# 4149
The slightly alarming, if not exactly accurate headline yesterday coming from the Novinite New agency of Sofia read:
Killer Goat Flu Appears in Netherlands
There have been press reports of an alarming new epidemic that has struck the Netherlands. Following bird flu, then swine flu, now goat flu is causing panic.
According to online news sources, up to 2 300 people have succumbed to goat flu in the country, and six people have died.
During a time when tens of thousands of deaths have been attributed to swine flu, a `killer goat flu’ makes for pretty good news copy. But this isn’t a `flu’ at all, and this outbreak isn’t `an alarming new epidemic’ - it’s been going on now for more than two years.
But other than that . . .
What this article is referring to in an ongoing zoonotic outbreak of Q-Fever in the Netherlands. Since Q-Fever isn’t something that a lot of my readers may be familiar with, a little background is in order.
Q-Fever is spread by a bacteria Coxiella burnetii (not a virus), often found in Cattle, sheep, and goats, but also found in other livestock and even domestic pets (cats, dogs). C. Burnetii doesn’t generally cause illness in these animals, although abortions in goats & sheep have been linked to the bacterial infection.
The bacteria are excreted in the milk, urine and feces of infected animals, and most abundantly in the amniotic fluid released during birthing. The bacteria are extremely hardy, and resistant to heat, drying, and many disinfectants.
Humans most often contract the bacteria through inhalation of contaminated barnyard dust. Many infections are subclinical, but some may be very serious; causing severe pneumonia and rarely hepatitis and a form of endocarditis.
While treatment with antibiotics generally resolves the infection, some victims develop a chronic (and more dangerous) form of the disease.
Q-Fever has been a notifiable disease in the US since 1999, but reporting is not required in many other countries. The disease, therefore is underreported, and its true extent globally is unknown.
This `alarming new epidemic’ was first noticed in the Netherlands (there have been outbreaks in other countries) in May of 2007, when a local doctor in a rural village in the south of that country reported an unusual cluster of pneumonia cases.
At first they were suspected to have due to Mycoplasma pneumoniae, but further testing revealed acute Coxiella burnetii infection.
As you can see from the graph above, the number of human infections in the Netherlands has grown each year since 2007.
In a normal year (2000-2006) the Netherlands might expect to see 5 to 20 infections with the bacteria. Currently, they are diagnosing more than 2,000 cases a year.
While goats are traditionally considered to be the prime source of this disease, other reservoirs have been identified as well.
For goats, mating generally occurs in the fall (gestation is about 5 months), and so kidding season falls in the spring.
In an attempt to curb the further spread of this disease, the RIVN [Dutch National Institute for Public Health and the Environment] is advising the Health Ministry to order the destruction of all pregnant goats from farms infected with Q-fever.
ProMed Mail has been following the outbreak of Q-fever in the Netherlands since 2007, and has more than one dozen updates on file. The latest was on December 9th of this year:
Archive Number 20091209.4198
Published Date 09-DEC-2009
Subject PRO/AH/EDR> Q fever - Netherlands (13): control measuresQ FEVER - NETHERLANDS (13): CONTROL MEASURES
Minister of Health Ab Klink and Minister of Agriculture Gerda Verburg have agreed that on infected farms where animals have not been vaccinated, all pregnant animals must be slaughtered, whether or not they have the virus [sic; the agent is a bacterium].
Q-fever is caused by bacteria (_Coxiella burnetii_) released when pregnant goats or sheep have spontaneous abortions. The disease is prevalent in areas in the southern Netherlands with large-scale goat farms and a relatively dense population. This year [2009] alone, 2200 [in fact, 2293 cases as of 25 Nov 2009] people have contracted it, most of them in the southern rural province of Brabant. At least 6 people have died.
While these control methods are hoped to reduce the spread of this bacterial disease, the editors of ProMed Mail remind their readers that goats may not be the only source of infection:
While small ruminants, namely goats and sheep are traditionally regarded as the main potential source of human infection, other animals, such as cattle, dogs and cats, are not to be disregarded. In urban areas, littering cats have been seriously suspected as a significant source of human infection.
In the Dutch context, the earlier (1997) review "Q fever in Europe" is of interest. It included the following text: "In some human cases, no relation with "classical" sources can be found, and possible new sources must be sought. In a serological study of dogs and cats [in central Netherlands, 1992], 13.2 percent (91/688) of dogs and 10.4 percent (46/441) of cats were found to be positive for specific antibodies against _C. burnetii_. This implies that cats and dogs may be a source of infection.
It should be noted that Q-fever can also be spread by ticks, although human infection via that route is considered rare. Since most cases of Q-fever result in mild or sub-clinical infections, the true extent of the spread of the disease is unknown.
While concerning, the potential for the spread of this disease is very low compared to influenza. According to the University of Wisconsin’s VetMed page on Q-Fever:
Reports of human-to-human transmission are extremely rare, but C. burnetii has been isolated from human milk and human placental tissues, and there are reports of transmission to physicians during abortion procedures and autopsies.
So the good news in all of this is, Q-fever doesn’t have pandemic potential, even if it can present serious localized problems.
For more on Q-Fever you may wish to check these resources:
