Q Fever protection in veterinary practice
Ratification Date: 07 Dec 2018
Veterinary practices must have a Q fever risk management protocol in place for all staff, clients and visitors to the practice, to ensure their protection.
This requirement applies to both livestock and companion animal practice.
The organism that causes Q fever in humans, Coxiella burnetii, is found in a variety of domestic and wild animals. Animals may be asymptomatic, or show reproductive disease such as abortion, stillbirth and retained foetal membranes.
In Australia, C. burnetii is maintained in wildlife such as kangaroos, bandicoots and rodents and their attendant ticks. Mutually coexistent ticks may involve feral and domestic goats, cattle or sheep which in turn infect their attendant ticks. Hide, fleece or hair contamination also occurs when infected ticks shed the heavily concentrated organism in their faeces while feeding on stock.
Humans are at potential risk of infection if exposed to products of parturition and other bodily fluids that may carry the Coxiella burnetii organism. Inhalation of the organism, as a result of direct or indirect exposure to contaminated aerosols, is the most common mechanism of human infection. Infection may also occur via skin abrasions and splashes of infected material into the eye. Infection can range from a non-specific illness or asymptomatic infection through to a severe chronic illness including meningitis, hepatitis, osteomyelitis and bacterial endocarditis.
It is a workplace health and safety expectation that veterinary practices protect their staff, clients and other visitors to the practice from recognised risks such as C.burnetii infection. Infection of personnel working at veterinary practices has been associated with:
- Direct contact with infected animals, tissues or animal products, especially those related to products of parturition. Aerosolised dust or particles can cause infection through respiratory and conjunctival routes. Infection can also be caused through cuts or needle-stick injuries.
- Indirect content with infected material via contaminated clothing or equipment eg cleaning equipment and clothing after assisting at a ruminant parturition. It should be noted that laundering of contaminated drapes or clothes can also pose a risk to people outside the practice not in direct contact with animals, such as family members, and a duty of care should also extend to advising these potential at-risk individuals.
- Environmental infection via dust contaminated by wildlife or products of parturition. C. burnetti is persistent in the environment for a significant time period.
Vaccination against Q Fever is available in Australia. Before being vaccinated, a thorough history should be taken and immune status determined by skin testing and serology. If serology and skin tests are negative, the vaccine can be administered. Undergraduate veterinary students in Australia are required to be tested and vaccinated if not immune. Veterinary nurses and other staff may not always be aware of the need for testing and vaccination, and cost may pose a barrier for these groups. Women of childbearing age may face an increased risk of chronic disease if infected while pregnant. Recent initiatives in human General Practitioner training, including online courses covering interpretation of the intradermal hypersensitivity test and serology, and criteria to enable safe administration of the Q Fever vaccine to suitable candidates, will hopefully increase vaccine availability and decrease costs for the recipient.
Unvaccinated persons and/or those with unknown immune status should be strongly discouraged from assisting with caesarean operations, resuscitation of neonates in veterinary practices or being in contact with periparturient ruminants. Should such an individual seek to assist or be in attendance in such cases, appropriate personal protective equipment (PPE) must be worn and they should be advised of the risk of infection. Staff with known vaccination and immune status should also observe requirements for appropriate PPE in such cases.
No staff or unpaid assistants should perform mouth-to-snout resuscitation of neonates; a neonatal resuscitator should always be used in preference.
Clients who are assessed to be at increased risk of exposure to Q fever, such as dog and cat breeders, those in contact with periparturient ruminants and wildlife carers, should be advised of the potential for zoonotic infection and advised to seek testing and vaccination through their medical practitioner. They should also be made aware of suitable PPE and biosecurity practices fitting to their potential exposure. It should be noted that the Q fever vaccine is currently not registered for use in children under 15.
Governments should subsidise Q fever testing and vaccination due to the public health risk to people involved in agricultural, veterinary and wildlife occupations.
- Governments should subsidise routine testing for Q fever, as well as provision of the Q fever vaccine, to agricultural, wildlife and veterinary industry personnel, including students in these disciplines. Addition of the vaccine to the Pharmaceutical Benefits Scheme (PBS) is recommended.
- Veterinary practices should implement a policy limiting only those personnel who are protected against Q fever assisting with birth, caesarean or resuscitation of neonates.
- Evidence of vaccination or previous Q fever exposure should be assessed at the time of employment, and the associated risks discussed during the induction process.
- Appropriate PPE should be provided to unvaccinated staff and volunteers, including personnel who cannot be vaccinated for medical reasons.