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Q FEVER AWARENESS TRAINING FOR DLAM Coxiella burnetii

Q Fever Awareness Training for DLAM

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Page 1: Q Fever Awareness Training for DLAM

Q FEVER AWARENESS

TRAINING FOR DLAM

Coxiella burnetii

Page 2: Q Fever Awareness Training for DLAM

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

Page 3: Q Fever Awareness Training for DLAM

• 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

Page 4: Q Fever Awareness Training for DLAM

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

Page 5: Q Fever Awareness Training for DLAM

Q Fever in Humans

Incubation: 2 to 4 weeks

Disease

50%-Show no symptoms at all

Acute

Chronic

Page 6: Q Fever Awareness Training for DLAM

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

Page 7: Q Fever Awareness Training for DLAM

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

Page 8: Q Fever Awareness Training for DLAM

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

Page 9: Q Fever Awareness Training for DLAM

TRANSMISSION

Page 10: Q Fever Awareness Training for DLAM

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

Page 11: Q Fever Awareness Training for DLAM

Who’s at risk? Farmers

Veterinarians

Meat processors/ abattoir workers

Laboratory workers/animal laboratory workers

Immunocompromised individuals

Pregnant women

Page 12: Q Fever Awareness Training for DLAM

Q Fever in the U.S.:

*CDC 2011

Page 13: Q Fever Awareness Training for DLAM

*CDC-2011

Page 14: Q Fever Awareness Training for DLAM

Medical Surveillance

Page 15: Q Fever Awareness Training for DLAM

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

Page 16: Q Fever Awareness Training for DLAM

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

Page 17: Q Fever Awareness Training for DLAM

Exposure Procedures

Page 18: Q Fever Awareness Training for DLAM

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)

Page 19: Q Fever Awareness Training for DLAM

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.

Page 20: Q Fever Awareness Training for DLAM

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.

Page 21: Q Fever Awareness Training for DLAM

Injuries Requiring Emergency

Medical Assistance

Call 911

Page 22: Q Fever Awareness Training for DLAM

Respiratory ProtectionN95/PAPR

Page 23: Q Fever Awareness Training for DLAM

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.

Page 24: Q Fever Awareness Training for DLAM

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.

Page 25: Q Fever Awareness Training for DLAM

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.

Page 26: Q Fever Awareness Training for DLAM

Prevention and Control

Page 27: Q Fever Awareness Training for DLAM

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.

Page 28: Q Fever Awareness Training for DLAM

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.

Page 29: Q Fever Awareness Training for DLAM

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.

Page 30: Q Fever Awareness Training for DLAM

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.

Page 31: Q Fever Awareness Training for DLAM

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.

Page 32: Q Fever Awareness Training for DLAM

Questions

If you have any questions or concerns, please contact your

DLAM Manager/Supervisor or

EHS (919-962-5507).

Thank you!