – stock​.adobe​.com

Respond­ing to a case

Per­son-to-per­son spread of Q Fever is very unlike­ly, so the main focus of the pub­lic health response is assess­ing the ongo­ing risk of the like­ly source of infection.

It is often chal­leng­ing to locate the ani­mal source, because the dis­ease is rarely salient in ani­mals, aside from its pos­si­ble impact on goat fertility.

Instead, the pub­lic health response focus­es on pro­tect­ing inter­con­nect­ed net­works of people.

Peo­ple don’t exist by them­selves but are part of a fam­i­ly, a com­mu­ni­ty, a set­ting,” Peter says.

The ques­tion we have is: is there any­body else in the house­hold, com­mu­ni­ty or work­site who could be at risk? Who could be vac­ci­nat­ed and pre­vent­ed from get­ting Q Fever?”

Com­mu­ni­ty clus­ters are rare but can be caused by spores of bac­te­ria blown from a cat­tle yard or abat­toir. The appro­pri­ate pub­lic health response in this instance may include dust mit­i­ga­tion strate­gies, includ­ing tree planting.

Because of the influ­ence of farm­ing prac­tices (e.g. inten­sive farm­ing height­ens the risk of ani­mal-to-ani­mal trans­mis­sion), population/​public health units includ­ing Hunter New Eng­land also col­lab­o­rate with pri­ma­ry indus­tries in the man­age­ment of zoonoses.

Let’s crack the whip on Q Fever’ formed part of NSW Farm­ers’ cam­paign. Pho­to: NSW Farmers.

Spread­ing the word

Peter and the team have been involved in gen­er­al media and stands at field days to raise aware­ness. He says the biggest in-roads in recent times occurred when NSW Farm­ers and the Aus­tralian Farm­ers Fed­er­a­tion took up the mantle.

They devel­oped a cam­paign a few years ago – which includ­ed some fan­tas­tic adver­tis­ing in the press, social media, and a sto­ry on a cur­rent affairs pro­gram,” he says.

When indus­try bod­ies or oth­er com­mu­ni­ty groups, like Rotary, Lions, Apex and Coun­try Women’s Asso­ci­a­tion, are involved, it makes a sub­stan­tial dif­fer­ence to the spread of the mes­sage and cre­ates oppor­tu­ni­ties for peo­ple to have bet­ter health.”

Every health pro­fes­sion­al also has the pow­er to raise aware­ness among clients, and to be aware them­selves. Two sim­ple ques­tions might be all it takes for ear­ly diag­no­sis of a zoono­sis in peo­ple pre­sent­ing with an unex­plained fever illness.

Num­ber 1, have you had con­tact with ani­mals? Num­ber 2, have you trav­elled recent­ly?” Peter says.

In health care, we have the oppor­tu­ni­ty and priv­i­lege of talk­ing to a lot of peo­ple, includ­ing a lot of peo­ple who have con­tact with ani­mals. Every inter­ac­tion is a chance to ask: have you thought about a Q Fever vac­cine?’ It takes less than 10 sec­onds, but it might save that person’s life.”

For con­tin­ued read­ing on Q Fever, view the Aus­tralian Immu­ni­sa­tion Hand­book, the Q Fever Reg­istry, or ACCRM’s online mod­ule, Q Fever – Ear­ly Diag­no­sis & Vaccination’.