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Q FEVER STILL ALIVE AND WELL: MEAT INDUSTRY TAKE CARE
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No jab, no job.
That's the motto of Australian meat industry employers who are trying to prevent Q fever outbreaks in their workers.
Dr Paul Van Buynder, senior medical adviser with the Victorian Department of Human Services, told a conference of the Royal Australasian College of Medicine that people associated with the meat industry such as railway workers who transport cattle, shearers, shooters, veterinarians, part-time contractors, and neighbours should all be vaccinated.
The peak in Australian notifications occurred in 1993, with almost 900 cases, and in 2001 there were over 700 cases.
Rarely does it fall below 500 cases per year despite vaccine availability.
Mortality is not high, except in endocarditis sufferers, but there is high morbidity, Dr Van Buynder said.
"It's clear we are not getting on top of the problem."
Q fever, first described in the 1930s, rarely attracts the public attention given other infectious diseases such as Legionella or meningococcal infections.
Yet it is one of the most costly and severe infectious diseases in Australia.
Cattle, sheep, and goats are the main reservoirs of human infection, although bandicoots, kangaroos, and dogs can also be infected.
Q fever resulting from exposure to parturient cats and from exposure during the skinning and dressing of wild rabbits has been reported in Canada.
The disease is caused by the organism Coxiella burnetii and causes a spectrum of illness from asymptomatic infection to acute or subacute or chronic infection.
A post-Q fever fatigue syndrome has also been described.
The typical presentation of acute Q fever is an acute illness following an incubation period of 15-25 days.
Dr Van Buynder said the key clinical features are rapid onset of high fever, rigours, profuse sweating, severe fatigue, severe headache, photophobia, and muscle and joint pain.
Chronic infection often manifests as bacterial endocarditis.
Transmission is most commonly considered to occur through respiratory infection due to aerosolization of contaminated material - often in dust or environmental material from a range of natural or occupational environments, such as abattoirs, shearing sheds, and livestock farms.
In Australia, 400-600 notifications of Q fever are made annually, with most coming from southeast Queensland and northern New South Wales.
The vaccine, Q-Vax, usually provides clinical protection within two weeks after vaccination.
Dr Van Buynder said this is probably a once in a lifetime vaccination, as good markers have been seen five years after vaccination.
A process of prevaccination screening is necessary to minimize the chance of potentially serious local injection site reactions.
"This is a nasty disease which is almost certainly underdiagnosed.
"It is better to prevent it than to treat it."
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