title: "The dust hasn't settled yet": the National Q fever Management Program, missed opportunities for vaccination and community exposures.
abstract: OBJECTIVE
  To determine the proportion of notifiable cases of Q fever attributable to occupational and community exposures and to identify missed opportunities for Q fever vaccination in notifications of occupational exposures.
  
  
  METHODS
  A review of Q fever notifications to the BSPHU from January 2000 to September 2006 was undertaken. Notifications were categorised according to probable exposure source. Occupational exposures were further categorised according to reported past exposure to Q fever and Q fever vaccination status.
  
  
  RESULTS
  One hundred and ninety-one Q fever notifications were identified, with occupational exposure reported in 106 cases and community exposure reported in 69 cases. In the occupational exposures, 76 cases (71%) were not vaccinated, 15 (14%) reported past exposure to Q fever and eight reported vaccination prior to illness onset, but vaccination status could not be independently verified. Community acquired Q fever was most commonly attributed to living or working near a high-risk industry (26, 38%), incidental exposures such as farm visits, or attending sale yards (27, 39%).
  
  
  CONCLUSIONS
  Occupationally acquired cases of Q fever continue to be reported in significant numbers and opportunities for vaccination are being missed. There is an ongoing need to ensure that all employees in high-risk industries are screened and vaccinated. The proportion of community acquired notifications of Q fever has increased since the National Q fever Management Program started, commensurate with the decline in occupationally acquired cases. These proportions may be expected to change with the cessation of the program in Queensland in December 2006.
authors.affiliation: Brisbane Southside Population Health Unit, Queensland. cheryn_palmer@health.qld.gov.au
authors.forename: Cheryn
authors.initials: C
authors.lastname: Palmer
authors.forename: Brad
authors.initials: B
authors.lastname: McCall
authors.forename: Kari
authors.initials: K
authors.lastname: Jarvinen
authors.forename: Michael
authors.initials: M
authors.lastname: Krause
authors.forename: Karen
authors.initials: K
authors.lastname: Heel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003153:Community Health Services; D005260:Female; D006801:Humans; D017589:Immunization Programs; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011634:Public Health; D011778:Q Fever / Q000453:epidemiology / Q000276:immunology*; D011793:Queensland / Q000453:epidemiology