A systematic knowledge synthesis on the spatial dimensions of Q fever epidemics

Abstract

From 2007 through 2010, the Netherlands experienced the largest Q fever epidemic ever reported. This study integrates the outcomes of a multidisciplinary research programme on spatial airborne transmission of Coxiella burnetii and reflects these outcomes in relation to other scientific Q fever studies worldwide. We have identified lessons learned and remaining knowledge gaps. This synthesis was structured according to the four steps of quantitative microbial risk assessment (QMRA): (a) Rapid source identification was improved by newly developed techniques using mathematical disease modelling; (b) source characterization efforts improved knowledge but did not provide accurate C. burnetii emission patterns; (c) ambient air sampling, dispersion and spatial modelling promoted exposure assessment; and (d) risk characterization was enabled by applying refined dose–response analyses. The results may support proper and timely risk assessment and risk management during future outbreaks, provided that accurate and structured data are available and exchanged readily between responsible actors.

Insights into Livestock-Related Microbial Concentrations in Air at Residential Level in a Livestock Dense Area

“…In the case of infectious disease outbreaks, air measurements can either prospectively or retrospectively contribute to source identification and source attribution. 9…”

“…1−8 Only for Q fever, the transmission of the causal bacteria via air has been firmly established; for other zoonotic diseases (campylobacteriosis, methicillin-resistant Staphylococcus aureus (MRSA) colonization), this is still to be ascertained. 1,9 Besides infectious diseases, other health outcomes like respiratory health effects and atopic sensitization were found to be associated with livestock density. 10−14 The underlying causal mechanisms for these more general health outcomes are unknown; microbial air pollution is suggested to potentially play a role.…”

“…Livestock farms are known to emit microorganisms, some of which are zoonotic pathogens or carriers of resistance to antimicrobials. A series of epidemiological studies identified associations between residential proximity to livestock farms and risk of zoonotic infections and suggest that environmental transmission might play a role. − Only for Q fever, the transmission of the causal bacteria via air has been firmly established; for other zoonotic diseases (campylobacteriosis, methicillin-resistant Staphylococcus aureus (MRSA) colonization), this is still to be ascertained. , Besides infectious diseases, other health outcomes like respiratory health effects and atopic sensitization were found to be associated with livestock density. − The underlying causal mechanisms for these more general health outcomes are unknown; microbial air pollution is suggested to potentially play a role. − …”

A Deterministic Model for Q Fever Transmission Dynamics within Dairy Cattle Herds: Using Sensitivity Analysis and Optimal Controls

“…In recent time, Q fever has received an increase in publicity on the potential source of transmission and possible preventative measures in both livestock and humans (see, for example, [11,16] and the references therein). e research by De Rooij et al [17] suggested that during any future epidemics, attention should be placed on a rapid source of identification, quantification of emission, accurate data collection, and smooth data exchange amongst relevant actors to enable effective risk assessment and risk management. Mori and Roest [18] pointed out that in achieving an effective control and management, there should be collective expertise from other scientific disciplines and stakeholder so that the expectations of farmers and the wider community can be met on the spread of the disease.…”

Relationship between Coxiella burnetii (Q fever) antibody serology and time spent outdoors

“…When human Q fever incidence was combined with data about C. burnetii status of farms, spatial relationships were identified: with increasing distance from C. burnetii positive farms, decreasing human Q fever incidence was observed 8 , 9 . This relationship has been thoroughly investigated in the past, focussing on environmental conditions 10 , 11 , meteorological conditions 12 , and mapping cases in relation to C. burnetii positive farms 2 , 13 as recently reviewed by De Rooij et al 5 .…”