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Q FEVER AWARENESS
TRAINING FOR DLAM
Coxiella burnetii
What is Q Fever?
• Ruminants such as sheep, goats, and cattle can present a significant risk to animal handlers/workers for exposure to Coxiella burnetii.
• Q fever is a zoonotic disease caused by the organism Coxiellaburnetii.
• Large numbers of the bacteria are found in certain tissues and fluids of pregnant ruminants, i.e., the uterus, the placenta, the mammary glands or udders, and milk. However, the bacteria may be found in both male and female sheep.
• Individuals acquire this infection by inhaling aerosols and contaminated dusts generated by animals or animal products.
• Coxiella burnetii is highly resistant to heat, drying, & some disinfectants
• Can survive for months in dust & feces particles
• Q stands for Query
• Discovered in 1937 in Queensland, Australia (slaughterhouse workers)
• 1938- Montana, USA (isolated from ticks)
• Outbreaks
– Largest outbreak 2007-2010 more than 4,000 cases in the Netherlands; required euthanizing 50,000 goats
– 2011- Northwestern US-involved 21 goat farms and resulted in 20 human infections
– Military troops • In areas with infected animals
– Cities and towns• Downwind from farms
• Near roads traveled by animals
Q Fever in Animals
• Sheep, goats, cattle
▫ Often asymptomatic
▫ Reproductive failure in females
Abortions
Stillbirths
Low birth weight
Infertility
• Rarely fatal to animals
• Has been found in other animal species
▫ Dogs, cats, horses, rabbits, birds
Q Fever in Humans
Incubation: 2 to 4 weeks
Disease
50%-Show no symptoms at all
Acute
Chronic
Acute Infection
Flu like symptoms: high fever (up to 104-105◦F),
headache, sore throat, vomiting, nausea, fatigue
Pneumonia with mild cough (50%)
Less common
• Hepatitis, central nervous system complications
Usually resolves after 2-3 weeks
>50% show no symptoms at all
2-4% require hospitalization
<1% mortality rate
Chronic Disease (> 6 months)
1-5% of acutely infected individuals develop chronic
disease.
Pre-existing heart conditions, pregnant women,
immunocompromised individuals at greater risk
Endocarditis-inflammation of the heart (60-70%)
Mortality rate >50%
Endocarditis- mortality rate 25-60% if untreated
Risk to Pregnant Women
Most show no symptoms (98%)
Can be passed from mother to baby
Reported complications
Premature birth
Low birth weight
Miscarriage
Placentitis (inflammation of placenta)
Greatest risk during 1st trimester
TRANSMISSION
Transmission
• Inhalation (most common)
▫ Dust, droplets
▫ Birthing fluids/materials
109 bacteria released per gram of placenta
▫ Urine, feces, raw milk
• Direct or indirect contact with infected animal
• Contaminated surfaces, clothing, equipment, bedding, etc
• Arthropods (ticks)
• Person to person transmission is rare
Who’s at risk? Farmers
Veterinarians
Meat processors/ abattoir workers
Laboratory workers/animal laboratory workers
Immunocompromised individuals
Pregnant women
Q Fever in the U.S.:
*CDC 2011
*CDC-2011
Medical Surveillance
Prior to working with sheep
The following should contact UEOHC for a medical
screening/risk assessment :
Immunocompromised individuals and those with pre-
existing heart valve conditions are at higher risk of
infection and should be fully informed of the increased
risks.
Pregnant women or women who are considering
becoming pregnant should also be fully informed of the
increased risks.
UEOHC
Monday- Friday (8:30am-4:30pm)
919-966-9119
Signs and Symptoms of Q Fever
Often there are no symptoms or mild flu-like symptoms
Common signs and symptoms include:
sudden onset of high fever (104-105°F)
headache
malaise and fatigue
nausea and/or vomiting
chills and sweating
general feeling of sickness and loss of appetite
More serious complications can affect the immune-compromised,
individuals with heart valve defects, and pregnant women.
UEOHC
Monday- Friday (8:30am-4:30pm)
919-966-9119
Exposure Procedures
Exposure Procedures
Immediate Response:
Mucous membrane exposure: flush in an eye wash or
potable water for a minimum of 15 minutes.
Non-intact skin exposure: Wash with soap and water
or antiseptic for 15 minutes.
REPORT ANY INJURIES AND ILLNESSES TO
DLAM MANAGER/SUPERVISOR AND IMMEDIATELY
REPORT TO UEOHC (919-966-9119)
Reporting Signs and Symptoms
of Exposure
Employees experiencing any of the symptoms
associated with exposure (even without an identified
exposure incident) must report it to the DLAM
Manager/Supervisor, UEOHC, and EHS.
If you have worked in the DLAM facility within the last
two weeks of experiencing any of the symptoms
associated with Q fever, report it to the DLAM
Manager/Supervisor, UEOHC, & EHS.
Post Exposure Treatment
If prophylactic antibiotic treatment is considered
appropriate by clinic or ER medical staff, antibiotics
are generally given for 2-3 weeks (acute) or for at
least 18 months (chronic) unless otherwise
contraindicated.
Injuries Requiring Emergency
Medical Assistance
Call 911
Respiratory ProtectionN95/PAPR
Respiratory Protection
Powered Air Purifying Respirators (PAPR’s) or N95
masks are required to enter the animal housing area
and laboratory.
Annual training and respiratory clearance required
(clearance is done at the UEOHC).
Annual fit testing for N95 is required.
DLAM staff will wear the PAPR to enter the animal
housing area.
Respiratory Protection Program Requirements29 CFR 1910.134
There are established procedures for selecting
respirators for use in the workplace.
A medical evaluation is required to use respirators.
Fit testing procedures are required for tight-fitting
respirators.
Procedures and schedules are in place for cleaning,
disinfecting, storing, inspecting, repairing, discarding,
and otherwise maintaining respirators.
Respiratory Protection Program Requirements29 CFR 1910.134
Training of employees in respiratory hazards to
which they are potentially exposed during routine
and emergency situations is required.
Training of employees in the proper use of
respirators, including putting on and removing, any
limitations on their use, and the maintenance of the
respirator is required.
Procedures are in place for regularly evaluating the
effectiveness of the program.
Prevention and Control
Personal Protective Equipment (PPE)
• Safety Shoes & Shoe Covers
• Powered Air Purifying Respirator (PAPR)
• Gloves
• Disposable Coveralls
PAPR must be worn by ALL DLAM staff when entering the sheep room. The
PAPR should be wiped down with alcohol after each use.
PPE should be removed immediately upon exiting the room & placed into
the PPE receptacle outside the room. Bags of used PPE will be tied
up and put in the dumpster when full.
Wash or sanitize your hands as soon as possible
after removing gloves.
Sanitation
Rubber mats will be placed on the floor to provide
traction for the sheep.
The mats will be covered with pine shavings.
Sheep rooms are spot cleaned daily.
Soiled areas should be scooped or shoveled up and
placed into a bedding bin. Take care not to produce
dust when cleaning.
Clean pine shavings should be added as necessary.
Sanitation
Feed bowls are rinsed daily and sanitized weekly.
Enrichment items are sanitized weekly.
Periodically, as determined by the DLAM
manager/supervisor, all shavings will be removed
from the room and replaced by clean shavings.
Sanitation
Rooms should be sanitized using approved disinfectants
at the end of each study (approximately every 4 weeks).
Shavings will be scooped or shoveled up and placed into
a bedding bin.
Bedding bins will be placed in designated areas outside
the building for pick up when full.
Send rubber floor mats to cage wash to be sanitized.
Foam walls, floor, and ceiling with Vimoba. Allow 15
minutes contact time.
Rinse all surfaces thoroughly.
Sheep Health
The sheep must be observed daily for signs of potential
illness.
Report any abnormal health condition to veterinary
services “Sick Animal Reporting”.
If immediate attention is required, you must contact and
speak directly to a member of the veterinary team.
If a dead sheep is found in the room, notify the
veterinary staff immediately and follow their instructions.
Notify your manager/supervisor and check the contact
sheet on the door to see if the research staff wants to be
notified.
Questions
If you have any questions or concerns, please contact your
DLAM Manager/Supervisor or
EHS (919-962-5507).
Thank you!