Q Fever: Prevention Overview for Clinicians

• Educate the public, persons at risk, and health care professionals on sources of infection.
• Counsel persons with occupational exposures that are at highest risk for developing chronic Q fever (i.e., veterinarians, workers at meat processing plants, sheep and dairy workers, livestock farmers, and researchers at facilities housing sheep), especially persons with pre-existing cardiac valvular disease or individuals with vascular grafts, and persons with immunosuppressive conditions.
• Persons at high risk for chronic Q fever should have regular health evaluations to promote early recognition of the development of endocarditis. Acute Q fever patients having recognizable valvular disease at the time of treatment/diagnosis should be carefully monitored by serologic procedure every three months for the next two years.
• Encourage the public to use only pasteurized milk and milk products.
• The following steps should be followed in farm settings:
  • Appropriately dispose of placenta, birth products, fetal membranes, and aborted fetuses at facilities housing cattle, sheep, and goats. Disinfect the area with an approved chemical solution.
  • Use quarantine procedure for new animals prior to introduction to a herd.
  • Holding facilities for ruminants should be located away from populated areas to prevent windborne spread of disease from infected herds.
• For medical research settings, use the farm-setting recommendations as well as the following precautions:
  • Whenever possible, try to ensure use of Q fever-free animals, especially sheep, through serologic testing programs
  • Restrict access to barns and laboratories used in housing potentially infected animals.
  • Measures should be implemented to prevent air flow to other areas of human or animal occupancy.
• Vaccinate (where possible) individuals engaged in laboratory research involving live C. burnetii.
  • A human vaccine for Q fever has been developed and used successfully in Australia. This vaccine is not commercially available in the United States.
  • In the United States, vaccine may be available only through use of an Investigational New Drug license, currently managed by the Department of Defense.
  • Prior to vaccination with whole cell vaccine, persons must have a skin test to verify they have not been previously exposed to C. burnetii. Individuals who have previously been exposed should not receive the vaccine because severe local reactions may occur.
• There are no approved vaccines for animals in the United States, although two vaccines are commercially available for animals in Europe.

Disinfectants for Coxiella burnetii

• Many standard disinfectants are not effective in killing C. burnetii. The most effective disinfectants are quaternary ammonium products (e.g., Microchem® 5% solution).
• Most disinfectant solutions will be adversely affected by organic materials, so complete disinfection of an area may be difficult.