title: Q fever epidemic in Hungary, April to July 2013.
abstract: We investigated a Q fever outbreak with human patients showing high fever, respiratory tract symptoms, headache and retrosternal pain in southern Hungary in the spring and summer of 2013. Seventy human cases were confirmed by analysing their serum and blood samples with micro-immunofluorescence test and real-time PCR. The source of infection was a merino sheep flock of 450 ewes, in which 44.6% (25/56) seropositivity was detected by enzyme-linked immunosorbent assay. Coxiella burnetii DNA was detected by real-time PCR in the milk of four of 20 individuals and in two thirds (41/65) of the manure samples. The multispacer sequence typing examination of C. burnetii DNA revealed sequence type 18 in one human sample and two manure samples from the sheep flock. The multilocus variable-number tandem repeat analysis pattern of the sheep and human strains were also almost identical, 4/5-9-3-3-0-5 (Ms23-Ms24-Ms27-Ms28-Ms33-Ms34). It is hypothesised that dried manure and maternal fluid contaminated with C. burnetii was dispersed by the wind from the sheep farm towards the local inhabitants. The manure was eliminated in June and the farm was disinfected in July. The outbreak ended at the end of July 2013.
authors.affiliation: Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Budapest, Hungary.
authors.forename: M
authors.initials: M
authors.lastname: Gyuranecz
authors.forename: Km
authors.initials: K
authors.lastname: Sulyok
authors.forename: E
authors.initials: E
authors.lastname: Balla
authors.forename: T
authors.initials: T
authors.lastname: Mag
authors.forename: A
authors.initials: A
authors.lastname: Balazs
authors.forename: Z
authors.initials: Z
authors.lastname: Simor
authors.forename: B
authors.initials: B
authors.lastname: Denes
authors.forename: S
authors.initials: S
authors.lastname: Hornok
authors.forename: P
authors.initials: P
authors.lastname: Bajnoczi
authors.forename: Hm
authors.initials: H
authors.lastname: Hornstra
authors.forename: T
authors.initials: T
authors.lastname: Pearson
authors.forename: P
authors.initials: P
authors.lastname: Keim
authors.forename: A
authors.initials: A
authors.lastname: Dan
mesh_terms: D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood*; D016997:Coxiella burnetii / Q000235:genetics* / Q000302:isolation & purification*; D004797:Enzyme-Linked Immunosorbent Assay; D058872:Epidemics; D005260:Female; D005334:Fever / Q000209:etiology; D005838:Genotype; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D058885:Multilocus Sequence Typing; D011778:Q Fever / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D060888:Real-Time Polymerase Chain Reaction; D012756:Sheep
chemical_list: D000907:Antibodies, Bacterial