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Q Fever Paul McDermott/Mike Paton Biological Agents Unit Health & Safety Executive.

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Presentation on theme: "Q Fever Paul McDermott/Mike Paton Biological Agents Unit Health & Safety Executive."— Presentation transcript:

1 Q Fever Paul McDermott/Mike Paton Biological Agents Unit Health & Safety Executive

2 Route Map Background to Biological Agents Unit Outbreak – Scotland 2006 Issues raised Vaccination Emerging guidance

3 HSE’s Biological Agents Unit Located at HQ in Bootle 14 x Specialist Health & Safety Inspectors –Microbiology & Molecular Biology Disciplines Approximate total of 26 staff with UK wide remit

4 Biological Agents Unit Hazardous Installations Directorate Chemicals Off-shore Specialised Industries – explosives, gas/pipelines, mines, microbiology & genetic modification (SI4) FMDV Pribright 2007

5 Laboratory work Cooling towers HCAI Biological Agents Unit Our work is aimed at ensuring that risks in the workplace from microbiological hazards are properly controlled Cover all aspects of GM and biotechnology related to human health and environmental safety Escape of Animal Pathogens from containment Animal Pathogens High containment

6 Q Fever - background highly infectious zoonosis - Coxiella burnetii widespread globally (including UK) among livestock - sheep, cattle and goats infection in animals is usually asymptomatic, but some abortions and stillbirths livestock - high concentrations of bacteria found in mammary glands, placental tissue and milk (lesser extent in urine and faeces)

7 Q fever – Human Infection Q fever endemic in the UK; ~70 UK cases of Q fever per year actual number of cases may be ~ 700 (1% of chronic atypical pneumonia) periodic outbreaks i.e. 4 major outbreaks in the UK over 17 years acute symptomatic human infection characterised by an influenza-like-illness (self limiting) chronic infection less common (~10% cases) but can result in pneumonia or endocarditis clinical diagnosis of Q fever difficult (presentation as non-specific illness) highest incidence of infection in humans in the UK spring/early summer (lambing season)

8 Outbreaks in UK Birmingham outbreak (1989): –similar wind borne spread outbreak from farms engaged in outdoor lambing and calving (147 cases, 85% male, 90% adults) Newport outbreak (2002): –106 cases out of 250 workers from a factory ? due to release of spore-like particles from drilling into strawboard ceilings during renovation works in a cardboard box manufacturing plant Stirling, Scotland outbreak (2006): –Meat processing plant outbreak thought to be related to a ewe that had aborted in May 2006. 138 cases. Cheltenham (2008): –31 diagnosed cases in urban setting

9 Route of transmission Usually inhalation of contaminated aerosols –Windblown spore-like particles –E.g. meat processing plants (Scotland 2006), straw materials embedded in constructions (Newport 2002) Ingestion of unpasteurised milk Little or no human to human spread (except possibly by inhalation of organisms contaminating clothing) Infectious dose very low ? 1 organism (in lab setting) – may be different in field Incubation period 14-39 days (may be shorter if there is a high infectious dose)

10 Scottish Outbreak Late June 2006, local GPs reported increasing numbers of sick people from meat processing plant (by end of outbreak >100 people confirmed positive); HSE asked to investigate possible source of legionella 17 July disease confirmed as Q Fever Environmental conditions – very hot, dry weather in early summer Plant processed ~2000 sheep per day (150 cows per day) No specific job/role within plant linked to exposure Source linked to sheep lairage and aborted foetus within exposure period

11 Meat Processing Lamb Chill Fat Plant Slaughter Meat Processing Canteen Loading Bay Cattle Lairage RunYard Sheep Lairage Car Park Entrance Offices Zoonoses – Q fever Smokers shed Access Door Ventilation fan Canteen Q-Fever Outbreak Scotland, June 2006

12 Sheep Lairage

13 Ventilation System Lairage supply fans

14 Fire Door Canteen entrance lairage fire exit

15 Contributory Factors General lack of understanding of the zoonotic risks Sheep aborted on site Site Layout (proximity animals/canteen) Ventilation (type & operation) Weather (hot/dry/dusty – access via fire door) Cleaning regime (infrequent) Throughput (2000 sheep per day) Cross contamination (hygiene measures/movement of staff) Animal welfare

16 Action Taken Raise awareness of zoonoses risk (risk assessment, training) Re-design of lairage interior (assist cleaning; not possible to relocate) New ventilation system fitted with an air scrubber Increased frequency cleaning of holding areas Procedures for disposal of birth products and other high risk material Hygiene procedures (segregation clean/dirty activities)

17 Advisory Committee on Dangerous Pathogens (ACDP) ACDP provides scientific and technical advice to HSE and others on the risks from exposure infectious microorganisms – independent, respected advice raised concerns over outbreak and emphasised need for further research - relationship between exposure, immunity and disease Supported the proportionate line of control taken by HSE Referred vaccination issue to JCVI Supported approach of raising awareness with industry

18 Guidance for Employers HSE worked with British Meat Processors Association to develop guidance – available on BMPA website Annual HSE/Defra press release related to risks to pregnant workers during spring lambing, calving and kidding (updated to reflect Q fever) VLA/HPA/Defra/HSE published a guidance note for farmers (Defra website) HSE articles in National Sheep Association magazine "Sheep Farmer" and British Veterinary Association magazine "In Practice“ HSE revised its agriculture supplement to reflect changes in working practices Coxiella burnetii

19 Health and Safety Executive Health & Safety Executive Field Operations Directorate Biological Agents Unit Agriculture sector Occupational Health specialists Occupational Hygiene specialists Other Government Departments Health Protection Scotland Health Protection Agency Department for Environment, Food, Rural Affairs Veterinary Laboratory Agency Industry Scot Beef Ltd British Meat Processors Association Acknowledgements

20 Thank you for your attention Any questions?

21 Q Fever Vaccine - Joint Committee for Vaccination & Immunisation (JCVI) HSE referred the matter to JCVI, who  Considered data from Australia & questioned supporting efficacy against UK strains  Potential uses of vaccine e.g. for outbreak scenarios or prophylactic use or specific occupations (abbatoir, vets, farmers)  Raised issue of severe reaction in vaccinees previously exposed to Q fever (severe reaction at inoculation site) and incidence pre-exposure (In NI, >50% farmers seropositive; 10%< urban population)  Met with scientists from Australia to discuss vaccine data JCVI yet to reach decision hence Q-Vac still not licensed for use in UK

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