title: Q fever outbreak in the terraced vineyards of Lavaux, Switzerland.
abstract: Coxiella burnetii infection (Q fever) is a widespread zoonosis with low endemicity in Switzerland, therefore no mandatory public report was required. A cluster of initially ten human cases of acute Q fever infections characterized by prolonged fever, asthenia and mild hepatitis occurred in 2012 in the terraced vineyard of Lavaux. Epidemiological investigations based on patients' interviews and veterinary investigations included environmental sampling as well as Coxiella-specific serological assay and molecular examinations (real-time PCR in vaginal secretions) of suspected sheep. These investigations demonstrated that 43% of sheep carried the bacteria whereas 30% exhibited anti-Coxiella antibodies. Mitigation measures, including limiting human contacts with the flock, hygiene measures, flock vaccination and a public official alert, have permitted the detection of four additional human cases and the avoidance of a much larger outbreak. Since November 2012, mandatory reporting of Q fever to Swiss public health authorities has been reintroduced. A close follow up of human cases will be necessary to identify chronic Q fever.
authors.affiliation: Service of Infectious Diseases, Riviera Regional Hospital Vevey, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Bellini
authors.affiliation: Veterinary Public Health Institute, Vetsuisse faculty, University of Bern Bern, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Magouras
authors.affiliation: Service of Infectious Diseases, Medical Centre of Vidy Lausanne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Chapuis-Taillard
authors.affiliation: Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Clerc
authors.affiliation: Service of Public Health, Canton of Vaud Lausanne, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Masserey
authors.affiliation: Service of Consumption and Veterinary Affairs, Canton of Vaud Lausanne, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Peduto
authors.affiliation: Service of Infectious Diseases, Central Institute of Valais Sion, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Péter
authors.affiliation: Institute of Veterinary Bacteriology, Vetsuisse faculty, University of Zurich Zurich, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Schaerrer
authors.affiliation: Veterinary Public Health Institute, Vetsuisse faculty, University of Bern Bern, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Schuepbach
authors.affiliation: Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland ; Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Greub
keywords: Coxiella burnetii; Q fever; environment; outbreak investigation; sheep; veterinary investigation