title: Q Fever Outbreak among Workers at a Waste-Sorting Plant.
abstract: An outbreak of Q fever occurred in February-April 2014 among workers at a waste-sorting plant in Bilbao (Spain). The outbreak affected 58.5% of investigated employees, 47.2% as confirmed cases (PCR and/or serology) and 11.3% as probable cases (symptoms without laboratory confirmation). Only employees who had no-access to the waste processing areas of the plant were not affected and incidence of infection was significantly higher among workers not using respiratory protection masks. Detection by qPCR of Coxiella burnetii in dust collected from surfaces of the plant facilities confirmed exposure of workers inside the plant. Animal remains sporadically detected among the residues received for waste-sorting were the most probable source of infection. After cleaning and disinfection, all environmental samples tested negative. Personal protection measures were reinforced and made compulsory for the staff and actions were taken to raise farmers' awareness of the biological risk of discharging animal carcasses as urban waste.
authors.affiliation: Department of Epidemiology, Subdirección de Salud Pública de Bizkaia, Gobierno Vasco, Bilbao, Bizkaia, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Alonso
authors.affiliation: Department of Epidemiology, OSALAN- Instituto Vasco de Seguridad y Salud Laborales, Barakaldo, Bizkaia, Spain.
authors.forename: Idoia
authors.initials: I
authors.lastname: Lopez-Etxaniz
authors.affiliation: Department of Animal Health, NEIKER- Instituto Vasco de Investigación y Desarrollo Agrario, Derio, Bizkaia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Hurtado
authors.affiliation: Department of Microbiology, Hospital Universitario de Basurto, Bilbao, Bizkaia, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Liendo
authors.affiliation: Department of Epidemiology, OSALAN- Instituto Vasco de Seguridad y Salud Laborales, Barakaldo, Bizkaia, Spain.
authors.forename: Felix
authors.initials: F
authors.lastname: Urbaneja
authors.affiliation: Department of Epidemiology, Subdirección de Salud Pública de Bizkaia, Gobierno Vasco, Bilbao, Bizkaia, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Aspiritxaga
authors.affiliation: Department of Epidemiology, OSALAN- Instituto Vasco de Seguridad y Salud Laborales, Barakaldo, Bizkaia, Spain.
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Olaizola
authors.affiliation: Department of Animal Health, NEIKER- Instituto Vasco de Investigación y Desarrollo Agrario, Derio, Bizkaia, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Piñero
authors.affiliation: Department of Agriculture, Diputación Foral de Bizkaia, Bilbao, Bizkaia, Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Arrazola
authors.affiliation: Department of Animal Health, NEIKER- Instituto Vasco de Investigación y Desarrollo Agrario, Derio, Bizkaia, Spain.
authors.forename: Jesús F
authors.initials: JF
authors.lastname: Barandika
authors.affiliation: Department of Microbiology, Hospital Universitario de Basurto, Bilbao, Bizkaia, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Hernáez
authors.affiliation: Department of Epidemiology, Subdirección de Salud Pública de Bizkaia, Gobierno Vasco, Bilbao, Bizkaia, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Muniozguren
authors.affiliation: Department of Animal Health, NEIKER- Instituto Vasco de Investigación y Desarrollo Agrario, Derio, Bizkaia, Spain.
authors.forename: Ana L
authors.initials: AL
authors.lastname: García-Pérez
mesh_terms: D000328:Adult; D000818:Animals; D004196:Disease Outbreaks; D005260:Female; D006256:Hazardous Waste; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D011778:Q Fever / Q000453:epidemiology* / Q000635:transmission; D012037:Refuse Disposal; D064091:Waste Disposal Facilities; D055815:Young Adult
chemical_list: D006256:Hazardous Waste