title: Coxiella burnetii Infection in a Community Operating a Large-Scale Cow and Goat Dairy, Missouri, 2013.
abstract: Coxiella burnetii is a zoonotic pathogen that causes Q fever in humans and is transmitted primarily from infected goats, sheep, or cows. Q fever typically presents as an acute febrile illness; however, individuals with certain predisposing conditions, including cardiac valvulopathy, are at risk for chronic Q fever, a serious manifestation that may present as endocarditis. In response to a cluster of Q fever cases detected by public health surveillance, we evaluated C. burnetii infection in a community that operates a large-scale cow and goat dairy. A case was defined as an individual linked to the community with a C. burnetii phase II IgG titer ≥ 128. Of 135 participants, 47 (35%) cases were identified. Contact with or close proximity to cows, goats, and their excreta was associated with being a case (relative risk 2.7, 95% confidence interval 1.3-5.3). Cases were also identified among individuals without cow or goat contact and could be related to windborne spread or tracking of C. burnetii on fomites within the community. A history of injection drug use was reported by 26/130 (20%) participants; follow-up for the presence of valvulopathy and monitoring for development of chronic Q fever may be especially important among this population.
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri hbiggs@cdc.gov.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Biggs
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: George
authors.initials: G
authors.lastname: Turabelidze
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Drew
authors.initials: D
authors.lastname: Pratt
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Todd
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Kara
authors.initials: K
authors.lastname: Jacobs-Slifka
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Naomi A
authors.initials: NA
authors.lastname: Drexler
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Gail
authors.initials: G
authors.lastname: McCurdy
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Evavold
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Fitzpatrick
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Priestley
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Joseph
authors.initials: J
authors.lastname: Singleton
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: David
authors.initials: D
authors.lastname: Sun
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Minh
authors.initials: M
authors.lastname: Tang
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Kato
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Gilbert J
authors.initials: GJ
authors.lastname: Kersh
authors.affiliation: Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Missouri Department of Health and Senior Services, Jefferson City, Missouri.
authors.forename: Alicia
authors.initials: A
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D016997:Coxiella burnetii / Q000302:isolation & purification*; D005260:Female; D015511:Goat Diseases / Q000453:epidemiology / Q000382:microbiology*; D006041:Goats; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D011778:Q Fever / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D055815:Young Adult; D015047:Zoonoses
references.citation: Clin Infect Dis. 2000 Feb;30(2):374-9
references.pmid: 10671344
references.citation: Am J Trop Med Hyg. 2015 Feb;92(2):247-55
references.pmid: 25404080
references.citation: Clin Infect Dis. 2001 Aug 1;33(3):312-6
references.pmid: 11438895
references.citation: Heart. 2003 May;89(5):577-81
references.pmid: 12695478
references.citation: Vector Borne Zoonotic Dis. 2002 Fall;2(3):179-91
references.pmid: 12737547
references.citation: Emerg Infect Dis. 2004 Jul;10(7):1264-9
references.pmid: 15324547
references.citation: Lancet. 1982 May 1;1(8279):1002-4
references.pmid: 6122818
references.citation: Epidemiol Infect. 1989 Feb;102(1):119-27
references.pmid: 2917613
references.citation: Am J Cardiol. 1992 Jan 15;69(3):238-41
references.pmid: 1731465
references.citation: Thorax. 1992 Apr;47(4):276-8
references.pmid: 1585291
references.citation: Arch Intern Med. 1995 Aug 7-21;155(15):1641-8
references.pmid: 7618988
references.citation: Commun Dis Public Health. 1998 Sep;1(3):180-7
references.pmid: 9782633
references.citation: Am J Epidemiol. 1999 Jul 1;150(1):67-74
references.pmid: 10400556
references.citation: Acad Emerg Med. 1999 Sep;6(9):911-5
references.pmid: 10490253
references.citation: Bacteriol Rev. 1961 Sep;25:285-93
references.pmid: 13921201
references.citation: Exp Appl Acarol. 2006;40(1):67-81
references.pmid: 17004028
references.citation: Am J Hyg. 1949 Jan;49(1):76-82
references.pmid: 18108523
references.citation: Epidemiol Infect. 2008 Aug;136(8):1084-7
references.pmid: 17892631
references.citation: Epidemiol Infect. 2009 Sep;137(9):1283-94
references.pmid: 19161644
references.citation: Am J Trop Med Hyg. 2009 Oct;81(4):691-4
references.pmid: 19815888
references.citation: BMC Infect Dis. 2010;10:69
references.pmid: 20230650
references.citation: Appl Environ Microbiol. 2010 Jul;76(13):4571-3
references.pmid: 20435765
references.citation: Epidemiol Infect. 2011 Sep;139(9):1332-41
references.pmid: 21087542
references.citation: Int J Environ Health Res. 2011 Dec;21(6):441-51
references.pmid: 21563011
references.citation: Epidemiol Infect. 2012 Jan;140(1):42-6
references.pmid: 21371363
references.citation: Clin Infect Dis. 2012 Dec;55(12):1591-9
references.pmid: 22918992
references.citation: Appl Environ Microbiol. 2013 Mar;79(5):1697-703
references.pmid: 23315737
references.citation: MMWR Recomm Rep. 2013 Mar 29;62(RR-03):1-30
references.pmid: 23535757
references.citation: Vector Borne Zoonotic Dis. 2014 Feb;14(2):111-7
references.pmid: 24350648
references.citation: PLoS One. 2014;9(5):e96607
references.pmid: 24788538
references.citation: Am J Cardiol. 2014 Jul 1;114(1):100-4
references.pmid: 24819896
references.citation: Clin Microbiol Infect. 2014 Jun;20(6):566-75
references.pmid: 24102907
references.citation: Medicine (Baltimore). 2000 Mar;79(2):109-23
references.pmid: 10771709