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Evaluation of Factors That Initiate Or Propagate Epidemic Coxiellosis in the U.S

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Evaluation of Factors That Initiate Or Propagate Epidemic Coxiellosis in the U.S United States Department of Evaluation of Factors that Would Agriculture Animal and Initiate or Propagate Epidemic Plant Health Inspection Service Coxiellosis in the U.S. Veterinary Services Centers for Domesticated Goat Population Epidemiology and Animal Health June 2013 Suggested bibliographical citation for this report: USDA. (2012). Evaluation of factors that would initiate or propagate epidemic coxiellosis in the U.S. domesticated goat population. USDA:APHIS:VS:Centers for Epidemiology and Animal Health. Fort Collins, CO. June 2013. 104 pages. Abstract Coxiellosis is a zoonosis caused by Coxiella burnetii, an intracellular Gram-negative bacterium that is prevalent globally. Many animal species are susceptible to infection by C. burnetii, including ruminants, domestic carnivores, wildlife mammals, birds, and arthropods. The clinical presentation of coxiellosis is non- specific in most animals, with the exception of ruminants where coxiellosis is responsible for reduced fertility, abortions, and stillbirths during late gestation, as well as low birth weight. In humans, two clinical patterns of Q fever are observed. The acute disease resembles a flu-like syndrome, and is usually a self-limiting febrile illness during which pneumonia or hepatitis can occur. The chronic disease is a severe and possibly fatal illness. Q fever can lead to abortions, stillbirth, or premature deliveries in pregnant women. In fewer than 5 percent of the cases it causes chronic illness which includes endocarditis and chronic fatigue syndrome. In 2005, coxiellosis was diagnosed for the first time in ruminants in the Netherlands as a cause of abortion on a dairy goat farm. In 2006, 2007, 2008, and 2009, six, seven, seven, and six new cases, respectively, were confirmed on other dairy goat farms. During the same period, two cases of abortion caused by C. burnetii were found on dairy sheep farms. In 1978, human Q fever became a notifiable disease in the Netherlands. The number of notifications per year between 1978 and 2006 was one to 32. In 2007, 168 confirmed human cases were reported. In 2008, 1,000 human cases were reported, making this the largest community outbreak of Q fever ever recorded. In 2009, 2,357 human cases of Q fever were reported. The human Q fever cases were linked to abortion epidemics on large dairy goat farms and dairy sheep farms. In the United States, on April 22, 2011 the coxiellosis bacterium C. burnetii was detected in a goat placenta collected from a farm in Washington where does had aborted during January to April 2011. An epidemiological investigation concluded that goats from the index premises had been dispersed to 21 farms in 3 States. Seventeen farms participated in the outbreak investigation; C. burnetii infection was detected in 16 of 17 goat herds and in 161 of 667 (24 percent) goats tested. Q fever in at least six people was linked to the index farm and/or associated premises. Coxiella burnetii infection in domesticated goats in the United States is endemic, and outbreaks of coxiellosis in goats are sporadic. Continual expansion of the goat industry in the United States, along with the explosive and concurrent epidemic of Q fever in the European Union (EU) Member States, has increased concerns among animal and human health officials of the likelihood of a similar epidemic in goats in the United States. To alleviate the concerns, we identified and evaluated factors that could potentially initiate and/or propagate an epidemic of coxiellosis in the U.S. goat population. We concluded the likelihood is low that three factors would initiate and/or propagate an epidemic of coxiellosis in the domesticated goat population in the United States. These three factors are: (1) goat industry structure, (2) laboratory capacity to diagnose coxiellosis, and (3) reporting and monitoring coxiellosis. We concluded that the likelihood is medium that four additional factors would initiate and/or propagate an epidemic of coxiellosis. These four factors are: (1) goat health and general management, (2) accessibility to caprine health professionals, (3) responses to coxiellosis diagnosis, and (4) accessibility to coxiellosis vaccines. Finally, we concluded that the likelihood is low to medium that all seven factors, when considered together, would initiate and/or propagate an epidemic of coxiellosis in the U.S. domesticated goat population. Keywords: Q fever, Coxiella burnetii, coxiellosis, epidemic, goat disease Audience: Health professionals whose primary responsibilities are to develop risk-reduction strategies for transmissible infectious diseases of animals and humans. Inquiries to: Reginald Johnson, USDA:APHIS:VS:CEAH, 970-494-7326, 2150B Centre Avenue, Fort Collins, CO 80526. [email protected]. Evaluation of Factors that Would Initiate or Propagate Epidemic Coxiellosis in the U.S. Domesticated Goat Population Acknowledgements American Association of Small Ruminant Dr. Katherine L. Marshall, Analytical Practitioners Epidemiologist, Project Consultant, Area Epidemiology Officers, USDA:APHIS:VS USDA:APHIS:VS:CEAH:NAHMS Dr. Stanley D. Bruntz, NAHLN, Member-laboratories of the National USDA:APHIS:VS:CEAH Animal Health Laboratory Network Ms. Mary Foley, Librarian, State Veterinarians and Animal Health USDA:APHIS:VS:CEAH:CAHIA Agencies, United States Ms. Christine Kopral, Statistician, State Public Health Veterinarians and Public USDA:APHIS:VS:CEAH:NAHMS Health Agencies, United States Ms. Carmen D. Ledesma-Feliciano, VA-MD Dr. Sarah Tomlinson, Associate Coordinator, Regional College Veterinary Medicine, DVM National Animal Health Laboratory Network 2012 Ms. Julie E. Wallin, USDA:APHIS:VS:CEAH: Ms. Carol LoSapio, Technical Writer/Editor, National Surveillance Unit USDA:APHIS:VS:CEAH:CAHIA Contributors Mr. Andrew M. Fox, Cartographer, Dr. Reginald Johnson, Risk Analyst, USDA:APHIS:VS:CEAH:CAHIA USDA:APHIS:VS:CEAH:CAHIA Dr. Robert E. Harris, Veterinary Medical Dr. Philip D. Riggs, Technical Information Officer, USDA:APHIS:VS:CEAH:CAHIA Specialist, USDA:APHIS:VS:CEAH:CAHIA Scientific Reviewers Dr. Michelle P. Emery, Veterinary Medical Dr. Katherine L. Marshall, Caprine Commodity Officer, National Veterinary Services Specialist, One Health Coordinating Office Laboratories Dr. Kristyn L. Stone, Agricultural Economist, Dr. Alan Huddleston, Veterinary Medical USDA:APHIS:VS:CEAH:CAHIA Officer, National Center for Animal Health Dr. Diane L. Sutton, National Scrapie Program Programs Coordinator, National Center for Animal Health Programs The U.S. Department of Agriculture (USDA) prohibits mentioned. USDA neither guarantees nor warrants discrimination in all its programs and activities on the the standard of any product mentioned. Product basis of race, color, national origin, age, disability, names are mentioned solely to report factually on and where applicable, sex, marital status, familial available data and to provide specific information. status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or USDA–APHIS–VS–CEAH because all or part of an individual's income is derived NRRC Building B, M.S. 2W4 from any public assistance program. (Not all 2150 Centre Avenue prohibited bases apply to all programs.) Persons with Fort Collins, CO 80526-8117 disabilities who require alternative means for (970) 494–7000 communication of program information (Braille, large Email: [email protected] print, audiotape, etc.) should contact USDA's http://www.aphis.usda.gov/about_aphis/programs_ TARGET Center at (202) 720-2600 (voice and TDD). offices/veterinary_services/ceah.shtml To file a complaint of discrimination, write USDA, #210.0613 Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer. Cover photos courtesy of: top left, Reginald Johnson, Veterinarian Epidemiologist, USDA:APHIS:VS:Center for Epidemiology and Animal Mention of companies or commercial products does Health, Fort Collins, CO; bottom right, Christianne not imply recommendation or endorsement by the Bruschke, Chief Veterinary Officer, Ministry of U.S. Department of Agriculture over others not Agriculture, Nature, and Food Quality, Netherlands. Evaluation of Factors that Initiate or Propagate Epidemic Coxiellosis in the U.S. Domesticated Goat Population Contents Acronyms ........................................................................................................................................ vi Glossary .......................................................................................................................................... vi 1. Executive Summary ........................................................................................................... 1 2. Introduction and Background ........................................................................................... 5 2.1 Coxiellosis and Q fever in the Netherlands, 2005 to 2010 ........................................................ 5 2.2 Coxiellosis and Q fever Outbreak Associated with Goats ........................................................ 5 2.3 Summary ................................................................................................................................... 6 2.4 Bibliography ............................................................................................................................... 7 3. Hazard Identification of Coxiellosis and Q fever .............................................................
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