1887
Surveillance Open Access
Like 0

Abstract

Background

Q fever is a zoonosis, included in category B of particularly dangerous infectious agents and as such merits careful surveillance and regular updating of the information about its distribution.

Aim

This observational retrospective study aimed to provide an overview of Q fever incidence in Bulgaria in the period 2011 to 2017.

Methods

Aggregated surveillance data from Bulgaria’s mandatory surveillance system, laboratory data on individual samples received at the National Reference Laboratory Rickettsiae and Cell Cultures and outbreak reports sent by the regional health authorities to the National Centre of Infectious and Parasitic Diseases, were used in this analysis. Cases were described by year, region, age group and most commonly identified risk behaviours.

Results

A total of 139 confirmed cases were reported in the study period (average annual incidence: 0.27 cases/100,000 inhabitants). No seasonality or trend in reported cases was observed. Cases were mostly sporadic, with two small outbreaks in 2017. Identified risk behaviours among cases were occupational exposure and consumption of milk and dairy products, although exposure data were incomplete. The male/female ratio was 1.4. The identification and resolution of the two rural outbreaks in 2017 with a total of 18 cases involved good practices: active case finding and collaboration between public health and veterinary authorities.

Conclusion

Between 2011 and 2017, Bulgaria retained low Q fever incidence, mostly sporadic cases and two small outbreaks. Occupational exposure and consumption of milk and dairy products were the most often reported likely exposures among cases. The outbreak investigations demonstrate the application of good control practices.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.37.1900119
2019-09-12
2019-11-14
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.37.1900119
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/37/eurosurv-24-37-4.html?itemId=/content/10.2807/1560-7917.ES.2019.24.37.1900119&mimeType=html&fmt=ahah

References

  1. Porter SR, Czaplicki G, Mainil J, Guattéo R, Saegerman C. Q Fever: current state of knowledge and perspectives of research of a neglected zoonosis. Int J Microbiol. 2011;2011:248418.  https://doi.org/10.1155/2011/248418  PMID: 22194752 
  2. Maurin M, Raoult D. Q fever. Clin Microbiol Rev. 1999;12(4):518-53.  https://doi.org/10.1128/CMR.12.4.518  PMID: 10515901 
  3. Karagiannis I, Morroy G, Rietveld A, Horrevorts AM, Hamans M, Francken P, et al. Q fever outbreak in the Netherlands: a preliminary report. Euro Surveill. 2007;12(8):E070809.2. PMID: 17868551 
  4. Gilsdorf A, Kroh C, Grimm S, Jensen E, Wagner-Wiening C, Alpers K. Large Q fever outbreak due to sheep farming near residential areas, Germany, 2005. Epidemiol Infect. 2008;136(8):1084-7. PMID: 17892631 
  5. Donaghy M, Prempeh H, Macdonald N. Outbreak of Q fever in workers at a meat processing plant in Scotland, July 2006. Euro Surveill. 2006;11(8):E060824.2. PMID: 16966788 
  6. Grilc E, Socan M, Koren N, Ucakar V, Avsic T, Pogacnik M, et al. Outbreak of Q fever among a group of high school students in Slovenia, March-April 2007. Euro Surveill. 2007;12(7):E070719.1. PMID: 17868556 
  7. Madariaga MG, Rezai K, Trenholme GM, Weinstein RA. Q fever: a biological weapon in your backyard. Lancet Infect Dis. 2003;3(11):709-21.  https://doi.org/10.1016/S1473-3099(03)00804-1  PMID: 14592601 
  8. Angelakis E, Raoult D. Q fever. Vet Microbiol. 2010;140(3-4):297-309.  https://doi.org/10.1016/j.vetmic.2009.07.016  PMID: 19875249 
  9. Guatteo R, Seegers H, Taurel AF, Joly A, Beaudeau F. Prevalence of Coxiella burnetii infection in domestic ruminants: a critical review. Vet Microbiol. 2011;149(1-2):1-16.  https://doi.org/10.1016/j.vetmic.2010.10.007  PMID: 21115308 
  10. Berri M, Rousset E, Champion JL, Russo P, Rodolakis A. Goats may experience reproductive failures and shed Coxiella burnetii at two successive parturitions after a Q fever infection. Res Vet Sci. 2007;83(1):47-52.  https://doi.org/10.1016/j.rvsc.2006.11.001  PMID: 17187835 
  11. Parker NR, Barralet JH, Bell AM. Q fever. Lancet. 2006;367(9511):679-88.  https://doi.org/10.1016/S0140-6736(06)68266-4  PMID: 16503466 
  12. Arricau-Bouvery N, Rodolakis A. Is Q fever an emerging or re-emerging zoonosis? Vet Res. 2005;36(3):327-49.  https://doi.org/10.1051/vetres:2005010  PMID: 15845229 
  13. Gale P, Kelly L, Mearns R, Duggan J, Snary EL. Q fever through consumption of unpasteurised milk and milk products - a risk profile and exposure assessment. J Appl Microbiol. 2015;118(5):1083-95.  https://doi.org/10.1111/jam.12778  PMID: 25692216 
  14. Honarmand H. Q Fever: an old but still a poorly understood disease. Interdiscip Perspect Infect Dis. 2012;2012:131932.  https://doi.org/10.1155/2012/131932  PMID: 23213331 
  15. Tissot-Dupont H, Raoult D. Q fever. Infect Dis Clin North Am. 2008;22(3):505-14, ix.  https://doi.org/10.1016/j.idc.2008.03.002  PMID: 18755387 
  16. Fenollar F, Thuny F, Xeridat B, Lepidi H, Raoult D. Endocarditis after acute Q fever in patients with previously undiagnosed valvulopathies. Clin Infect Dis. 2006;42(6):818-21.  https://doi.org/10.1086/500402  PMID: 16477559 
  17. Mitov A, Shindarov L, Serbezov V. Q fever in Bulgaria. Mod Med. 1959;1-2:39-46.
  18. Serbezov VS, Kazár J, Novkirishki V, Gatcheva N, Kovácová E, Voynova V. Q fever in Bulgaria and Slovakia. Emerg Infect Dis. 1999;5(3):388-94.  https://doi.org/10.3201/eid0503.990309  PMID: 10341175 
  19. Martinov S. Contemporary state of the problem Q fever in Bulgaria. Biotechnol Biotechnol Equip. 2007;21(3):353-61.  https://doi.org/10.1080/13102818.2007.10817473 
  20. Kamenov G, Tiholova M. Q fever outbreak in Botevgrad, Bulgaria: May-June 2004. Euro Surveill. 2004;8(35):2535.
  21. Panaiotov S, Ciccozzi M, Brankova N, Levterova V, Mitova-Tiholova M, Amicosante M, et al. An outbreak of Q fever in Bulgaria. Ann Ist Super Sanita. 2009;45(1):83-6. PMID: 19567983 
  22. European Commission. Commission implementing decision (EU) 2018/945) of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Luxembourg: Official Journal of the European Union. 2018. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv%3AOJ.L_.2018.170.01.0001.01.ENG
  23. Ministry of Health of Bulgaria. [Ordinance No 21/18.07.2005 on the procedure for registration, notification and reporting of communicable diseases in Bulgaria]. State Gazette. 2005;62. Bulgarian. Available from: https://lex.bg/bg/laws/ldoc/2135508238
  24. Stein A, Raoult D. Detection of Coxiella burnetti by DNA amplification using polymerase chain reaction. J Clin Microbiol. 1992;30(9):2462-6. PMID: 1401016 
  25. Bulgarian Food Safety Agency. Program for surveillance and control of Q-fever disease in Bulgaria in 2016 - 2018. Sofia: Ministry of Agriculture and Food.; 2016. Bulgarian. Available from: http://www.babh.government.bg/userfiles/files/ZHOJKF/npp/10%20Programme_Q_fever%202016%20-%202018%20NEW.pdf
  26. Guideline for control of Q fever. In: Collection of guidelines for control of communicable diseases, a manual issued by the Bulgarian Ministry of Health. Sofia: Ministry of Health; 1984: pp 167-71. Bulgarian.
  27. National programme for prevention and control of vector-borne diseases in humans in the Republic of Bulgaria 2014 – 2018. Sofia: Ministry of Health; 2014. Bulgarian. Available from: https://www.strategy.bg/StrategicDocuments/View.aspx?lang=bg-BG&Id=893
  28. European Centre for Disease Prevention and Control (ECDC). Q fever. In: ECDC. Annual epidemiological report for 2016. Stockholm: ECDC; 2019. Available from: https://ecdc.europa.eu/en/publications-data/q-fever-annual-epidemiological-report-2016
  29. European Centre for Disease Prevention and Control (ECDC). Q fever. In: ECDC. Annual epidemiological report for 2015. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-Q-fever.pdf
  30. de Valk H. Q fever: new insights, still many queries. Euro Surveill. 2012;17(3):20062. PMID: 22297098 
/content/10.2807/1560-7917.ES.2019.24.37.1900119
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error