1. Q fever in an occupational setting: a preventable public health challenge
Heidi Lord
BN MPH
South Western Sydney Local Health District
Public Health Unit
WCPH - April 2017

2. Outline Background Cluster investigation Public health challenge
Recommendations for the way forward

3. Background Highly infectious and efficient pathogen
Humans predominately infected through inhalation of airborne dust or droplets
Clinical presentation: acute, chronic, asymptomatic (60%)
Q fever is notifiable in all Australian jurisdictions
Approximately 550 cases notified in Australia in 2016
Males represent 70% of notifications

4. Investigation SWS PHU notified of two Q fever cases in September 2015
Case investigations revealed both had been employed at the same abattoir during their incubation period
Cases reported that co-workers had experienced similar symptoms

5. Methods
Field Investigation
Risk factor survey
Active case finding

6. Results: 8 cases, 7 confirmed and 1 suspected
Case No.
Age, Sex
Onset date
Notification Date
Laboratory evidence
Investigation classification
Method for identification 1
17, M
24/11/2014
10/12/2014
Definitive seroconversion
Confirmed
Notification; linked after Retrospective Review 2
28, M
27/11/2014
09/01/2015
Definitive – nucleic acid testing 3
28/11/2014
08/09/2015
Notification to Public Health Unit 4
22, M
11/01/2015
13/10/2015
Suspected case
(no convalescent sample available)
Retrospective Review 5
27, M
27/07/2015
30/11/2015 6
31/08/2015
21/10/2015
Abattoir line listing 7
60, M
7/09/2015
(deceased 30/9/2015)
18/09/2015 8
45, M

7. Results – Active case finding
6 additional cases identified
4 cases were identified through retrospective review of laboratory results
2 through the abattoir line listing

8. Results – Risk factor surveys
Conducted between October – November 2015
All 8 cases had high risk exposures during their current employment
None identified risk factors outside of their occupational setting
Attempts to interview or have asymptomatic staff complete the risk factor survey were unsuccessful

9. Results - Field investigation
33 staff employed at the abattoir
23/33 employed as kill staff and 10/33 management, maintenance and stock handling
High-risk exposures:
- animals aborting/giving birth in the holding yards
- foetuses pulled out and dumped into a slops chute
- kill floor staff exposed to aerosolisation of birthing products
- inconsistent PPE, staff smoking during their breaks
High staff turnover
Inadequate record keeping

10. Implications for the abattoir
Reported to SafeWork NSW - enforcing body for Work Health and Safety Regulations in NSW
Abattoir issued with a strict warning and a recommendation to implement a vaccination program for existing and future staff
Action not comparable to restrictions place on abattoirs in previously reported outbreaks

11. Public health challenge
Legislative authority lies with other agencies
High turnover of staff and ongoing pressure to start staff immediately
Absence of a pre-screening and vaccination program
Lack of knowledge: abattoir management and staff
Timely notification
Improving adoption of prevention strategies

12. Way forward Tighter regulation and increased monitoring
Mandatory pre-screening and vaccination programs for high-risk occupations
Multi-agency collaboration: human health, animal health, industry, and work, health and safety regulatory bodies
Education: industry and GP’s
Research: non-compliance of work, health and safety legislation in abattoirs across NSW

13. Acknowledgement
South Western Sydney Local Health District Public Health Unit
NSW Health
Greater Sydney Local Land Services
SafeWork NSW
Publication:
Lord H, Fletcher-Lartey S, Weerasinghe G, Chandra M, Egana N, Schembri N, et al. A Q fever cluster among workers at an abattoir in south-western Sydney, Australia, Western Pac Surveill Response J Nov 10;7(4). doi: /wpsar