Coxiellosis (Q Fever)
Q Fever or coxiellosis is a zoonotic disease which means it can be transmitted between animals and humans. It is caused by a rickettsia called Coxiella burnetii. Coxiella burnetii is very resistant to environmental factors and can persist in the environment for up to six months.
Q Fever in Animals
Sheep, goats and cattle as well as wildlife infected with Coxiella burnetii usually shed the agent with no outward signs of disease. The agent may persist in the animal and be shed intermittently. The agent is shed in very high numbers in birthing products (placenta, placental fluid, and fetus), therefore, non-pregnant animals are less of a risk. It is also shed in milk, feces, urine and blood. Q Fever is occasionally a cause of abortion in animals. The amount of agent can be reduced in the environment by regular cleaning and disinfection of animal facilities with particular care of lambing areas, and surgery and necropsy rooms. Placentas should be incinerated, composted, autoclaved or spread on fields not to be harvested or grazed for 6 months. Abortions in animals are investigated to determine if a disease is present that may affect the health of humans or other animals. Identification of shedding animals is not practical.
Q Fever in Humans
Infection is most commonly a result of inhalation of the agent in aerosols originating from placenta and placental fluids. Also, infection may be a result of airborne transmission by inhalation of the agent on particles of dust. Q Fever has occurred in people with no animal contact because the agent may be transmitted in the air. Only a few organisms need to be inhaled to produce disease. In addition to inhalation, the agent may enter the body by ingestion or contamination of wounds, for example, contaminated needle sticks. Consuming unpasteurized milk or milk products can be another source of human infection with Coxiella burnetii.
The disease in humans may appear 2-4 weeks after infection. Many human infections are mild and inapparent and thus go undetected. A prominent symptom of the disease is severe headache. Pain in back of the eyes is common. Fever, chills, profuse sweating, malaise, loss of appetite, muscle aches and sometimes nausea and vomiting are also symptoms. About 50% the people with this disease develop pneumonia with a mild cough and 50% develop gastrointestinal tract disorders (nausea, vomiting, diarrhea). Endocarditis (heart valve problems) and hepatitis (liver problems) can be complications associated with Q Fever. People with a valvular heart disease are at greater risk of developing complications associated with Q Fever.
Safe Work Practices
1. Use Good Personal Hygiene
- Wash your hands after animal contact and before you leave the laboratory or animal facility. Wash your hands after using the restroom.
- Do not eat, drink, use tobacco products, take or apply medicine, store human food, handle contact lenses or apply cosmetics in animal facilities and laboratories. Wash your hands before engaging in these activities. Mouth pipetting is prohibited.
- Do not drink unpasteurized (raw) milk.
2. Wear Personal Protective Equipment
- Wear protective clothing in animal housing and laboratory. Protective clothing and shoe coverings should be worn when working with animals.
- Do not wear soiled protective clothing outside of the laboratory or animal facility. Do not launder soiled protective clothing at home. All soiled nondisposable clothing must be Institutionally laundered.
- Wear gloves when handling contaminated surfaces or equipment or known infected animals. Avoid direct contact with birthing products. Wear obstetrical sleeves when assisting ewes giving birth. Wear gloves or use an implement to remove the placenta and contaminated bedding from animal housing.
Additional Biosafety Level (BSL) 3 Precautions in Pregnant Ewe Enclosed Rooms: Wear outer garments, shoe coverings, gloves and face mask for protection.
Additional BSL 3 Precautions in Enclosed Surgery, Necropsy and Lambing Rooms during lambing or procedures that involve the uterus or fetus: Wear solid front surgical gowns or wraparound smocks, gloves, head covering, shoe covers, and respiratory protection (N95TB Health Care Worker Duckbill Respirator) as directed.
Duration of Respirator Use: N95 Respirators will be worn by all personnel entering enclosed lambing, surgery or necropsy rooms during lambing or procedures involving the uterus and fetus until after the room has been cleaned and 4 room changes have taken place (or the disinfectant is dry or 30 minutes have passed). This includes wearing respirators during room cleaning. Biohazard signage is to be removed after room cleaning.
Additional BSL 3 Precautions: Special biohazard procedures for soiled linens are required in animal BSL 3 facilities.
3. Animal Care
- Pregnant ewes housed in enclosed buildings, that is, animal rooms, not barns, should be maintained under Biosafety Level 3 conditions during parturition or when surgical and necropsy procedures are conducted on reproductive tissues and products.
- Isolate ewes that have aborted whenever possible.
- Handle and care for ewes that have aborted last whenever possible.
4. Cleaning and Disinfection
- Disinfect laboratory work surfaces daily and after any spills with a disinfectant approved by the facility supervisor.
- Disinfect animal areas and equipment with a disinfectant approved by the facility supervisor.
5. Avoid Exposure to Sharps
- Follow Sharps Precautions when handling sharps (surgical needles, hypodermic needles, hypodermic syringes, scalpel blades, Pasteur pipettes, glassware).
6. Minimize Aerosol Production
- Conduct procedures so that aerosol production is minimized. Protect yourself from exposure to inhalation of aerosols or ingestion of splashes or sprays of body fluids.
- Wear gloves, mouth and respiratory protection (N95TB Health Care Worker Duckbill Respirator) when hosing down surfaces contaminated with ewe birthing products in all animal facilities.
Additional BSL 3 Precautions: Use an approved BSC (biological safety cabinet) 2 when performing necropsies or handling reproductive tissues or body fluids from pregnant ewes in animal BSL 3 facilities whenever possible. Wear respiratory protection (N95TB Health Care Worker Duckbill Respirator) if the appropriate BSC 2 is not available.
7. Waste Management
- Dispose of laboratory waste, contaminated bedding, animal carcasses, animal products, and items contaminated by their products as approved of by the facility supervisor.
- Dispose of sharps in a Biohazard Sharps Container.
Additional BSL 3 Precautions: Special biohazard procedures for waste disposal are required in animal BSL 3 facilities.
8. Follow Safety Precautions
- Follow these and posted Safe Work Practices.
- Follow requirements for entry into and exit from posted areas.
9. Participate in the Occupational Health and Safety Program.
- Provide an annual medical health history to the Health Center.
- Report accidents, illnesses and zoonotic diseases on the Accident Report Form.
10. Notify the Supervisor
- Notify your supervisor if an animal has an abnormal birth so causes of abortion may be investigated.
- Notify your supervisor if you have a fever or other symptoms associated with Q Fever or if you have been exposed to an animal diagnosed with Q Fever.
11. Seek Medical Attention
- Visit the Health Center for evaluation and possible treatment if you have a fever or other symptoms associated with Q Fever. Let them know you are an animal worker exposed to the hazard Coxiella burnetii.
Safe work practices reduce the risk of hazards to you, your coworkers and the animals you care for.
If you have any questions, contact Dr. J.M. Peralta at (607) 253-3351 or jmp13@cornell.edu