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Taking the query out of Q Fever
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.
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.
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.
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.
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.
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’.