title: A large Q fever outbreak in an urban school in central Israel.
abstract: BACKGROUND. On 28 June 2005, numerous cases of febrile illness were reported among 322 students and employees of a boarding high school located in an urban area in central Israel. Subsequent investigation identified a large outbreak of Q fever which started 2 weeks earlier. We describe the investigation of this outbreak and its possible implications. METHODS. We conducted a case-control study to identify risk factors for Q fever disease. Environmental sampling was conducted to identify the source and the mode of transmission of Coxiella burnetii, the infectious agent. RESULTS. Of 303 individuals, 187 (62%) reported being ill between 15 June and 13 July 2005. Serological evidence for C. burnetii infection was evident in 144 (88%) of the 164 tested individuals. Being a student, dining regularly at the school dining room, and boarding at school during a June religious holiday and the preceding weekend were all significant risk factors for contracting Q fever. C. burnetii DNA was detected using polymerase chain reaction on samples from the school dining room's air conditioning system, supporting contribution of the air conditioning system to the aerosol transmission of the infectious agent. CONCLUSIONS. We report a large outbreak of Q fever in an urban school, possibly transmitted through an air conditioning system. A high level of suspicion for C. burnetii infection should be maintained when investigating point source outbreaks of influenza-like disease, especially outside the influenza season.
authors.affiliation: Tel Aviv District Health Office, Ministry of Health, Israel.
authors.forename: Ziva
authors.initials: Z
authors.lastname: Amitai
authors.forename: Michal
authors.initials: M
authors.lastname: Bromberg
authors.forename: Michael
authors.initials: M
authors.lastname: Bernstein
authors.forename: David
authors.initials: D
authors.lastname: Raveh
authors.forename: Avi
authors.initials: A
authors.lastname: Keysary
authors.forename: Dan
authors.initials: D
authors.lastname: David
authors.forename: Silvio
authors.initials: S
authors.lastname: Pitlik
authors.forename: David
authors.initials: D
authors.lastname: Swerdlow
authors.forename: Robert
authors.initials: R
authors.lastname: Massung
authors.forename: Sabine
authors.initials: S
authors.lastname: Rzotkiewicz
authors.forename: Ora
authors.initials: O
authors.lastname: Halutz
authors.forename: Tamy
authors.initials: T
authors.lastname: Shohat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000389:Air Conditioning; D000907:Antibodies, Bacterial / Q000097:blood; D016022:Case-Control Studies; D016997:Coxiella burnetii / Q000302:isolation & purification*; D004269:DNA, Bacterial / Q000302:isolation & purification; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011778:Q Fever / Q000453:epidemiology*; D012574:Schools; D014505:Urban Population; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial