Concept of an Active Surveillance System for Q Fever in German Small Ruminants—Conflicts Between Best Practices and Feasibility

Winter, Fenja; Schoneberg, Clara; Wolf, Annika; Bauer, B.; Prüfer, T.; Fischer, Silke; Gerdes, Ursula; Runge, Martin; Ganter, Martin; Campe, Amely

doi:10.3389/fvets.2021.623786

Cited by 12 publications

(7 citation statements)

References 44 publications

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“…Hence, it is desirable that the public health sector financially supports the vaccination of sheep, in particular of flocks, which are involved in public functions like dyke protection and landscape conservation. This holistic approach is in the spirit of the One Health concept ( 79 ). Furthermore, during abortion investigations, it is important to examine aborted fetuses and placentas for several agents, as different pathogens such as Chl.…”

Section: Discussionmentioning

confidence: 99%

Impact of Coxiella burnetii vaccination on humoral immune response, vaginal shedding, and lamb mortality in naturally pre-infected sheep

et al. 2022

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IntroductionSheep are considered to be one of the main reservoirs for Coxiella burnetii, a gram-negative bacterium with high zoonotic potential. Infected sheep shed tremendous amounts of the pathogen through birth products which caused human Q fever epidemics in several countries. Information about the impact of an inactivated C. burnetii Phase I vaccine on humoral immune response, vaginal shedding, and lamb mortality in naturally pre-infected sheep is scarce.MethodsTwo identically managed and naturally C. burnetii-infected sheep flocks were examined for two lambing seasons (2019 and 2020). One flock (VAC) received a primary vaccination against Q fever before mating and the second flock served as control (CTR). In each flock, one cohort of 100 ewes was included in follow-up investigations. Serum samples at eight different sampling dates were analyzed by C. burnetii phase-specific ELISAs to differentiate between the IgG Phase I and II responses. Vaginal swabs were collected within three days after parturition and examined by a C. burnetii real-time PCR (IS1111). Lamb losses were recorded to calculate lamb mortality parameters.ResultsAfter primary vaccination, almost all animals from cohort VAC showed a high IgG Phase I response up until the end of the study period. In cohort CTR, the seropositivity rate varied from 35.1% to 66.3%, and the Phase I and Phase II pattern showed an undulating trend with higher IgG Phase II activity during both lambing seasons. The number of vaginal shedders was significantly reduced in cohort VAC compared to cohort CTR during the lambing season in 2019 (p < 0.0167). There was no significant difference of vaginal shedders in 2020. The total lamb losses were low in both cohorts during the two investigated lambing seasons (VAC 2019: 6.8%, 2020: 3.2%; CTR 2019: 1.4%, 2020: 2.7%).DiscussionNeither the C. burnetii vaccine nor the C. burnetii infection seem to have an impact on lamb mortality. Taken together, the inactivated C. burnetii Phase I vaccine induced a strong IgG Phase I antibody response in naturally pre-infected sheep. It might also reduce vaginal shedding in the short term but seems to have little beneficial impact on lamb mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of Coxiella burnetii vaccination on humoral immune response, vaginal shedding, and lamb mortality in naturally pre-infected sheep

et al. 2022

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“…Conversely, this result also indicates that Q fever is not high on the list of differential diagnoses, based on these symptoms. This scenario may lead to an underreporting of Q fever cases in Germany [ 25 – 28 ]. This scenario also indicates that the awareness of this zoonosis can be enhanced among stakeholder groups by making useful information about Q fever more accessible to them.…”

Section: Discussionmentioning

confidence: 99%

“…Regional and seasonal accumulations can be identified in human and ruminant populations via data analyses of the reported cases [ 23 – 25 ]. As these systems depend on the awareness of human and veterinary health professionals (among other relevant stakeholders), underreporting has to be presumed, and the true number of (sporadic) cases and (small) outbreaks cannot be reliably estimated [ 25 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

Q fever expertise among human and veterinary health professionals in Germany – A stakeholder analysis of knowledge gaps

Winter

Campe

2022

PLoS ONE

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Q fever is a zoonosis caused by Coxiella burnetii. In Germany, the common sources of human infections include small ruminants that excrete the pathogen. Q fever in humans can be asymptomatic or nonspecific. However, severe disease progression is also possible, which can lead to death. Q fever in small ruminants is usually asymptomatic, although reproductive disorders may occur. To protect humans from Q fever, it is important that human and veterinary health professionals (practitioners/health authority employees) have comprehensive knowledge of the diagnosis, control and prevention of Q fever, and its zoonotic potential. To ensure and enhance this understanding, this stakeholder analysis assessed Q fever expertise in human and veterinary health professionals in Germany and investigated how these knowledge gaps can best be resolved. For this purpose, an online survey and two focus group discussions were conducted with 836 and 18 participants, respectively. Knowledge gaps are due to a lack of awareness of Q fever, especially among human health practitioners. Moreover, colleagues who have heard about Q fever still lack the necessary cross-species knowledge to successfully diagnose, control and prevent this zoonosis. Additionally, differences exist between stakeholders regarding their work context and the region in which they work. In this study, stakeholders in southwestern Germany had slightly better Q fever knowledge than their colleagues in northeastern Germany. In addition, information sources aimed at resolving knowledge gaps involve direct conversations between the stakeholders, as well as reading materials and seminars. Each of these information sources should focus on interdisciplinary resources to strengthen the cooperation between human and veterinary health professionals and to raise awareness of the strengths of each stakeholder group. These results have already been implemented by the Q-GAPS project, with goals of raising awareness of Q fever and filling knowledge gaps.

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“…Coxiella burnetti,a small intracellular Gram-negative bacterium, is the aetiologic agent of Q fever; a worldwidezoonotic disease with a broad clinical spectrum ranging from either asymptomatic or mild disease to life threateninginfection (1,2). Animals, in particular small ruminants, act as reservoirs for the bacterium with transmission occurring through close contact with contaminated tissue in particular birth products of these animals (1,3). Ticks are also important vectors of transmission (4).…”

Section: Responsementioning

confidence: 99%

“…Coxiella burnetti,a small intracellular Gram-negative bacterium, is the aetiologic agent of Q fever; an illness with a broad clinical spectrum ranging from either asymptomatic or mild disease to life threating infection (1) Changed to:…”

Section: Responsementioning

confidence: 99%

Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

Grey,

Simos,

Runnegar

et al. 2023

Access Microbiology

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Diagnosis of chronic Q fever is often difficult for clinicians, particularly in the presence of a second pathology. In addition to the chronic constitutional symptoms, the most common manifestations of chronic Q fever include infective endocarditis and endovascular infection. We describe a case of prosthetic valve infective endocarditis caused by both Streptococcus sanguinis and Coxiella burnetti on a background of a previous aortic graft and bioprosthetic aortic valve replacement 2 years earlier. The diagnosis of chronic Q fever infective endocarditis was delayed because the significance of the abnormal valve histology from the patient’s previous surgery was initially overlooked. It was only after the patient had relapsed on appropriate therapy for the S. sanguinis prosthetic valve endocarditis that a subsequent review of the operative valve histology, along with the patient’s epidemiological risk factors, led to consideration of an additional culture-negative cause for infective endocarditis. Histological examination of the valve tissue had shown exophytic fibrin vegetations and acute inflammation. Further clinical assessment revealed previous exposure to Q fever and C. burnetti DNA was detected via polymerase chain reaction on the valve tissue. Q fever infective endocarditis must be considered if valves are inflamed or have vegetations with a subsequent negative culture. It should also still be considered in the presence of an alternative bacteraemia if the patient has risk factors for exposure.

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Concept of an Active Surveillance System for Q Fever in German Small Ruminants—Conflicts Between Best Practices and Feasibility

Cited by 12 publications

References 44 publications

Impact of Coxiella burnetii vaccination on humoral immune response, vaginal shedding, and lamb mortality in naturally pre-infected sheep

Impact of Coxiella burnetii vaccination on humoral immune response, vaginal shedding, and lamb mortality in naturally pre-infected sheep

Q fever expertise among human and veterinary health professionals in Germany – A stakeholder analysis of knowledge gaps

Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

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