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Hamad G, Ranmuthugala G. Q fever awareness in Australia: A scoping review. Aust N Z J Public Health 2023; 47:100099. [PMID: 38016201 DOI: 10.1016/j.anzjph.2023.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To investigate the level of Q fever awareness in Australia. METHODS A scoping review was conducted by searching the electronic databases Medline, PubMed and Web of Science using keywords for Q fever, awareness, knowledge, and Australian locations. The search was initially limited to articles published in the 10 years prior to June 2022 and then extended up to and including August 2023; yielding 387 records. RESULTS Fifteen articles were assessed as being eligible. These articles reported on surveys and interviews conducted with farmers, veterinary practitioners and nurses, medical practitioners, policy makers, researchers, industry representatives, animal science students, cat breeders, wildlife rehabilitators, and agriculture show attendees. Farmers were the largest group represented. Level of Q fever awareness amongst these communities, including those at high-risk, was generally low. The need for increased awareness was recognised. General practitioner awareness levels were low and recognised to be so by high-risk groups. Awareness of preventive measures including vaccination was greater among those with greater awareness and risk. CONCLUSION With the availability of a highly effective vaccine in Australia, there is a need to increase Q fever knowledge and awareness among high-risk groups and primary health care practitioners. IMPLICATIONS FOR PUBLIC HEALTH Strategies to increase awareness and knowledge of Q fever risks and prevention strategies may assist with reducing Q fever burden in Australia.
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Affiliation(s)
- George Hamad
- Department of Rural Health, Melbourne Medical School, The University of Melbourne, Australia
| | - Geetha Ranmuthugala
- Department of Rural Health, Melbourne Medical School, The University of Melbourne, Australia; School of Rural Medicine, University of New England, Australia.
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Dolcé P, de Beaumont-Dupont A, Jutras P, Mailhot-Léonard F, Alexandra Rosca M, Aubé-Maurice J. The lower Saint Lawrence River region of Quebec, a hot spot for sheepfold-associated Q fever in Canada: Review of 258 cases. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2023; 8:201-213. [PMID: 38058500 PMCID: PMC10697106 DOI: 10.3138/jammi-2023-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/18/2023] [Indexed: 12/08/2023]
Abstract
Background The lower Saint Lawrence river region (LSLRR), in Quebec, has a 10-fold higher incidence of Q fever compared to the provincial rate. This study aimed to review clinical cases and the Q fever risk exposure in this region. Methods Data were retrieved from microbiology laboratory, medical records from Rimouski Regional Hospital and Public Health reports between 1991 and 2018. They were analyzed with Epi Info 7.2.2.6. Patients with confirmed acute, probable acute, and chronic Q fever were classified using standard case definitions and mapped according to the postal code, to assess the correlation between cases and sheep distribution. Results Out of 295 cases, 258 were included (241 confirmed acute, seven probable acute, 10 chronic). Median age was 49 years, 76% were male. For acute cases, the prominent symptoms were fever (99%), headache (83%), chills (80%), sweating (72%), myalgia (69%), and fatigue (67%). Clinical presentation was mostly febrile syndrome with mild hepatitis (84%). A seasonal peak was observed from May to July (56% of acute cases). Most cases (56%) occurred within the two counties where sheep production was highest. Exposure to sheep was prominent 93%, including 64% direct contact (15% shepherds, 49% sheepfold visitors), 14% indirect contact, and 15% sheepfold neighbors. Conclusions To our knowledge, this is one of the largest retrospective studies of Q fever cases reported in Canada. Q fever in Quebec LSLRR is associated mainly with sheep exposure. Fever and hepatitis were the most common manifestations. Preventive measures should be considered in this region to protect sheepfold workers, visitors, and their neighbors.
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Affiliation(s)
- Patrick Dolcé
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
| | - Annie de Beaumont-Dupont
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
- Department of Biology, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Philippe Jutras
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
| | - Florence Mailhot-Léonard
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
| | - Maria Alexandra Rosca
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Joanne Aubé-Maurice
- Department of Public Health, CISSS du Bas-St-Laurent, Kamouraska, Quebec, Canada
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Jan S, Fratzke AP, Felgner J, Hernandez-Davies JE, Liang L, Nakajima R, Jasinskas A, Supnet M, Jain A, Felgner PL, Davies DH, Gregory AE. Multivalent vaccines demonstrate immunogenicity and protect against Coxiella burnetii aerosol challenge. Front Immunol 2023; 14:1192821. [PMID: 37533862 PMCID: PMC10390735 DOI: 10.3389/fimmu.2023.1192821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/16/2023] [Indexed: 08/04/2023] Open
Abstract
Vaccines are among the most cost-effective public health measures for controlling infectious diseases. Coxiella burnetii is the etiological agent of Q fever, a disease with a wide clinical spectrum that ranges from mild symptoms, such as fever and fatigue, to more severe disease, such as pneumonia and endocarditis. The formalin-inactivated whole-cell vaccine Q-VAX® contains hundreds of antigens and confers lifelong protection in humans, but prior sensitization from infection or vaccination can result in deleterious reactogenic responses to vaccination. Consequently, there is great interest in developing non-reactogenic alternatives based on adjuvanted recombinant proteins. In this study, we aimed to develop a multivalent vaccine that conferred protection with reduced reactogenicity. We hypothesized that a multivalent vaccine consisting of multiple antigens would be more immunogenic and protective than a monovalent vaccine owing to the large number of potential protective antigens in the C. burnetii proteome. To address this, we identified immunogenic T and B cell antigens, and selected proteins were purified to evaluate with a combination adjuvant (IVAX-1), with or without C. burnetii lipopolysaccharide (LPS) in immunogenicity studies in vivo in mice and in a Hartley guinea pig intratracheal aerosol challenge model using C. burnetii strain NMI RSA 493. The data showed that multivalent vaccines are more immunogenic than monovalent vaccines and more closely emulate the protection achieved by Q-VAX. Although six antigens were the most immunogenic, we also discovered that multiplexing beyond four antigens introduces detectable reactogenicity, indicating that there is an upper limit to the number of antigens that can be safely included in a multivalent Q-fever vaccine. C. burnetii LPS also demonstrates efficacy as a vaccine antigen in conferring protection in an otherwise monovalent vaccine formulation, suggesting that its addition in multivalent vaccines, as demonstrated by a quadrivalent formulation, would improve protective responses.
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Affiliation(s)
- Sharon Jan
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Alycia P. Fratzke
- Department of Microbial Pathogenesis and Immunology, Texas A&M Health Science Center, Bryan, TX, United States
- Department of Pathology, Charles River Laboratories, Reno, NV, United States
| | - Jiin Felgner
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Jenny E. Hernandez-Davies
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Li Liang
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Rie Nakajima
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Algimantas Jasinskas
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Medalyn Supnet
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Aarti Jain
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Philip L. Felgner
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - D. Huw Davies
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
| | - Anthony E. Gregory
- Vaccine Research & Development Center, Department of Physiology & Biophysics, University of California, Irvine, Irvine, CA, United States
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4
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Mathews KO, Norris JM, Phalen D, Malikides N, Savage C, Sheehy PA, Bosward KL. Factors associated with Q fever vaccination in Australian wildlife rehabilitators. Vaccine 2023; 41:201-210. [PMID: 36424259 DOI: 10.1016/j.vaccine.2022.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
Australian wildlife rehabilitators (AWR) are at risk of contracting Q fever, a serious zoonotic disease caused by Coxiella burnetii. Despite Australian government recommendations for AWR to receive Q fever vaccination (QFV), and the availability of a safe and effective vaccine in Australia, shortfalls in vaccine uptake have been observed in AWR. This study aimed to determine factors associated with QFV status and describe AWR attitudes and potential barriers towards QFV. Data were obtained from a nationwide, online, cross-sectional survey of AWR undertaken in 2018. Approximately-three quarters (200/265; 75.5 %) of those that had heard of Q fever were also aware of the Q fever vaccine, and of those, 25.5 % (51/200) were vaccinated. Barriers to QFV, among unvaccinated respondents who had also heard of Q fever and the vaccine (149/200; 74.5 %), included concerns regarding the safety, efficacy, and importance of the Q fever vaccine. Complacency toward vaccination, convenience of vaccination, and a lack of Q fever knowledge were also notable barriers. Only 27.7 % (41/148) of respondents reported having had vaccination recommended to them. Multivariable logistic regression identified that vaccinated AWR were more likely to be aged ≤ 50 years (OR 4.51, 95 % CI: 2.14-10.11), have had a university level education (OR 2.78, 95 % CI: 1.39-5.73), have resided in New South Wales/Australian Capital Territory and Queensland than in other Australian jurisdictions (OR 2.9, 95 % CI: 1.10-8.83 and OR 4.82, 95 % CI: 1.64-16.00 respectively) and have attended an animal birth (OR 2.14, 95 % CI: 1.02-4.73). Knowledge gaps regarding Q fever and QFV in AWR demonstrated the need for interventions to raise the awareness of the potential health consequences of C. burnetii exposure and Q fever prevention. Education programs to allow AWR to develop an informed perspective of Q fever and QFV, coupled with improvements in vaccine affordability and the implementation of programs to enhance accessibility, may also increase vaccine uptake.
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Affiliation(s)
- Karen O Mathews
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Jacqueline M Norris
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia; Sydney Institute for Infectious Diseases, University of Sydney, Sydney 2006, New South Wales, Australia
| | - David Phalen
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | | | | | - Paul A Sheehy
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Katrina L Bosward
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia; Sydney Institute for Infectious Diseases, University of Sydney, Sydney 2006, New South Wales, Australia.
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Hobbs MJ, Ketheesan N, Eastwood K, Massey P, Ranmuthugala G, Norton R, Quirk FH. Q Fever awareness and risk profiles among agricultural show attendees. Aust J Rural Health 2022; 30:601-607. [PMID: 35816572 PMCID: PMC9796403 DOI: 10.1111/ajr.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess awareness and risk of Q fever among agricultural show attendees. SETTING University of New England's Farm of the Future Pavilion, 2019, Sydney Royal Agricultural Show. PARTICIPANTS Participants were ≥18 years, fluent in English, Australian residents, and gave their informed consent. MAIN OUTCOME MEASURES Participants reported whether they had ever heard of Q fever and then completed the 'Q Tool' (www.qfevertool.com), which was used to assess participants' demographics and risk profiles. Cross-tabulations and logistic regression analyses were used to examine the relationship between these factors. RESULTS A total of 344 participants were recruited who, in general, lived in major NSW cities and were aged 40-59 years. 62% were aware of Q fever. Living in regional/remote areas and regular contact with livestock, farms, abattoirs and/or feedlots increased the likelihood of Q fever awareness. Direct or indirect contact with feral animals was not associated with Q fever awareness after controlling for the latter risk factors. 40% of participants had a high, 21% a medium, and 30% a low risk of exposure. Slightly less than 10% reported a likely existing immunity or vaccination against Q fever. Among those who were not immune, living in a regional or remote area and Q fever awareness were independently associated with increased likelihood of exposure. CONCLUSIONS Awareness of Q fever was relatively high. Although 61% of participants had a moderate to high risk of exposure to Q fever, they had not been vaccinated. This highlights the need to explore barriers to vaccination including accessibility of providers and associated cost.
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Affiliation(s)
- Megan J. Hobbs
- New England Institute of Healthcare Research, UNEArmidaleNSWAustralia,School of Rural Medicine, UNEArmidaleNSWAustralia
| | - Natkunam Ketheesan
- New England Institute of Healthcare Research, UNEArmidaleNSWAustralia,Q Fever Research Consortium, UNEArmidaleNSWAustralia,School of Science and Technology, UNEArmidaleNSWAustralia
| | - Keith Eastwood
- Q Fever Research Consortium, UNEArmidaleNSWAustralia,School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia,Population HealthHunter New England Local Health DistrictNew LambtonNSWAustralia
| | - Peter Massey
- Q Fever Research Consortium, UNEArmidaleNSWAustralia,Population HealthHunter New England Local Health DistrictNew LambtonNSWAustralia
| | - Geetha Ranmuthugala
- New England Institute of Healthcare Research, UNEArmidaleNSWAustralia,School of Rural Medicine, UNEArmidaleNSWAustralia,Q Fever Research Consortium, UNEArmidaleNSWAustralia
| | - Robert Norton
- Q Fever Research Consortium, UNEArmidaleNSWAustralia,Townsville Hospital Health Service, Queensland HealthDouglasQldAustralia,School of Biomedical SciencesUniversity of QueenslandSt LuciaQldAustralia
| | - Frances H. Quirk
- New England Institute of Healthcare Research, UNEArmidaleNSWAustralia,School of Rural Medicine, UNEArmidaleNSWAustralia,Q Fever Research Consortium, UNEArmidaleNSWAustralia
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6
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Raju Paul S, Scholzen A, Mukhtar G, Wilkinson S, Hobson P, Dzeng RK, Evans J, Robson J, Cobbold R, Graves S, Poznansky MC, Garritsen A, Sluder AE. Natural Exposure- and Vaccination-Induced Profiles of Ex Vivo Whole Blood Cytokine Responses to Coxiella burnetii. Front Immunol 2022; 13:886698. [PMID: 35812430 PMCID: PMC9259895 DOI: 10.3389/fimmu.2022.886698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Q fever is a zoonotic disease caused by the highly infectious Gram-negative coccobacillus, Coxiella burnetii (C. burnetii). The Q fever vaccine Q-VAX® is characterised by high reactogenicity, requiring individuals to be pre-screened for prior exposure before vaccination. To date it remains unclear whether vaccine side effects in pre-exposed individuals are associated with pre-existing adaptive immune responses to C. burnetii or are also a function of innate responses to Q-VAX®. In the current study, we measured innate and adaptive cytokine responses to C. burnetii and compared these among individuals with different pre-exposure status. Three groups were included: n=98 Dutch blood bank donors with unknown exposure status, n=95 Dutch village inhabitants with known natural exposure status to C. burnetii during the Dutch Q fever outbreak of 2007-2010, and n=96 Australian students receiving Q-VAX® vaccination in 2021. Whole blood cytokine responses following ex vivo stimulation with heat-killed C. burnetii were assessed for IFNγ, IL-2, IL-6, IL-10, TNFα, IL-1β, IP-10, MIP-1α and IL-8. Serological data were collected for all three cohorts, as well as data on skin test and self-reported vaccine side effects and clinical symptoms during past infection. IFNγ, IP-10 and IL-2 responses were strongly elevated in individuals with prior C. burnetii antigen exposure, whether through infection or vaccination, while IL-1β, IL-6 and TNFα responses were slightly increased in naturally exposed individuals only. High dimensional analysis of the cytokine data identified four clusters of individuals with distinct cytokine response signatures. The cluster with the highest levels of adaptive cytokines and antibodies comprised solely individuals with prior exposure to C. burnetii, while another cluster was characterized by high innate cytokine production and an absence of C. burnetii-induced IP-10 production paired with high baseline IP-10 levels. Prior exposure status was partially associated with these signatures, but could not be clearly assigned to a single cytokine response signature. Overall, Q-VAX® vaccination and natural C. burnetii infection were associated with comparable cytokine response signatures, largely driven by adaptive cytokine responses. Neither individual innate and adaptive cytokine responses nor response signatures were associated retrospectively with clinical symptoms during infection or prospectively with side effects post-vaccination.
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Affiliation(s)
- Susan Raju Paul
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | - Ghazel Mukhtar
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | - Peter Hobson
- Sullivan Nicolaides Pathology, Brisbane, QLD, Australia
| | - Richard K. Dzeng
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Rowland Cobbold
- School of Veterinary Science, University of Queensland, Gatton, QLD, Australia
| | - Stephen Graves
- Australian Rickettsial Reference Laboratory, Geelong, VIC, Australia
| | - Mark C. Poznansky
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Ann E. Sluder, ; Anja Garritsen, ; Mark C. Poznansky,
| | - Anja Garritsen
- InnatOss Laboratories B.V., Oss, Netherlands
- *Correspondence: Ann E. Sluder, ; Anja Garritsen, ; Mark C. Poznansky,
| | - Ann E. Sluder
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Ann E. Sluder, ; Anja Garritsen, ; Mark C. Poznansky,
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Mathews KO, Toribio JA, Norris JM, Phalen D, Wood N, Graves SR, Sheehy PA, Bosward KL. Coxiella burnetii seroprevalence and Q fever in Australian wildlife rehabilitators. One Health 2021; 12:100197. [PMID: 33319024 PMCID: PMC7725937 DOI: 10.1016/j.onehlt.2020.100197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022] Open
Abstract
Coxiella burnetii is the causative bacterium of the zoonotic disease Q fever, which is recognised as a public health concern globally. Macropods have been suggested as a potential source of C. burnetii infection for humans. The aim of this cross-sectional study was to determine the prevalence of C. burnetii exposure in a cohort of Australian wildlife rehabilitators (AWRs) and assess Q fever disease and vaccination status within this population. Blood samples were collected from adult participants attending the Australian Wildlife Rehabilitation Conference in Sydney in July 2018. Participants completed a questionnaire at the time of blood collection. Antibody titres (IgG, IgA and IgM) against phase I and phase II C. burnetii antigens as determined by immunofluorescence assay, revealed that of the unvaccinated participants, 6.1% (9/147) had evidence of exposure to C. burnetii. Of the total participants, 8.1% (13/160) had received Q fever vaccination, four of whom remained seropositive at the time of blood collection. Participants reporting occupational contact with ruminants, were eight times more likely to have been vaccinated against Q fever, than those reporting no occupational animal contact (OR 8.1; 95% CI 1.85-45.08). Three AWRs (2%) reported having had medically diagnosed Q fever, two of whom remained seropositive at the time of blood collection. Despite the lack of association between macropod contacts and C. burnetii seropositivity in this cohort, these findings suggest that AWRs are approximately twice as likely to be exposed to C. burnetii, compared with the general Australian population. This provides support for the recommendation of Q fever vaccination for this potentially 'at-risk' population. The role of macropods in human Q fever disease remains unclear, and further research into C. burnetii infection in macropods including: infection rate and transmission cycles between vectors, macropods as reservoirs, other animals and humans is required.
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Key Words
- Australia, wildlife rehabilitators
- Australian Statistical Geography Standard, ASGS
- Australian Wildlife Rehabilitation Conference, AWRC
- Australian wildlife rehabilitators, AWRs
- Coxiella burnetii
- Indirect immunofluorescence assay, IFA
- Macropods, kangaroos
- Personal protection equipment, PPE
- Q fever
- Q fever disease status, QFDS
- Q fever disease, QFD
- Q fever serostatus, QFSS
- Q fever vaccination status, QFVS
- Q fever vaccination, QFV
- Seroprevalence
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Affiliation(s)
- Karen O. Mathews
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Jenny-Ann Toribio
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Jacqueline M. Norris
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - David Phalen
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Nicholas Wood
- The University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Camperdown, NSW, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Victoria 3220, Australia
| | - Paul A. Sheehy
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
| | - Katrina L. Bosward
- The University of Sydney, Sydney School of Veterinary Science, Faculty of Science, Camden, NSW, Australia
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Long CM, Beare PA, Cockrell DC, Fintzi J, Tesfamariam M, Shaia CI, Heinzen RA. Contributions of lipopolysaccharide and the type IVB secretion system to Coxiella burnetii vaccine efficacy and reactogenicity. NPJ Vaccines 2021; 6:38. [PMID: 33741986 PMCID: PMC7979919 DOI: 10.1038/s41541-021-00296-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
Coxiella burnetii is the bacterial causative agent of the zoonosis Q fever. The current human Q fever vaccine, Q-VAX®, is a fixed, whole cell vaccine (WCV) licensed solely for use in Australia. C. burnetii WCV administration is associated with a dermal hypersensitivity reaction in people with pre-existing immunity to C. burnetii, limiting wider use. Consequently, a less reactogenic vaccine is needed. Here, we investigated contributions of the C. burnetii Dot/Icm type IVB secretion system (T4BSS) and lipopolysaccharide (LPS) in protection and reactogenicity of fixed WCVs. A 32.5 kb region containing 23 dot/icm genes was deleted in the virulent Nine Mile phase I (NMI) strain and the resulting mutant was evaluated in guinea pig models of C. burnetii infection, vaccination-challenge, and post-vaccination hypersensitivity. The NMI ∆dot/icm strain was avirulent, protective as a WCV against a robust C. burnetii challenge, and displayed potentially altered reactogenicity compared to NMI. Nine Mile phase II (NMII) strains of C. burnetii that produce rough LPS, were similarly tested. NMI was significantly more protective than NMII as a WCV; however, both vaccines exhibited similar reactogenicity. Collectively, our results indicate that, like phase I LPS, the T4BSS is required for full virulence by C. burnetii. Conversely, unlike phase I LPS, the T4BSS is not required for vaccine-induced protection. LPS length does not appear to contribute to reactogenicity while the T4BSS may contribute to this response. NMI ∆dot/icm represents an avirulent phase I strain with full vaccine efficacy, illustrating the potential of genetically modified C. burnetii as improved WCVs.
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Affiliation(s)
- Carrie M Long
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
| | - Paul A Beare
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Diane C Cockrell
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Jonathan Fintzi
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Mahelat Tesfamariam
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Carl I Shaia
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Robert A Heinzen
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
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9
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Devaux CA, Osman IO, Million M, Raoult D. Coxiella burnetii in Dromedary Camels ( Camelus dromedarius): A Possible Threat for Humans and Livestock in North Africa and the Near and Middle East? Front Vet Sci 2020; 7:558481. [PMID: 33251255 PMCID: PMC7674558 DOI: 10.3389/fvets.2020.558481] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
The "One Health" concept recognizes that human health is connected to animal health and to the ecosystems. Coxiella burnetii-induced human Q fever is one of the most widespread neglected zoonosis. The main animal reservoirs responsible for C. burnetii transmission to humans are domesticated ruminants, primarily goats, sheep, and cattle. Although studies are still too sparse to draw definitive conclusions, the most recent C. burnetii serosurvey studies conducted in herds and farms in Africa, North Africa, Arabian Peninsula, and Asia highlighted that seroprevalence was strikingly higher in dromedary camels (Camelus dromedarius) than in other ruminants. The C. burnetii seroprevalence in camel herds can reach more than 60% in Egypt, Saudi Arabia, and Sudan, and 70 to 80% in Algeria and Chad, respectively. The highest seroprevalence was in female camels with a previous history of abortion. Moreover, C. burnetii infection was reported in ticks of the Hyalomma dromedarii and Hyalomma impeltatum species collected on camels. Even if dromedary camels represent <3% of the domesticated ruminants in the countries of the Mediterranean basin Southern coast, these animals play a major socioeconomic role for millions of people who live in the arid zones of Africa, Middle East, and Asia. In Chad and Somalia, camels account for about 7 and 21% of domesticated ruminants, respectively. To meet the growing consumers demand of camel meat and milk (>5 million tons/year of both raw and pasteurized milk according to the Food and Agriculture Organization) sustained by a rapid increase of population (growth rate: 2.26-3.76 per year in North Africa), dromedary camel breeding tends to increase from the Maghreb to the Arabic countries. Because of possible long-term persistence of C. burnetii in camel hump adipocytes, this pathogen could represent a threat for herds and breeding farms and ultimately for public health. Because this review highlights a hyperendemia of C. burnetii in dromedary camels, a proper screening of herds and breeding farms for C. burnetii is urgently needed in countries where camel breeding is on the rise. Moreover, the risk of C. burnetii transmission from camel to human should be further evaluated.
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Affiliation(s)
- Christian A. Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- CNRS, Marseille, France
| | - Ikram Omar Osman
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- Faculty of Sciences Ben-Ben-M'Sik, University Hassan II, Casablanca, Morocco
| | - Matthieu Million
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Vacunas en salud laboral… una oportunidad para prevenir e invertir en salud. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Gidding HF, Faddy HM, Durrheim DN, Graves SR, Nguyen C, Hutchinson P, Massey P, Wood N. Seroprevalence of Q fever among metropolitan and non‐metropolitan blood donors in New South Wales and Queensland, 2014–2015. Med J Aust 2019; 210:309-315. [DOI: 10.5694/mja2.13004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Heather F Gidding
- Northern Clinical SchoolUniversity of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases Sydney NSW
| | | | | | - Stephen R Graves
- Australian Rickettsial Reference LaboratoryUniversity Hospital Geelong VIC
| | - Chelsea Nguyen
- Australian Rickettsial Reference LaboratoryUniversity Hospital Geelong VIC
| | | | - Peter Massey
- Hunter New England Local Health District Newcastle NSW
- University of New England Armidale NSW
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases Sydney NSW
- University of Sydney Sydney NSW
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Rahaman MR, Milazzo A, Marshall H, Bi P. Is a One Health Approach Utilized for Q Fever Control? A Comprehensive Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E730. [PMID: 30823481 PMCID: PMC6427780 DOI: 10.3390/ijerph16050730] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 02/07/2023]
Abstract
Q fever, a zoonotic disease transmitted from animals to humans, is a significant public health problem with a potential for outbreaks to occur. Q fever prevention strategies should incorporate human, animal, and environmental domains. A One Health approach, which engages cross-sectoral collaboration among multiple stakeholders, may be an appropriate framework and has the underlying principles to control Q fever holistically. To assess whether components of One Health for Q fever prevention and control have been applied, a comprehensive literature review was undertaken. We found 16 studies that had practiced or recommended a One Health approach. Seven emerging themes were identified: Human risk assessment, human and animal serology, integrated human⁻animal surveillance, vaccination for at-risk groups, environmental management, multi-sectoral collaboration, and education and training. Within the multi-sectoral theme, we identified five subthemes: Policy and practice guidelines, information sharing and intelligence exchange, risk communication, joint intervention, and evaluation. One Health practices varied between studies possibly due to differences in intercountry policy, practice, and feasibility. However, the key issue of the need for multi-sectoral collaboration was highlighted across most of the studies. Further research is warranted to explore the barriers and opportunities of adopting a One Health approach in Q fever prevention and control.
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Affiliation(s)
- Md Rezanur Rahaman
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
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13
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Scholzen A, Richard G, Moise L, Baeten LA, Reeves PM, Martin WD, Brauns TA, Boyle CM, Raju Paul S, Bucala R, Bowen RA, Garritsen A, De Groot AS, Sluder AE, Poznansky MC. Promiscuous Coxiella burnetii CD4 Epitope Clusters Associated With Human Recall Responses Are Candidates for a Novel T-Cell Targeted Multi-Epitope Q Fever Vaccine. Front Immunol 2019; 10:207. [PMID: 30828331 PMCID: PMC6384241 DOI: 10.3389/fimmu.2019.00207] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022] Open
Abstract
Coxiella burnetii, the causative agent of Q fever, is a Gram-negative intracellular bacterium transmitted via aerosol. Regulatory approval of the Australian whole-cell vaccine Q-VAX® in the US and Europe is hindered by reactogenicity in previously exposed individuals. The aim of this study was to identify and rationally select C. burnetii epitopes for design of a safe, effective, and less reactogenic T-cell targeted human Q fever vaccine. Immunoinformatic methods were used to predict 65 HLA class I epitopes and 50 promiscuous HLA class II C. burnetii epitope clusters, which are conserved across strains of C. burnetii. HLA binding assays confirmed 89% of class I and 75% of class II predictions, and 11 HLA class II epitopes elicited IFNγ responses following heterologous DNA/DNA/peptide/peptide prime-boost immunizations of HLA-DR3 transgenic mice. Human immune responses to the predicted epitopes were characterized in individuals naturally exposed to C. burnetii during the 2007–2010 Dutch Q fever outbreak. Subjects were divided into three groups: controls with no immunological evidence of previous infection and individuals with responses to heat-killed C. burnetii in a whole blood IFNγ release assay (IGRA) who remained asymptomatic or who experienced clinical Q fever during the outbreak. Recall responses to C. burnetii epitopes were assessed by cultured IFNγ ELISpot. While HLA class I epitope responses were sparse in this cohort, we identified 21 HLA class II epitopes that recalled T-cell IFNγ responses in 10–28% of IGRA+ subjects. IGRA+ individuals with past asymptomatic and symptomatic C. burnetii infection showed a comparable response pattern and cumulative peptide response which correlated with IGRA responses. None of the peptides elicited reactogenicity in a C. burnetii exposure-primed guinea pig model. These data demonstrate that a substantial proportion of immunoinformatically identified HLA class II epitopes show long-lived immunoreactivity in naturally infected individuals, making them desirable candidates for a novel human multi-epitope Q fever vaccine.
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Affiliation(s)
| | | | - Leonard Moise
- EpiVax, Inc., Providence, RI, United States.,Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, United States
| | - Laurie A Baeten
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Patrick M Reeves
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | - Timothy A Brauns
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | - Susan Raju Paul
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | - Richard Bucala
- Department of Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Richard A Bowen
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Anne S De Groot
- EpiVax, Inc., Providence, RI, United States.,Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, United States
| | - Ann E Sluder
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | - Mark C Poznansky
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
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Frequency of Adverse Events Following Q Fever Immunisation in Young Adults. Vaccines (Basel) 2018; 6:vaccines6040083. [PMID: 30551615 PMCID: PMC6313871 DOI: 10.3390/vaccines6040083] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/08/2018] [Accepted: 12/08/2018] [Indexed: 12/14/2022] Open
Abstract
Q fever is a zoonosis of concern in many countries. Vaccination is the most effective means of prevention, and since 1989, Australia has had a licensed Q fever vaccine, Q-VAX®. This vaccine was also used in the Netherlands in 2011 following the largest recorded Q fever outbreak globally. There is a paucity of available data regarding adverse events following immunisation (AEFI) for young adult females. Such data are important for informing future vaccination recommendations both within Australia and internationally. This study collected Q fever vaccine (Q-VAX®) AEFI data in veterinary and animal science students at Australian universities. Students were enrolled at the time of vaccination and were emailed a link to an online AEFI survey one week later. Of the 60% (499/827) that responded, 85% were female and the median age was 18 years. Local injection site reactions (ISRs) occurred in 98% (95%; CI 96–99%) of respondents, of which 30% (95% CI 24–32%) were severe. Systemic AEFI occurred in 60% (95%; CI 55–64%) of respondents within the seven days following immunisation. Medical attention was sought by 19/499 (3.8%) respondents, of whom one sought treatment at a hospital emergency department. Females were more likely than males to experience any local ISR (odds ratio [OR] 9.3; 95% CI 2.5–33.8; p < 0.001), ISRs of greater severity (OR 2.5; 95% CI 1.5–4.2; p < 0.001), and any systemic AEFI (OR 1.9; 95% CI 1.1–3.1; p = 0.016). These safety data suggest that a high frequency of adverse events following immunisation should be expected in young adults, particularly females. However, the consequences of Q fever disease are potentially far more debilitating.
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Sellens E, Norris JM, Dhand NK, Heller J, Hayes L, Gidding HF, Willaby H, Wood N, Bosward KL. Willingness of veterinarians in Australia to recommend Q fever vaccination in veterinary personnel: Implications for workplace health and safety compliance. PLoS One 2018; 13:e0198421. [PMID: 29856835 PMCID: PMC5983556 DOI: 10.1371/journal.pone.0198421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/19/2018] [Indexed: 02/07/2023] Open
Abstract
Q fever vaccine uptake among veterinary nurses in Australia is low, suggesting veterinarians are not recommending the vaccination to veterinary personnel. This study aimed to determine the willingness of veterinarians to recommend Q fever vaccination to veterinary personnel and to identify factors influencing Q fever vaccine uptake by veterinary nurses in Australia. An online cross sectional survey targeted veterinarians and veterinary nurses in Australia in 2014. Responses were analysed using multivariable logistic regression. Factors significantly (p<0.05) associated with a willingness to recommend the vaccination, expressed by 35% (95% CI 31-38%) of veterinarians (n = 828), were (1) being very concerned for colleagues regarding Coxiella burnetii (OR 4.73), (2) disagreeing the vaccine is harmful (OR 3.80), (3) high Q fever knowledge (OR 2.27), (4) working within small animal practice (OR 1.67), (5) disagreeing the vaccine is expensive (OR 1.55), and (6) age, with veterinarians under 39 years most likely to recommend vaccination. Of the veterinary nursing cohort who reported a known Q fever vaccination status (n = 688), 29% (95% CI 26-33%) had sought vaccination. This was significantly (p<0.05) associated with (1) agreeing the vaccine is important (OR 8.34), (2) moderate/high Q fever knowledge (OR 5.51), (3) working in Queensland (OR 4.00), (4) working within livestock/mixed animal practice (OR 3.24), (5) disagreeing the vaccine is expensive (OR 1.86), (6) strong reliance on work culture for biosecurity information (OR 2.5), (7) perceiving personal exposure to Coxiella burnetii to be at least low/moderate (OR 2.14), and (8) both agreeing the vaccine is safe and working within a corporate practice structure (OR 4.28). The study identified the need for veterinarians to take greater responsibility for workplace health and safety promotion, and calls for better education of veterinary personnel to raise awareness of the potential for occupational exposure to C. burnetii and improve the perception of the Q fever vaccine as being important, safe and cost-effective.
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Affiliation(s)
- Emily Sellens
- Sydney School of Veterinary Sciences, Faculty of Science, the University of Sydney, Camperdown, NSW, Australia
| | - Jacqueline M. Norris
- Sydney School of Veterinary Sciences, Faculty of Science, the University of Sydney, Camperdown, NSW, Australia
| | - Navneet K. Dhand
- Sydney School of Veterinary Sciences, Faculty of Science, the University of Sydney, Camperdown, NSW, Australia
| | - Jane Heller
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Lynne Hayes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Heather F. Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Harold Willaby
- Sydney School of Public Health, the University of Sydney, Camperdown, NSW, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, the University of Sydney, Camperdown, NSW, Australia
| | - Katrina L. Bosward
- Sydney School of Veterinary Sciences, Faculty of Science, the University of Sydney, Camperdown, NSW, Australia
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17
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Bond KA, Franklin LJ, Sutton B, Firestone SM. Q-Vax Q fever vaccine failures, Victoria, Australia 1994-2013. Vaccine 2017; 35:7084-7087. [PMID: 29132996 DOI: 10.1016/j.vaccine.2017.10.088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/12/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
Q-Vax®, a whole cell formalin inactivated vaccine, is currently the only licensed Q fever vaccine for humans world-wide. Efficacy is high, although vaccine failures have been described for those vaccinated within the incubation of a naturally acquired infection. In Australia, it is widely used to prevent occupational acquisition of Q fever and is the mainstay for outbreak control. A retrospective review of all notified cases of acute Q fever to the Victorian department of health, 1993-2013, revealed 34 of 659 cases were previously vaccinated and 10 cases were positive on pre-vaccination screening, precluding vaccination. Twenty-one cases described high-risk exposures for C. burnetii prior to and within 15 days post vaccination and are likely to have been vaccinated within the incubation period of a natural infection. Thirteen cases described symptom onset more than 15 days post vaccination and thus may represent the first described series of Q-Vax vaccine failures following appropriate vaccination.
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Affiliation(s)
- Katherine A Bond
- Communicable Disease Section, Health Protection Branch, Department of Health and Human Services, Victoria, Australia; Infectious Diseases Department, Austin Health, Australia.
| | - Lucinda J Franklin
- Communicable Disease Section, Health Protection Branch, Department of Health and Human Services, Victoria, Australia
| | - Brett Sutton
- Communicable Disease Section, Health Protection Branch, Department of Health and Human Services, Victoria, Australia
| | - Simon M Firestone
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Australia.
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Lower T, Corben P, Massey P, Depczynski J, Brown T, Stanley P, Osbourn M, Durrheim D. Farmers' knowledge of Q fever and prevention approaches in New South Wales. Aust J Rural Health 2017; 25:306-310. [PMID: 28618042 DOI: 10.1111/ajr.12346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify what New South Wales (NSW) farmers know about Q fever to inform preventive approaches. DESIGN Thematic analysis of qualitative data gathered through semi-structured individual interviews, focus groups and a community meeting. SETTING Rural communities in NSW, Australia. PARTICIPANTS A total of 25 farmers participated in individual interviews (n = 4) or three focus groups, each with seven participants (n = 21). A further 27 persons, were involved in a community meeting. MAIN OUTCOME MEASURES Themes derived from the interviews, focus groups and community meeting. RESULTS Knowledge variations regarding Q fever risk and transmission highlight a need for improved risk communication. Vaccination was viewed as the preferred prevention approach; barriers were raised including time, costs, access to screening/vaccination and General Practitioner (GP) knowledge about Q fever. Local vaccination initiatives were supported. CONCLUSIONS Strengthening existing GP knowledge and services leading to expanded provision of screening/vaccination could improve the coverage of Q fever vaccine in endemic NSW farming and rural communities.
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Affiliation(s)
- Tony Lower
- Australian Centre for Agricultural Health & Safety, University of Sydney, Moree, New South Wales, Australia
| | - Paul Corben
- North Coast Public Health, NSW Health, Port Macquarie, New South Wales, Australia
| | - Peter Massey
- Hunter New England Population Health, NSW Health, Newcastle, Australia
| | - Julie Depczynski
- Australian Centre for Agricultural Health & Safety, University of Sydney, Moree, New South Wales, Australia
| | - Tony Brown
- School of Rural Health Dubbo, University of Sydney, Dubbo, Australia
| | | | - Margaret Osbourn
- Hunter New England Population Health, NSW Health, Newcastle, Australia
| | - David Durrheim
- Hunter New England Population Health, NSW Health, Newcastle, Australia
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Vanderbeke L, Peetermans WE, Saegeman V, De Munter P. Q fever: a contemporary case series from a Belgian hospital. Acta Clin Belg 2016; 71:290-296. [PMID: 27118360 DOI: 10.1080/17843286.2016.1165397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Q fever is a global zoonosis that can cause both acute and chronic infections in humans through aerogenic transmission. Although Q fever was discovered already 80 years ago, this infectious disease remains largely unknown. We studied a case series in a Belgian tertiary care hospital. METHODS A laboratory and file query at our department was performed to detect patients who were newly diagnosed with Q fever from 01 January 2005 to 01 October 2014. RESULTS In total, 10 acute Q fever and 5 chronic Q fever infections were identified. An aspecific flu-like illness was the prevailing manifestation of acute Q fever, while this was infective endocarditis in chronic Q fever cases. Noteworthy are the high percentage of myocarditis cases in the acute setting and one case of amyloidosis as a manifestation of chronic Q fever. No evolution from acute to chronic Q fever was noted; overall outcome for both acute and chronic Q fever was favourable with a 94% survival rate. DISCUSSION Q fever is an infectious disease characterised by a variable clinical presentation. Detection requires correct assessment of the clinical picture in combination with a laboratory confirmation. Treatment and follow-up are intended to avoid a negative outcome.
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Q Fever Knowledge, Attitudes and Vaccination Status of Australia's Veterinary Workforce in 2014. PLoS One 2016; 11:e0146819. [PMID: 26756210 PMCID: PMC4710533 DOI: 10.1371/journal.pone.0146819] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/22/2015] [Indexed: 12/03/2022] Open
Abstract
Q fever, caused by Coxiella burnetii, is a serious zoonotic disease in humans with a worldwide distribution. Many species of animals are capable of transmitting C. burnetii, and consequently all veterinary workers are at risk for this disease. An effective Q fever vaccine has been readily available and used in Australia for many years in at-risk groups, and the European Centre for Disease Prevention and Control has recently also called for the use of this vaccine among at-risk groups in Europe. Little is known about attitudes towards this vaccine and vaccine uptake in veterinary workers. This study aimed to determine the Q fever vaccination status of veterinarians and veterinary nurses in Australia and to assess and compare the knowledge and attitudes towards Q fever disease and vaccination of each cohort. An online cross-sectional survey performed in 2014 targeted all veterinarians and veterinary nurses in Australia. Responses from 890 veterinarians and 852 veterinary nurses were obtained. Binary, ordinal and multinomial logistic regression were used to make comparisons between the two cohorts. The results showed that 74% of veterinarians had sought vaccination compared to only 29% of veterinary nurses. Barriers to vaccination among those not vaccinated did not differ between cohorts, and included a lack of perceived risk, financial expense, time constraints, and difficulty in finding a vaccine provider. Poor knowledge and awareness of Q fever disease and vaccination were additional and notable barriers for the veterinary nursing cohort, suggesting veterinary clinics and veterinarians may not be meeting their legal responsibility to educate staff about risks and risk prevention. Further evaluation is needed to identify the drivers behind seeking and recommending vaccination so that recommendations can be made to improve vaccine uptake.
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Abstract
Q fever is a zoonosis of worldwide distribution with the exception of New Zealand. It is caused by an intracellular bacterium, Coxiella burnetii. The disease often goes underdiagnosed because the main manifestation of its acute form is a general self-limiting flu-like syndrome. The Dutch epidemics renewed attention to this disease, which was less considered before. This review summarizes the description of C. burnetii (taxonomy, intracellular cycle, and genome) and Q fever disease (description, diagnosis, epidemiology, and pathogenesis). Finally, vaccination in humans and animals is also considered.
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Affiliation(s)
- Samira Boarbi
- Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique.,Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique
| | - David Fretin
- Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique.,Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique
| | - Marcella Mori
- Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique.,Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique
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van Holland BJ, Soer R, de Boer MR, Reneman MF, Brouwer S. Preventive occupational health interventions in the meat processing industry in upper-middle and high-income countries: a systematic review on their effectiveness. Int Arch Occup Environ Health 2014; 88:389-402. [PMID: 25099824 DOI: 10.1007/s00420-014-0964-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effectiveness of occupational health interventions in the meat processing industry on work and health-related outcomes. METHODS A systematic literature review was performed. PubMed, Embase, and The Cochrane Library were searched. Studies were included when they reported on an intervention among employees in the meat processing industry and with outcomes related to work or health. Studies were assessed on risk of bias, and data were synthesized by type of intervention. RESULTS A total of 13 articles reporting on two randomized controlled trials and nine non-randomized intervention studies were retrieved. Studies were categorized into three topics: ergonomics programs, skin protection, and Q fever vaccination. All studies had high risk of bias. Based on four studies, there was limited evidence for workplace health and safety programs showing reductions in musculoskeletal injury severity, reduction of lost work days, and reduction of costs and claims for several musculoskeletal disorders. There was limited evidence for added rest breaks resulting in improved productivity at the end of a workday and in reductions of perceived discomfort in various body regions at the end of the workday. One study on skin protection showed reductions of eczema prevalence, although evidence was moderate. Based on four studies, there was high-quality evidence for strong effectiveness of Q fever vaccination. CONCLUSION This review presents evidence for the effectiveness of a variety of workplace interventions. There was limited evidence for effectiveness of ergonomic interventions, moderate evidence of a skin protection intervention, and strong evidence for Q fever vaccination.
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Affiliation(s)
- Berry J van Holland
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Dilgtweg 5, 9751 ND, Haren, Groningen, The Netherlands,
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Schoffelen T, Herremans T, Sprong T, Nabuurs-Franssen M, Wever PC, Joosten LA, Netea MG, van der Meer JW, Bijlmer HA, van Deuren M. Limited humoral and cellular responses to Q fever vaccination in older adults with risk factors for chronic Q fever. J Infect 2013; 67:565-73. [DOI: 10.1016/j.jinf.2013.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 02/06/2023]
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O'Neill TJ, Sargeant JM, Poljak Z. The effectiveness of Coxiella burnetii vaccines in occupationally exposed populations: a systematic review and meta-analysis. Zoonoses Public Health 2013; 61:81-96. [PMID: 23721172 DOI: 10.1111/zph.12054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Indexed: 12/21/2022]
Abstract
To estimate the effect of vaccination in preventing acute Q fever in individuals occupationally exposed to Coxiella burnetii, a systematic review and meta-analysis were undertaken in controlled trials and observational studies. Publications were obtained through a scoping study of English and non-English articles, and those reporting a commercially licensed or licensable vaccine compared with an unvaccinated or placebo control group were included in the review. Two authors performed independent assessment of risk of systematic error and data extraction. One controlled trial and five cohort publications met the inclusion criteria. All trials used a Henzerling phase I vaccine. A random-effects meta-analysis estimated significant protection in abattoir workers (RR = 0.07; 95% confidence interval [CI] 0.02-0.22) compared with the control individuals. In individuals with rare or sporadic contact with the abattoir, a significant benefit of vaccination was also found (RR = 0.06; 95% CI 0-0.93). Overall, the vaccine effectively prevented acute Q fever in individuals responsible for handling animals or their products and those working in the abattoir but not directly exposed to animals (RR = 0.06; 95% CI 0.02-0.18). Caution must be taken when interpreting the effect of C. burnetii vaccination as significant heterogeneity amongst publications was observed. A meta-regression found no significant univariate associations. This may reflect the uncertainty provided by reported data in the cohort publications. Potential systematic biases were present in the publications, and evidence included may not be sufficiently robust to extrapolate the effect of vaccination on occupationally exposed groups beyond the population of abattoir employees in Australia where all included studies occurred.
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Affiliation(s)
- T J O'Neill
- Centre for Public Health and Zoonoses, Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Trubiano JA, Holmes NE, Williams DS, Ng J, Chua K, Howden BP. Coxiella burnetii endocarditis after Q fever vaccination. J Med Microbiol 2012; 61:1775-1779. [PMID: 22956746 DOI: 10.1099/jmm.0.050880-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Coxiella burnetii is the causative bacterium of Q fever, a vaccine-preventable infection. C. burnetii is an unusual cause of culture-negative endocarditis. Here, we present a case of Q fever native valve endocarditis that developed in a young man despite prior vaccination. Definitive diagnosis was difficult and required C. burnetii-specific PCR testing.
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Affiliation(s)
- Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | - David S Williams
- Department of Anatomical Pathology, Austin Health, Heidelberg, VIC, Australia
| | - Jimmy Ng
- Institute for Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, NSW, Australia
| | - Kyra Chua
- Department of Microbiology, Austin Health, Heidelberg, VIC, Australia
| | - Benjamin P Howden
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC, Australia.,Department of Microbiology, Austin Health, Heidelberg, VIC, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
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Bults M, Beaujean DJMA, Wijkmans CJ, Timen A, Richardus JH, Voeten HACM. Why did patients with cardiovascular disease in the Netherlands accept Q fever vaccination? Vaccine 2012; 30:3369-75. [PMID: 22475862 DOI: 10.1016/j.vaccine.2012.03.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 03/06/2012] [Accepted: 03/21/2012] [Indexed: 11/25/2022]
Abstract
This study examines patient's reasons for accepting Q fever vaccination, including risk perception, feelings of doubt, social influence, information-seeking behavior, preventive measures taken, and perceptions regarding received information and governmental action. Data was obtained from exit interviews conducted after Q fever vaccination, between January and April 2011. A total of 413 patients with specific cardiovascular conditions in the Netherlands participated in exit interviews; 70% were older than 60 years. Most reported reasons for accepting Q fever vaccination were: "I am at an increased risk for developing (chronic) Q fever" (69%) and "my general practitioner recommends Q fever vaccination for me" (34%). The majority (86%) reported a high perceived severity of Q fever, and only 6% felt vulnerable to Q fever after vaccination. One-third had doubts about getting vaccinated, primarily related to fears of side effects and practical barriers. Fifty-two percent solicited advice from their social networks; of these, 67% reported influence on their vaccination decision. General practitioners and family were the most reported sources of advice. Thirty percent actively sought information about Q fever vaccination. Twenty-two percent of all respondents had taken other preventive measures, such as avoiding contact with goats and sheep (74%), and cancelling or postponing visits to Q fever-affected areas (36%). Almost one-half of all respondents reported negative feelings regarding governmental action to control Q fever. Significant differences were observed regarding feelings of doubt, information-seeking behavior, perceived vulnerability, preventive measures taken, and perceptions regarding received information and governmental action regarding gender, age, educational level, and/or employment status. Vaccination decision-making may differ among socio-demographic subgroups. When preparing future vaccination campaigns, it is important to obtain greater insight into these differences and take these aspects into account in risk communication strategies by tailoring information to specific target groups.
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Affiliation(s)
- Marloes Bults
- Municipal Public Health Service Rotterdam-Rijnmond, 3000 LP Rotterdam, The Netherlands.
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Epidemic Q fever in humans in the Netherlands. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 984:329-64. [PMID: 22711640 DOI: 10.1007/978-94-007-4315-1_17] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2005, Q fever was diagnosed on two dairy goat farms and 2 years later it emerged in the human population in the south of the Netherlands. From 2007 to 2010, more than 4,000 human cases were notified with an annual seasonal peak. The outbreaks in humans were mainly restricted to the south of the country in an area with intensive dairy goat farming. In the most affected areas, up to 15% of the population may have been infected. The epidemic resulted in a serious burden of disease, with a hospitalisation rate of 20% of notified cases and is expected to result in more cases of chronic Q fever among risk groups in the coming years. The most important risk factor for human Q fever is living close (<5 km) to an infected dairy goat farm. Occupational exposure plays a much smaller role. In 2009 several veterinary control measures were implemented including mandatory vaccination of dairy goats and dairy sheep, improved hygiene measures, and culling of pregnant animals on infected farms. The introduction of these drastic veterinary measures has probably ended the Q fever outbreak, for which the Netherlands was ill-prepared.
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Porter SR, Czaplicki G, Mainil J, Guattéo R, Saegerman C. Q Fever: current state of knowledge and perspectives of research of a neglected zoonosis. Int J Microbiol 2011; 2011:248418. [PMID: 22194752 PMCID: PMC3238387 DOI: 10.1155/2011/248418] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 08/23/2011] [Indexed: 12/19/2022] Open
Abstract
Q fever is an ubiquitous zoonosis caused by an resistant intracellular bacterium, Coxiella burnetii. In certain areas, Q fever can be a severe public health problem, and awareness of the disease must be promoted worldwide. Nevertheless, knowledge of Coxiella burnetii remains limited to this day. Its resistant (intracellular and environmental) and infectious properties have been poorly investigated. Further understanding of the interactions between the infected host and the bacteria is necessary. Domestic ruminants are considered as the main reservoir of bacteria. Infected animals shed highly infectious organisms in milk, feces, urine, vaginal mucus, and, very importantly, birth products. Inhalation is the main route of infection. Frequently asymptomatic in humans and animals, Q fever can cause acute or chronic infections. Financial consequences of infection can be dramatic at herd level. Vaccination with inactive whole-cell bacteria has been performed and proved effective in humans and animals. However, inactive whole-cell vaccines present several defects. Recombinant vaccines have been developed in experimental conditions and have great potential for the future. Q fever is a challenging disease for scientists as significant further investigations are necessary. Great research opportunities are available to reach a better understanding and thus a better prevention and control of the infection.
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Affiliation(s)
- Sarah Rebecca Porter
- Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR), Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, University of Liège, B42, Boulevard de Colonster 20, 4000 Liège, Belgium
| | - Guy Czaplicki
- Département de Sérologie, Association Régionale de Santé et d'Identification Animales, 4431 Loncin, Belgium
| | - Jacques Mainil
- Laboratory of Bacteriology, Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, University of Liège, Sart-Tilman B43a, 4000 Liège, Belgium
| | - Raphaël Guattéo
- UMR 1300 Bio-Agression, Epidémiologie et Analyse de Risque, INRA, 44307 Nantes, France
| | - Claude Saegerman
- Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR), Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, University of Liège, B42, Boulevard de Colonster 20, 4000 Liège, Belgium
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Bailey MS, Trinick T, Dunbar J, Hatch R, Osborne J, Brooks T, Green A. Undifferentiated Febrile Illnesses Amongst British Troops in Helmand, Afghanistan. J ROY ARMY MED CORPS 2011; 157:150-5. [DOI: 10.1136/jramc-157-02-05] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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