Risk of type 1 diabetes at 3 years is high for initially multiple and single Ab+ IT and multiple Ab+ NT. Genetic predisposition, age, and male sex are significant risk factors for development of Ab+ in twins.

Q fever is undoubtedly a disease of military significance. Whilst so far it has only been described in troops operating in Mediterranean countries, the Balkans and southern Europe, it is a potential hazard for nonindigenous soldiers in at least 51 countries on 5 continents. Sheep and goats are the main source of infection, and the disease is almost entirely acquired by inhalation of dust-borne rickettsiae from an environment contaminated with infected placentae. The commonest vehicle of transmission is infected hay and straw. On the available evidence, Q fever is simply and largely preventible as a significant military disease by implementation of the following measures: (I) Education on the source and methods of infection. (2) Banning the use of hay and straw for bedding, and the clearing and burning of hay and straw fromfarm buildings prior to occupation. (3) The exclusion of sheep and goats from military areas. (4) Regular serological surveillance of flocks adjoining military areas for evidence of heavy infection by Coxiella burnet;’ (5) Vigilance for an unusually high incidence of abortion in flocks adjoining military areas, which should initiate an immediate serological survey to determine the possibility of gross environmental contamination by the Q fever organism. (6) The possible use of short term prophylaxis with tetracycline for limited exposures to Q fever.

Seventy-eight British soldiers stationed in the Eastern Sovereign Base Area (ESBA) in Cyprus contracted Q fever in the period December 1974 to June 1975. Pneumonia developed in 59% of cases. Of 31 patients tested, 81% had biochemical evidence of hepatitis although only one became clinically jaundiced. Three patients (4%) suffered pericarditis. Treatment with tetracycline had no apparent effect on the course of the disease. Investigation revealed an abortion epidemic involving 21 mixed flocks of sheep and goats in the south-eastern coastal region. 11 of the flocks grazed in and around the ESBA. A serological survey of 10 affected flocks, and evidence collected from previous years, indicated that the abortion epidemic was the result of infection with Coxiella burneti. Infection in the humans was almost certainly acquired by inhalation of dust from brush contaminated with rickettsial parturition products of the aborting flocks. A human serological survey revealed a number of cases of subclinical Q fever in a susceptivle military population, and an asymptomatic epidemic in a largely immune local position.

The possible role of Coxiella burneti as a cause of chronic liver disease in man was investigated in Cyprus. Serology, using the complement fixation test and phase 1 and phase 2 antigens, was performed on 16 patients with cryptogenic cirrhosis and two patients with chronic active hepatitis. Antibody studies were also done on 106 adult Cypriot villagers and on 13 shepherds from flocks infected with C. burneti, to provide a base line for comparative purposes. No evidence was found to implicate the organism as a cause of chronic liver disease. As the number of patients investigated was small it was not possible to exclude C. burneti as an occasional pathogen, and guiding principles were formulated for future investigations.

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