Volume 94, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



is a zoonotic pathogen that causes Q fever in humans and is transmitted primarily from infected goats, sheep, or cows. Q fever typically presents as an acute febrile illness; however, individuals with certain predisposing conditions, including cardiac valvulopathy, are at risk for chronic Q fever, a serious manifestation that may present as endocarditis. In response to a cluster of Q fever cases detected by public health surveillance, we evaluated infection in a community that operates a large-scale cow and goat dairy. A case was defined as an individual linked to the community with a phase II IgG titer ≥ 128. Of 135 participants, 47 (35%) cases were identified. Contact with or close proximity to cows, goats, and their excreta was associated with being a case (relative risk 2.7, 95% confidence interval 1.3–5.3). Cases were also identified among individuals without cow or goat contact and could be related to windborne spread or tracking of on fomites within the community. A history of injection drug use was reported by 26/130 (20%) participants; follow-up for the presence of valvulopathy and monitoring for development of chronic Q fever may be especially important among this population.


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  1. Anderson A, Bijlmer H, Fournier PE, Graves S, Hartzell J, Kersh GJ, Limonard G, Marrie TJ, Massung RF, McQuiston JH, Nicholson WL, Paddock CD, Sexton DJ, , 2013. Diagnosis and management of Q fever–United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 62: 130. [Google Scholar]
  2. Dijkstra F, Riphagen-Dalhuisen J, Wijers N, Hak E, Van der Sande MA, Morroy G, Schneeberger PM, Schimmer B, Notermans DW, Van der Hoek W, , 2011. Antibiotic therapy for acute Q fever in the Netherlands in 2007 and 2008 and its relation to hospitalization. Epidemiol Infect 139: 13321341.[Crossref] [Google Scholar]
  3. Sobradillo V, Zalacain R, Capelastegui A, Uresandi F, Corral J, , 1992. Antibiotic treatment in pneumonia due to Q fever. Thorax 47: 276278.[Crossref] [Google Scholar]
  4. Tigertt WD, Benenson AS, Gochenour WS, , 1961. Airborne Q fever. Bacteriol Rev 25: 285293. [Google Scholar]
  5. Kersh GJ, Fitzpatrick KA, Self JS, Priestley RA, Kelly AJ, Lash RR, Marsden-Haug N, Nett RJ, Bjork A, Massung RF, Anderson AD, , 2013. Presence and persistence of Coxiella burnetii in the environments of goat farms associated with a Q fever outbreak. Appl Environ Microbiol 79: 16971703.[Crossref] [Google Scholar]
  6. McCaul TF, Williams JC, Thompson HA, , 1991. The development cycle of Coxiella burnetii . , ed. Q Fever: The Biology of Coxiella burnetii . Boca Raton, FL: CRC Press, 223258. [Google Scholar]
  7. Hawker JI, Ayres JG, Blair I, Evans MR, Smith DL, Smith EG, Burge PS, Carpenter MJ, Caul EO, Coupland B, Desselberger U, Farrell ID, Saunders PJ, Wood MJ, , 1998. A large outbreak of Q fever in the West Midlands: windborne spread into a metropolitan area? Commun Dis Public Health 1: 180187. [Google Scholar]
  8. Tissot-Dupont H, Amadei MA, Nezri M, Raoult D, , 2004. Wind in November, Q fever in December. Emerg Infect Dis 10: 12641269.[Crossref] [Google Scholar]
  9. Tissot-Dupont H, Torres S, Nezri M, Raoult D, , 1999. Hyperendemic focus of Q fever related to sheep and wind. Am J Epidemiol 150: 6774.[Crossref] [Google Scholar]
  10. Hackert VH, van der Hoek W, Dukers-Muijrers N, de Bruin A, Al Dahouk S, Neubauer H, Bruggeman CA, Hoebe CJ, , 2012. Q fever: single-point source outbreak with high attack rates and massive numbers of undetected infections across an entire region. Clin Infect Dis 55: 15911599.[Crossref] [Google Scholar]
  11. McQuiston JH, Childs JE, , 2002. Q fever in humans and animals in the United States. Vector Borne Zoonotic Dis 2: 179191.[Crossref] [Google Scholar]
  12. Loftis AD, Reeves WK, Szumlas DE, Abbassy MM, Helmy IM, Moriarity JR, Dasch GA, , 2006. Rickettsial agents in Egyptian ticks collected from domestic animals. Exp Appl Acarol 40: 6781.[Crossref] [Google Scholar]
  13. Fitzpatrick KA, Kersh GJ, Massung RF, , 2010. Practical method for extraction of PCR-quality DNA from environmental soil samples. Appl Environ Microbiol 76: 45714573.[Crossref] [Google Scholar]
  14. Anderson AD, Kruszon-Moran D, Loftis AD, McQuillan G, Nicholson WL, Priestley RA, Candee AJ, Patterson NE, Massung RF, , 2009. Seroprevalence of Q fever in the United States, 2003–2004. Am J Trop Med Hyg 81: 691694.[Crossref] [Google Scholar]
  15. Walsh MG, , 2012. Assessing Q fever in a representative sample from the United States population: identification of a potential occupational hazard. Epidemiol Infect 140: 4246.[Crossref] [Google Scholar]
  16. Hermans T, Jeurissen L, Hackert V, Hoebe C, , 2014. Land-applied goat manure as a source of human Q-fever in the Netherlands, 2006–2010. PLoS One 9: e96607.[Crossref] [Google Scholar]
  17. National Association of State Public Health Veterinarians, National Assembly of State Animal Health Officials, 2013. Prevention and Control of Coxiella burnetii Infection among Humans and Animals: Guidance for a Coordinated Public Health and Animal Health Response. Available at: http://www.nasphv.org/Documents/Q_Fever_2013.pdf. [Google Scholar]
  18. Casman EA, , 1996. Chemical and Microbiological Consequences of Anaerobic Digestion of Livestock Manure, A Literature Review. Interstate Commission on the Potomac River Basin, Report #96-6. Available at: https://www.potomacriver.org/wp-content/uploads/2014/12/ICP96-6_Casman.pdf. [Google Scholar]
  19. Dahlgren FS, McQuiston JH, Massung RF, Anderson AD, , 2015. Q fever in the United States: summary of case reports from two national surveillance systems, 2000–2012. Am J Trop Med Hyg 92: 247255.[Crossref] [Google Scholar]
  20. Gilsdorf A, Kroh C, Grimm S, Jensen E, Wagner-Wiening C, Alpers K, , 2008. Large Q fever outbreak due to sheep farming near residential areas, Germany, 2005. Epidemiol Infect 136: 10841087.[Crossref] [Google Scholar]
  21. The National Drought Mitigation Center. United States Drought Monitor, Tabular Data Archive. Available at: http://droughtmonitor.unl.edu/MapsandData/DataTables.aspx?midwest. Accessed January 15, 2015. [Google Scholar]
  22. Karagiannis I, Schimmer B, Van Lier A, Timen A, Schneeberger P, Van Rotterdam B, De Bruin A, Wijkmans C, Rietveld A, Van Duynhoven Y, , 2009. Investigation of a Q fever outbreak in a rural area of the Netherlands. Epidemiol Infect 137: 12831294.[Crossref] [Google Scholar]
  23. van der Hoek W, Hunink J, Vellema P, Droogers P, , 2011. Q fever in the Netherlands: the role of local environmental conditions. Int J Environ Health Res 21: 441451.[Crossref] [Google Scholar]
  24. Schimmer B, Ter Schegget R, Wegdam M, Züchner L, de Bruin A, Schneeberger PM, Veenstra T, Vellema P, van der Hoek W, , 2010. The use of a geographic information system to identify a dairy goat farm as the most likely source of an urban Q-fever outbreak. BMC Infect Dis 10: 69.[Crossref] [Google Scholar]
  25. Salmon MM, Howells B, Glencross EJ, Evans AD, Palmer SR, , 1982. Q fever in an urban area. Lancet 1: 10021004.[Crossref] [Google Scholar]
  26. Oliphant JW, Gordon DA, Meis A, Parker RR, , 1949. Q fever in laundry workers, presumably transmitted from contaminated clothing. Am J Hyg 49: 7682. [Google Scholar]
  27. Marrie TJ, Langille D, Papukna V, Yates L, , 1989. Truckin' pneumonia: an outbreak of Q fever in a truck repair plant probably due to aerosols from clothing contaminated by contact with newborn kittens. Epidemiol Infect 102: 119127.[Crossref] [Google Scholar]
  28. Fenollar F, Fournier PE, Carrieri MP, Habib G, Messana T, Raoult D, , 2001. Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 33: 312316.[Crossref] [Google Scholar]
  29. Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E, Stein A, Nesri M, Harle JR, Weiller PJ, , 2000. Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 79: 109123.[Crossref] [Google Scholar]
  30. Frontera JA, Gradon JD, , 2000. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis 30: 374379.[Crossref] [Google Scholar]
  31. Levitt MA, Snoey ER, Tamkin GW, Gee G, , 1999. Prevalence of cardiac valve abnormalities in afebrile injection drug users. Acad Emerg Med 6: 911915.[Crossref] [Google Scholar]
  32. Pons-Lladó G, Carreras F, Borrás X, Cadafalch J, Fuster M, Guardia J, Casas M, , 1992. Findings on Doppler echocardiography in asymptomatic intravenous heroin users. Am J Cardiol 69: 238241.[Crossref] [Google Scholar]
  33. Axelsson A, Søholm H, Dalsgaard M, Helweg-Larsen J, Ihlemann N, Bundgaard H, Køber L, Iversen K, , 2014. Echocardiographic findings suggestive of infective endocarditis in asymptomatic Danish injection drug users attending urban injection facilities. Am J Cardiol 114: 100104.[Crossref] [Google Scholar]
  34. Alagna L, Park LP, Nicholson BP, Keiger AJ, Strahilevitz J, Morris A, Wray D, Gordon D, Delahaye F, Edathodu J, Miró JM, Fernández-Hidalgo N, Nacinovich FM, Shahid R, Woods CW, Joyce MJ, Sexton DJ, Chu VH, , 2013. Repeat endocarditis: analysis of risk factors based on the International Collaboration on Endocarditis: prospective cohort study. Clin Microbiol Infect 20: 566575.[Crossref] [Google Scholar]
  35. Moss R, Munt B, , 2003. Injection drug use and right sided endocarditis. Heart 89: 577581.[Crossref] [Google Scholar]
  36. Mathew J, Addai T, Anand A, Morrobel A, Maheshwari P, Freels S, , 1995. Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users. Arch Intern Med 155: 16411648.[Crossref] [Google Scholar]
  37. Bjork A, Marsden-Haug N, Nett RJ, Kersh GJ, Nicholson W, Gibson D, Szymanski T, Emery M, Kohrs P, Woodhall D, Anderson AD, , 2014. First reported multistate human Q fever outbreak in the United States, 2011. Vector Borne Zoonotic Dis 14: 111117.[Crossref] [Google Scholar]

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  • Received : 06 Oct 2015
  • Accepted : 06 Dec 2015
  • Published online : 02 Mar 2016

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