Abstract
We investigated a Q fever outbreak with human patients showing high fever, respiratory tract symptoms, headache and retrosternal pain in southern Hungary in the spring and summer of 2013. Seventy human cases were confirmed by analysing their serum and blood samples with micro-immunofluorescence test and real-time PCR. The source of infection was a merino sheep flock of 450 ewes, in which 44.6% (25/56) seropositivity was detected by enzyme-linked immunosorbent assay. Coxiella burnetii DNA was detected by real-time PCR in the milk of four of 20 individuals and in two thirds (41/65) of the manure samples. The multispacer sequence typing examination of C. burnetii DNA revealed sequence type 18 in one human sample and two manure samples from the sheep flock. The multilocus variable-number tandem repeat analysis pattern of the sheep and human strains were also almost identical, 4/5-9-3-3-0-5 (Ms23-Ms24-Ms27-Ms28-Ms33-Ms34). It is hypothesised that dried manure and maternal fluid contaminated with C. burnetii was dispersed by the wind from the sheep farm towards the local inhabitants. The manure was eliminated in June and the farm was disinfected in July. The outbreak ended at the end of July 2013.
Highlights
Coxiella burnetii is the causative agent of Q fever, a worldwide zoonotic disease [1,2]
During the epidemic investigation a suspected human case was defined by high fever and radiological evidence of pneumonia occurring after 17 April 2013, and by geographic proximity to the outbreak area after 4 April
A non-dairy merino sheep flock (450 ewes) near Vokány, a small cattle herd (40 animals), a small mixed flock of sheep and goats (20 animals) and some individually kept animals were the only livestock in the region
Summary
Coxiella burnetii is the causative agent of Q fever, a worldwide zoonotic disease [1,2]. Domestic ruminants are the most important recognised reservoirs of C. burnetii; they are often asymptomatic carriers, but the agent may cause abortion in these animals [1,3]. Ticks may act as reservoirs of C. burnetii in nature [1,4]. Domestic ruminants are considered the most important source of human Q fever infection. Outbreaks in human populations have been linked to slaughterhouses or dispersion of C. burnetii by wind from farms where infected ruminants were kept [1,5]. Q fever is typically an acute febrile illness with nonspecific clinical signs such as atypical pneumonia and hepatitis in roughly 40% of cases, while 60% remain asymptomatic after infection [6]. A small percentage (ca 5%) of infected people may develop chronic infection with life-threatening valvular endocarditis [7,8]
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