Q Fever: The Importance Of Surveillance In The Autonomous Province Of Bolzano (Italy)

Background: Q fever caused by Coxiella burnetii is mainly an occupational disease in agriculture, cattle, sheep, and goats, being the primary reservoirs. Usually animal hosts are asymptomatic. The zoonosis is transmitted primarily through inhalation of aerosols or contact with specific tissues and fluids of shedding animals; rarely by tick bites, ingestion of unpasteurized milk or dairy products, and from person-to-person. Only half of the infections develop in acute Q fever with self-limited, influenza-like febrile symptoms, at times complicated by pneumonia and hepatitis. Chronic Q fever patients mainly show endocarditis with negative culture findings and seropositivity.Animal cases, routinely seen in the Autonomous Province of Bolzano (APB), supported the hypothesis of local disease transmission to people.However,no national data concerning human cases were available, as Q fever only recently requires compulsory, official notification in Italy. Methods & Materials: Between 2008 and 2012 active veterinary surveillance was implemented. This consisted in the use of various diagnostic methods to analyse bovine, ovicaprine samples (CBR, ELISA, PCR).For the same period, retrospective case finding, at health district level, was carried out.Criteria for including cases: compatible clinical symptoms and laboratory confirmation by immunofluorescent assay (IFA). Results: In ABP, for the 5-year period considered, Q fever's annual diagnostic rate in humans was 1/100.000 inhabitants. A total of 5 cases were identified, 4 of them autochthonous. Four patients with complications had been hospitalised and three of the autochthonous cases were exposed to livestock. 9700 blood samples in total, gave an overall prevalence of 13,6% for cattle; 11,7% for sheep and 7,9% for goats. For confirmation, PCR was carried out on organ tissues and swabs. Overall, PCR-Test on milk from shedding animals contributed to the timely prevention of zoonosis transmission. Conclusion: At present, in Italy, Q fever is not considered a major health problem, however this disease may have an unexpected impact at local level, especially in areas with intense animal production and countryside tourism activities. More research is needed to understand the epidemiology of Q fever in APB. The interdisciplinary approach is essential and will be pursued in future in order to fill the knowledge gaps.