Published Date: 2009-10-04 15:00:03
Subject: PRO/AH/EDR> Q fever - Netherlands (09): predictions
Archive Number: 20091004.3452

Q FEVER - NETHERLANDS (09): PREDICTIONS
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Date: Sun 4 Oct 2009
From: Jim van Steenbergen <lci@rivm.nl>


One has to realise that, if all sheep and goats are to be vaccinated in
2010, we might hope for a lower number of billions of _Coxiella_ added in
2011 into the environment, resulting in possibly fewer new cases of human Q
fever in April 2011 and onwards.

In other words, depending on the weather conditions in March and April
2010, we will experience many new human cases of Q fever in 2010. We would
not be surprised if the numbers exceed those of 2009.

a) in the vaccinated area:
The environment was heavily contaminated during the years 2007, 2008, and
2009. _Coxiella_ is environment-resistant. In warm dry months, we will see
many new human cases in 2010 (even if the vaccine is 100 per cent effective
in preventing abortions in goats in that area).
b) other areas:
In 2009, we have seen spread of human and goat Q fever *outside* the
designated vaccination area. The vaccination of sheep and goats in those
["other"] areas will start *after* the 2010 lambing season. We expect in
2010 several newly infected goat farms experiencing high abortion
percentages. This will inevitably lead to spread of _Coxiella_ in the
environment in the immediate surroundings, leading to many new human cases
in 2010 (assuming favourable weather conditions).

--
Jim van Steenbergen
LCI/Unit Preparedness and Response
Centre for Infectious Disease Control/RIVM
NL-3720 BA Bilthoven, Netherlands
<lci@rivm.nl>
<http://www.rivm.nl/infectieziekten>

[The concerns expressed by Dr Steenbergen, who views the issue from the
standpoint of a physician and public health epidemiologist, are underlined
by the fact that human Q fever cases are now not restricted to the south.
Dr Steenbergen was one of the first to indicate the possible origin of the
outbreak in humans, as early as 2007, as related to goat holdings. Cases,
though not numerous, are now being recorded also from other parts of the
Netherlands, including northern provinces. This can be seen in the map
showing the spread of the 2193 human Q fever cases recorded this year (1
Jan-30 Sep 2009) available at
<http://www.rivm.nl/cib/binaries/Qkoorts_per_gemeente_tcm92-60500.pdf#%20class=>.
The total number of human patients since the start of the outbreak in
summer 2007, as of 30 Sep 2009, exceeds 3350. This has become the largest Q
fever epidemic ever reported globally.

Browsing through recent Dutch animal and public health publications
unravels some expressions of discontent, in particular related to the steps
undertaken to contain infection in animals. The situation has been
addressed, among others, in several recent publications of the Royal Dutch
Veterinary Society (KNMvD).

A main obstacle in the handling of the disease in animals is the fact that,
while exposing humans, the disease has -- so far -- not caused serious
direct losses to the farming industry. Animal vaccination has, therefore,
been more a matter of public health than animal health concern. A KNMvD
newsletter, dedicated to the recently published new measures (as detailed
in posting 20090927.3380) includes the following statement: "Ministers
Klink [public health] and Verburg [agriculture] intend to reduce the number
of human cases by these measures, but they warn against excessive optimism
in the short term: a reduction in the number of Q-fever patients is not
expected in 2010, at most, stabilization is expected. This is related to
the fact that the animal vaccine, while in state to prevent mass abortions
on the animal holdings, thus eliminating a significant source of infection,
is not capable of suppressing the disease altogether. Another point of
significance is the fact that the Q fever bacterium will survive in the
environment among dust particles." The Society encouraged practitioners to
stimulate their client-farmers to report even sporadic abortions in sheep
and goats. Obviously, such stimulation is not sufficient if farmers fear
resulting repercussions.

Subscribers may consider viewing the presentation "Q-fever in the
Netherlands - Vaccination strategy, 2009" of the Dutch Veterinary Services,
presented by Christianne Bruschke during the 5-6 May 2009 monthly meeting
of EU's Standing Committee on the Food Chain and Animal Health (SCFCAH),
(ANIMAL HEALTH & ANIMAL WELFARE). The presentation is available at
<http://ec.europa.eu/food/committees/regulatory/scfcah/animal_health/presentations/q_fever0506052009.pdf>.
Among other things, it shows that, during 2007, Q-fever outbreaks were
diagnosed on 7 dairy-goat farms, and during 2008 on 7 dairy-goat farms and
one dairy-sheep farm. This looks like a strikingly low number of outbreaks,
in the context of the alarmingly extensive spread in humans.

Various aspects of this outbreak remain enigmatic, in particular its
epidemiology within the animal population, the interface with humans, its
dimensions and the role of climate/weather conditions (such as wind,
temperature, humidity, precipitation). Dr Steenbergen referred to these as
"favorable weather conditions"; specification could help.

Further reading: Delsing CE, Kullberg BJ. Q fever in the Netherlands: a
concise overview and implications of the largest ongoing outbreak. Neth J
Med 2008; 66(9): 365-7.
<http://www.zuidencomm.nl/njm/getpdf.php?id=10000365>. - Mod.AS]

See Also

Q fever - Netherlands (08): update, monitoring & animal vaccination
20090927.3380
Q fever - Netherlands (07) 20090908.3169
Q fever - Netherlands (06) 20090814.2889
Q fever - Netherlands (05) 20090629.2355
Q fever - Netherlands (04): fatalities 20090626.2330
Q Fever - Netherlands (03): update, animal vaccination 20090510.1744
Q Fever - Netherlands (02): (NB) 20090508.1721
Q fever, caprine - Netherlands: (LI) 20090331.1230
Q fever - Netherlands: sheep & goat vaccination 20090228.0841
2008
---
Q fever - Netherlands (04): sheep & goat vaccination 20081023.3352
Q fever - Netherlands (03): (NBR, GEL) 20080802.2367
Q fever - Netherlands (02): (NBR) 20080728.2306
Q fever - Netherlands: (NBR) 20080725.2267
2007
---
Q fever - Netherlands (Noord-Brabant, Gelderland) 20070809.2592

..................arn/msp/sh



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