q fever in the panhandle the saga continues james l. alexander, dshs kelly fitzpatrick, cdc lindsay...
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Q FEVER IN THE PANHANDLE Q FEVER IN THE PANHANDLE THE SAGA CONTINUESTHE SAGA CONTINUES
James L. Alexander, DSHSJames L. Alexander, DSHSKelly Fitzpatrick, CDCKelly Fitzpatrick, CDCLindsay Oliver, CDCLindsay Oliver, CDCGilbert Kersh, CDCGilbert Kersh, CDC
Robert Massung, CDCRobert Massung, CDCKevin McClaran, DSHSKevin McClaran, DSHS
2006 Environmental Survey2006 Environmental Survey
50% of agriculturally-50% of agriculturally-related sites positiverelated sites positive
69% of non-69% of non-agriculturally-related agriculturally-related sites positivesites positive
59% of all sites 59% of all sites positivepositive
3 areas of West Texas sampled3 areas of West Texas sampled
Tested for Presence of Tested for Presence of Coxiella burnetii Coxiella burnetii DNA in dirt/dust/manureDNA in dirt/dust/manure
2008 Construction Site Incident2008 Construction Site Incident 17/199 (8.5%) sero-positive 17/199 (8.5%) sero-positive >> 128 128
10/15 (66.7%) interviewees 10/15 (66.7%) interviewees symptomaticsymptomatic
Why?Why?
““What is the prevalence of antibodies What is the prevalence of antibodies to q fever in the Panhandle to q fever in the Panhandle
population?”population?”
NetherlandsNetherlands
2009: 2357 new human q fever cases2009: 2357 new human q fever cases– US 43,855 (109)US 43,855 (109)
Slaughtered about 62,500 pregnant goats Slaughtered about 62,500 pregnant goats and sheepand sheep
455,000 doses of vaccine distributed455,000 doses of vaccine distributed
90% of sheep/goat herds vaccinated90% of sheep/goat herds vaccinated
““What is the prevalence of antibodies What is the prevalence of antibodies to q fever in the Panhandle to q fever in the Panhandle
population?”population?”
DSHS collaborated with the local blood bankDSHS collaborated with the local blood bank
IRB approval obtainedIRB approval obtained
Donors were apprised of the project, given a fact sheet Donors were apprised of the project, given a fact sheet and asked if they would participateand asked if they would participate
DSHS provided a vacuum tube which the phlebotomists DSHS provided a vacuum tube which the phlebotomists used when collecting the routine samples for screening used when collecting the routine samples for screening tests.tests.
A questionnaire was administered by a DSHS A questionnaire was administered by a DSHS representative.representative.
2009 Sero-survey for Q-fever 2009 Sero-survey for Q-fever
2009 Sero-survey for Q-fever 2009 Sero-survey for Q-fever
600 serum samples were collected600 serum samples were collected– 591 from blood donors591 from blood donors– 9 from people who could not donate, or who chose 9 from people who could not donate, or who chose
not to donate, but desired to participatenot to donate, but desired to participate– 4 regular donors who were unable to donate blood 4 regular donors who were unable to donate blood
participated in the surveyparticipated in the survey– 589 donors in the study589 donors in the study
19 blood drive events in 17 counties19 blood drive events in 17 counties
Residents from 26 counties and 2 states participatedResidents from 26 counties and 2 states participated
Samples from a New Mexico resident and 3 residents Samples from a New Mexico resident and 3 residents of non-Panhandle counties in Texas were removed.of non-Panhandle counties in Texas were removed.
Samples from 5 non-donors, 1 without a Samples from 5 non-donors, 1 without a questionnaire, and a 17 y.o. were also removedquestionnaire, and a 17 y.o. were also removed
Tubes were centrifuged, serum was pipetted and Tubes were centrifuged, serum was pipetted and samples were stored on dry ice until they could be samples were stored on dry ice until they could be placed in a Revcoplaced in a Revco®® @ -80 @ -80oo C C
Held @ -80Held @ -80o o C until shipped to CDC for testing.C until shipped to CDC for testing.
2009 Sero-survey for Q-fever2009 Sero-survey for Q-fever
2009 Sero-survey for Q-fever2009 Sero-survey for Q-fever
All samples screened by ELISAAll samples screened by ELISA
All ELISA positive/equivocal samples All ELISA positive/equivocal samples tested by IFA @ 1:16tested by IFA @ 1:16
Samples reactive @ 1:16 were titrated Samples reactive @ 1:16 were titrated to their endpoint to their endpoint
CDC Test Protocol
PrevalencePrevalence
589 samples utilized in the study589 samples utilized in the study
Antibody prevalence:Antibody prevalence:
10.7% in 589 people 10.7% in 589 people from 23 Countiesfrom 23 Counties
CountiesCounties Donation SitesDonation Sites
6 Counties with 0% 6 Counties with 0% 2 Sites with 0% 2 Sites with 0%
1-6 donors (14)1-6 donors (14) 8 and 35 donors (43)8 and 35 donors (43)
9 Counties with 3-8%9 Counties with 3-8% 10 Sites with 3-8%10 Sites with 3-8%
19-99 donors (385)19-99 donors (385) 12-80 donors (350) 12-80 donors (350)
8 Counties with 16-50%8 Counties with 16-50% 8 Sites with 19-43% 8 Sites with 19-43%
5-68 donors (190)5-68 donors (190) 4-72 donors (196) 4-72 donors (196)
PrevalencePrevalence
SymptomsSymptoms
Do you recall having an illness, possibly lasting 7 days or more, that began suddenly with fever, chills, profuse sweating, muscle and joint pains,
severe headache and fatigue for which a definitive diagnosis was not made?
SymptomsSymptoms
11.1% of people with sero-11.1% of people with sero-positive results said “Yes”positive results said “Yes”
Male (6):Male (6): 14%14%
Female (1):Female (1): 5% 5%
All White Non-HispanicAll White Non-Hispanic
SymptomsSymptoms
10.3% of people with negative 10.3% of people with negative results also said “Yes” results also said “Yes”
Male (23):Male (23): 8.7%8.7%
Female (31):Female (31): 12%12%
Age DataAge Data
Positives:Positives:
AllAll PosPos NegNeg
RangeRange 18-82 18-82 18-7618-76 18-8218-82
MeanMean 46.3 46.3 46.4 46.4 46.2 46.2
Median Median 48 48 49 49 48 48
ModeMode 53, 55 53, 55 38, 49, 51 38, 49, 51 55 55
DemographicsDemographicsRacial Percentages Racial Percentages
White Non-Hispanic 85.6 62.8
Hispanic 12.7 29.3
Black Non-Hispanic 0.3 5.4
Amer. Indian/Alaskan Native 0.7 1.0
Asian-Pacific Islander 0.2 1.4
Black Hispanic 0.2 NA
None Provided 0.3 NA
Survey Popn
US Sero-prevalence StudyUS Sero-prevalence Study
Seroprevalence of Q Fever in the United Seroprevalence of Q Fever in the United States, 2003–2004, States, 2003–2004, Anderson, et alAnderson, et al
2003-20042003-2004
Stratified for ageStratified for age
Part of the National Health and Nutrition Part of the National Health and Nutrition Examination Survey programExamination Survey program
Comparison of StudiesComparison of StudiesAnderson, et alAnderson, et al11
PanhandlePanhandle ((> > 20 y.o.)20 y.o.) ((>> 18 18
y.o.)y.o.)
Sample SizeSample Size 44374437 589 589
Sero-prevalenceSero-prevalence 3.1%*3.1%* 10.7%10.7%((>>1:16)1:16) ((>>1:128)1:128)
* * Weighted popWeighted popn n estimateestimate
1 Seroprevalence of Q Fever in the United States, 2003–20041 Seroprevalence of Q Fever in the United States, 2003–2004
Comparison of StudiesComparison of Studies
Anderson, et alAnderson, et alPanhandlePanhandle
Male +Male + 3.8%3.8% 14%14%
Female +Female + 2.4%2.4% 7% 7%
Male:FemaleMale:Female 1.5:11.5:1 2:12:1
AgeAge Age Risk Age Risk No EffectNo Effect
Seroprevalence of Q Fever in the United States, 2003–2004Seroprevalence of Q Fever in the United States, 2003–2004
Anderson, et alAnderson, et al PanhandlePanhandle
Male vs FemaleMale vs Female 1.5 OR (1.0-2.3)1.5 OR (1.0-2.3) 2.1 OR (1.2-2.1 OR (1.2-3.8)3.8)
White Non-HispanicWhite Non-Hispanic 2.8%2.8% 10.4%10.4%
HispanicsHispanics 7.4%7.4% 10.7%10.7%
Geometric meanGeometric mean 95 (16 - 4096)95 (16 - 4096) 597 (64 - 597 (64 - 65536)65536)
(Phase II IgG)(Phase II IgG)
Comparison of StudiesComparison of Studies
Panhandle Study LimitationsPanhandle Study Limitations
Of 19 counties with more than 1 participant, 5 Of 19 counties with more than 1 participant, 5 were under-represented and 14 were over-were under-represented and 14 were over-represented.represented.
Residents of 4 counties provided 50% of the Residents of 4 counties provided 50% of the samplessamples
2 of those counties (large pop2 of those counties (large popn)n) were over were over represented and 2 (moderate poprepresented and 2 (moderate popn)n) were were under representedunder represented
Used healthy blood donorsUsed healthy blood donors
Racial/ethnic representation did not match Racial/ethnic representation did not match the area’s diversitythe area’s diversity
Convenience sampleConvenience sample
Not stratified for ageNot stratified for age
Study LimitationsStudy Limitations
ConclusionsConclusions Exposure to Exposure to Coxiella burnetii Coxiella burnetii appears to be appears to be
significant in some parts of the Texas significant in some parts of the Texas PanhandlePanhandle
If the healthy, blood donor population has a If the healthy, blood donor population has a 10.7% prevalence, it is logical to suspect that 10.7% prevalence, it is logical to suspect that a random sample across our population a random sample across our population might detect a higher prevalence might detect a higher prevalence
Analysis continues to examine risk factors, Analysis continues to examine risk factors, including occupation, association with including occupation, association with livestock and location of residence livestock and location of residence
Thanks to:Thanks to:
HSR 1 Zoonosis Control teamHSR 1 Zoonosis Control team Kevin McClaran, DSHS EpidemiologistKevin McClaran, DSHS Epidemiologist HSR 1 Immunization, PHP and Social HSR 1 Immunization, PHP and Social
Programs StaffPrograms Staff Coffee Memorial Blood Center StaffCoffee Memorial Blood Center Staff CDC teamCDC team Patrick Hunt, DSHS Zoonosis ControlPatrick Hunt, DSHS Zoonosis Control