title: Q fever in Japan: an update review.
abstract: As neglected zoonosis for many years, Q fever is now ubiquitous in Japan. Similarly to elsewhere in the world, domestic animals are considered to be important reservoirs of the causal agent, Coxiella burnetii, a resistant intracellular bacterium. Infected animals shed bacteria in milk, feces, urine, vaginal mucous and birth products. Inhalation of bacteria present in the environment is the main route of animal and human infection. Shedding of C. burnetii in milk by domestic ruminants has a very limited impact as raw milk is seldom ingested by the Japanese population. The clinical expression of Q fever in Japan is similar to its clinical expression elsewhere. However clinical cases in children are more frequently reported in this country. Moreover, C. burnetii is specified as one of the causative organisms of atypical pneumonia in the Japanese Respiratory Society Guideline for the management of community-acquired pneumonia. In Japan, C. burnetii isolates are associated with acute illness and are mainly of moderate to low virulence. Cats are considered a significant source of C. burnetii responsible for human outbreaks in association with the presence of infected parturient cats. Since its recognition as a reportable disease in 1999, 7-46 clinical cases of Q fever have been reported by year. The epidemiology of Q fever in Japan remains to be elucidated and the exact modes of transmission are still unproven. Important further research is necessary to improve knowledge of the disease itself, the endogenous hosts and reservoirs, and the epidemiological cycle of coxiellosis in Japan.
authors.affiliation: Research Unit in Epidemiology and Risk Analysis applied to Veterinary Sciences (UREAR), Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, University of Liege, Boulevard de Colonster 20, B42, 4000 Liege, Belgium.
authors.forename: Sarah Rebecca
authors.initials: SR
authors.lastname: Porter
authors.forename: Guy
authors.initials: G
authors.lastname: Czaplicki
authors.forename: Jacques
authors.initials: J
authors.lastname: Mainil
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Horii
authors.forename: Naoaki
authors.initials: N
authors.lastname: Misawa
authors.forename: Claude
authors.initials: C
authors.lastname: Saegerman
mesh_terms: D000818:Animals; D000829:Animals, Domestic / Q000382:microbiology; D001715:Bird Diseases / Q000382:microbiology; D001717:Birds / Q000382:microbiology; D002371:Cat Diseases / Q000382:microbiology; D002415:Cats / Q000382:microbiology; D002648:Child; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D016997:Coxiella burnetii / Q000302:isolation & purification; D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008892:Milk / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology; D011247:Pregnancy; D015995:Prevalence; D011778:Q Fever / Q000453:epidemiology* / Q000635:transmission / Q000662:veterinary; D015047:Zoonoses / Q000453:epidemiology* / Q000635:transmission