A Large Q Fever Outbreak in an Urban School in Central Israel

Abstract

BACKGROUND. On 28 June 2005, numerous cases of febrile illness were reported among 322 students and employees of a boarding high school located in an urban area in central Israel. Subsequent investigation identified a large outbreak of Q fever which started 2 weeks earlier. We describe the investigation of this outbreak and its possible implications. METHODS. We conducted a case-control study to identify risk factors for Q fever disease. Environmental sampling was conducted to identify the source and the mode of transmission of Coxiella burnetii, the infectious agent. RESULTS. Of 303 individuals, 187 (62%) reported being ill between 15 June and 13 July 2005. Serological evidence for C. burnetii infection was evident in 144 (88%) of the 164 tested individuals. Being a student, dining regularly at the school dining room, and boarding at school during a June religious holiday and the preceding weekend were all significant risk factors for contracting Q fever. C. burnetii DNA was detected using polymerase chain reaction on samples from the school dining room's air conditioning system, supporting contribution of the air conditioning system to the aerosol transmission of the infectious agent. CONCLUSIONS. We report a large outbreak of Q fever in an urban school, possibly transmitted through an air conditioning system. A high level of suspicion for C. burnetii infection should be maintained when investigating point source outbreaks of influenza-like disease, especially outside the influenza season.

Detection of Coxiella burnetii DNA on Small-Ruminant Farms during a Q Fever Outbreak in the Netherlands

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Polymicrobial Q Fever and Enterococcal Aortic Prosthetic Valve Endocarditis with Aortic Root Abscess

“…In Israel the average annual incidence of Q fever is 0.6 cases per 100,000 persons, and several outbreaks have been reported in the past, including an urban outbreak (Amitai et al 2010). Endocarditis is the most severe and potentially fatal form of chronic Q fever, with an overall 10-year mortality of 27% (Million et al 2010).…”

Coxiella burnetii, agent de la fièvre Q

“…Les principales cellules cibles sont les macrophages (lymphe et ganglions lymphatiques, rate, foie, poumons…), les monocytes circulant du sang (Baca et Paretsky 1983) et les trophoblastes (Ben Amara et al 2010). Son existence dans des amibes libres a également été décrite (La Scola et Raoult 2001;Amitai et al 2010) ainsi que sa persistance dans les adipocytes murins (Bechah et al 2014). La division de C. burnetii est complexe et caractérisée par la présence de 2 formes morphologiques correspondant à différentes phases de développement : -Les variants de petite taille (en anglais « small cell variant »), mesurent de 0,2 à 0,5 m, et sont denses en microscopie électronique.…”