1. Q FEVER AWARENESS TRAINING FOR DLAM Coxiella burnetii

2. What is Q Fever? Ruminants such as sheep, goats, and cattle can present a significant risk to animal handlers/workers for exposure to Coxiella burnetii. Q fever is a zoonotic disease caused by the organism Coxiella burnetii. Large numbers of the bacteria are found in certain tissues and fluids of pregnant ruminants, i.e., the uterus, the placenta, the mammary glands or udders, and milk. However, the bacteria may be found in both male and female sheep. Individuals acquire this infection by inhaling aerosols and contaminated dusts generated by animals or animal products. Coxiella burnetii is highly resistant to heat, drying, & some disinfectants Can survive for months in dust & feces particles

3. Q stands for Query Discovered in 1937 in Queensland, Australia (slaughterhouse workers) 1938- Montana, USA (isolated from ticks) Outbreaks – Largest outbreak 2007-2010 more than 4,000 cases in the Netherlands; required euthanizing 50,000 goats – 2011- Northwestern US-involved 21 goat farms and resulted in 20 human infections – Military troops In areas with infected animals – Cities and towns Downwind from farms Near roads traveled by animals

4. Q Fever in Animals Sheep, goats, cattle ▫ Often asymptomatic ▫ Reproductive failure in females  Abortions  Stillbirths  Low birth weight  Infertility Rarely fatal to animals Has been found in other animal species ▫ Dogs, cats, horses, rabbits, birds

5. Q Fever in Humans  Incubation: 2 to 4 weeks  Disease  50%-Show no symptoms at all  Acute  Chronic

6. Acute Infection  Flu like symptoms: high fever (up to 104-105 ◦ F), headache, sore throat, vomiting, nausea, fatigue  Pneumonia with mild cough (50%)  Less common Hepatitis, central nervous system complications  Usually resolves after 2-3 weeks  >50% show no symptoms at all  2-4% require hospitalization  <1% mortality rate

7. Chronic Disease (> 6 months)  1-5% of acutely infected individuals develop chronic disease.  Pre-existing heart conditions, pregnant women, immunocompromised individuals at greater risk  Endocarditis-inflammation of the heart (60-70%)  Mortality rate >50%  Endocarditis- mortality rate 25-60% if untreated

8. Risk to Pregnant Women  Most show no symptoms (98%)  Can be passed from mother to baby  Reported complications  Premature birth  Low birth weight  Miscarriage  Placentitis (inflammation of placenta) Greatest risk during 1 st trimester

9. TRANSMISSION

10. Transmission Inhalation (most common) ▫ Dust, droplets ▫ Birthing fluids/materials  10 9 bacteria released per gram of placenta ▫ Urine, feces, raw milk Direct or indirect contact with infected animal Contaminated surfaces, clothing, equipment, bedding, etc Arthropods (ticks) Person to person transmission is rare

11. Who’s at risk?  Farmers  Veterinarians  Meat processors/ abattoir workers  Laboratory workers/animal laboratory workers  Immunocompromised individuals  Pregnant women

12. Q Fever in the U.S.: *CDC 2011

13. *CDC-2011

14. Medical Surveillance

15. Prior to working with sheep  The following should contact UEOHC for a medical screening/risk assessment :  Immunocompromised individuals and those with pre- existing heart valve conditions are at higher risk of infection and should be fully informed of the increased risks.  Pregnant women or women who are considering becoming pregnant should also be fully informed of the increased risks. UEOHC Monday- Friday (8:30am-4:30pm) 919-966-9119

16. Signs and Symptoms of Q Fever  Often there are no symptoms or mild flu-like symptoms  Common signs and symptoms include:  sudden onset of high fever (104-105°F)  headache  malaise and fatigue  nausea and/or vomiting  chills and sweating  general feeling of sickness and loss of appetite  More serious complications can affect the immune-compromised, individuals with heart valve defects, and pregnant women. UEOHC Monday- Friday (8:30am-4:30pm) 919-966-9119

17. Exposure Procedures

18. Immediate Response:  Mucous membrane exposure: flush in an eye wash or potable water for a minimum of 15 minutes.  Non-intact skin exposure: Wash with soap and water or antiseptic for 15 minutes. REPORT ANY INJURIES AND ILLNESSES TO DLAM MANAGER/SUPERVISOR AND IMMEDIATELY REPORT TO UEOHC (919-966-9119)

19. Reporting Signs and Symptoms of Exposure  Employees experiencing any of the symptoms associated with exposure (even without an identified exposure incident) must report it to the DLAM Manager/Supervisor, UEOHC, and EHS.  If you have worked in the DLAM facility within the last two weeks of experiencing any of the symptoms associated with Q fever, report it to the DLAM Manager/Supervisor, UEOHC, & EHS.

20. Post Exposure Treatment If prophylactic antibiotic treatment is considered appropriate by clinic or ER medical staff, antibiotics are generally given for 2-3 weeks (acute) or for at least 18 months (chronic) unless otherwise contraindicated.

21. Injuries Requiring Emergency Medical Assistance Call 911

22. Respiratory Protection N95/PAPR

23. Respiratory Protection  Powered Air Purifying Respirators (PAPR’s) or N95 masks are required to enter the animal housing area and laboratory.  Annual training and respiratory clearance required (clearance is done at the UEOHC).  Annual fit testing for N95 is required.  DLAM staff will wear the PAPR to enter the animal housing area.

24. Respiratory Protection Program Requirements 29 CFR 1910.134  There are established procedures for selecting respirators for use in the workplace.  A medical evaluation is required to use respirators.  Fit testing procedures are required for tight-fitting respirators.  Procedures and schedules are in place for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise maintaining respirators.

25. Respiratory Protection Program Requirements 29 CFR 1910.134  Training of employees in respiratory hazards to which they are potentially exposed during routine and emergency situations is required.  Training of employees in the proper use of respirators, including putting on and removing, any limitations on their use, and the maintenance of the respirator is required.  Procedures are in place for regularly evaluating the effectiveness of the program.

26. Prevention and Control

27. Personal Protective Equipment (PPE) Safety Shoes & Shoe Covers Powered Air Purifying Respirator (PAPR) Gloves Disposable Coveralls PAPR must be worn by ALL DLAM staff when entering the sheep room. The PAPR should be wiped down with alcohol after each use. PPE should be removed immediately upon exiting the room & placed into the PPE receptacle outside the room. Bags of used PPE will be tied up and put in the dumpster when full. Wash or sanitize your hands as soon as possible after removing gloves.

28. Sanitation  Rubber mats will be placed on the floor to provide traction for the sheep.  The mats will be covered with pine shavings.  Sheep rooms are spot cleaned daily.  Soiled areas should be scooped or shoveled up and placed into a bedding bin. Take care not to produce dust when cleaning.  Clean pine shavings should be added as necessary.

29. Sanitation  Feed bowls are rinsed daily and sanitized weekly.  Enrichment items are sanitized weekly.  Periodically, as determined by the DLAM manager/supervisor, all shavings will be removed from the room and replaced by clean shavings.

30. Sanitation  Rooms should be sanitized using approved disinfectants at the end of each study (approximately every 4 weeks).  Shavings will be scooped or shoveled up and placed into a bedding bin.  Bedding bins will be placed in designated areas outside the building for pick up when full.  Send rubber floor mats to cage wash to be sanitized.  Foam walls, floor, and ceiling with Vimoba. Allow 15 minutes contact time.  Rinse all surfaces thoroughly.

31. Sheep Health  The sheep must be observed daily for signs of potential illness.  Report any abnormal health condition to veterinary services “Sick Animal Reporting”.  If immediate attention is required, you must contact and speak directly to a member of the veterinary team.  If a dead sheep is found in the room, notify the veterinary staff immediately and follow their instructions.  Notify your manager/supervisor and check the contact sheet on the door to see if the research staff wants to be notified.

32. Questions If you have any questions or concerns, please contact your DLAM Manager/Supervisor or EHS (919-962-5507). Thank you!