A systematic review of global Q fever outbreaks.

Q fever is an important zoonotic disease with a worldwide distribution. Outbreaks of Q fever are unpredictable and can affect many people, resulting in a significant burden on public health. The epidemiology of the disease is complex and substantial efforts are required to understand and control Q fever outbreaks. The purpose of this study was to systematically review previous investigations of outbreaks and summarise important epidemiological features. This will improve knowledge of the factors driving the occurrence of Q fever outbreaks and assist decision makers in implementing mitigation strategies. A search of four electronic databases identified 94 eligible articles published in English between 1990 and 2022 that related to 81 unique human Q fever outbreaks. Outbreaks were reported across 27 countries and mostly in industrialised nations. Documented Q fever outbreaks varied in size (2 to 4107 cases) and duration (4 to 1722 days). Most outbreaks (43/81) occurred in communities outside of traditional at-risk occupational settings and were frequently associated with living in proximity to livestock holdings (21/43). Indirect transmission via environmental contamination, windborne spread or fomites was the most common route of infection, particularly for large community outbreaks. Exposure to ruminants and/or their products were confirmed as the principal risk factors for infection, with sheep (28/81) as the most common source followed by goats (12/81) and cattle (7/81). Cooperation and data sharing between human and animal health authorities is valuable for outbreak investigation and control using public health and veterinary measures, but this multisectoral approach was seldom applied (14/81). Increased awareness of Q fever among health professionals and the public may facilitate the early detection of emerging outbreaks that are due to non-occupational, environmental exposures in the community.

In vitro evaluation of a hybrid negative pressure system for wound therapy.

OBJECTIVE: The objective of this study was to assess whether negative pressure could be maintained accurately and repeatably with a wall-suction-based hybrid negative pressure wound therapy (h-NPWT) system by comparing it with a commercial negative pressure wound therapy (NPWT) device. STUDY DESIGN: In vitro experimental study. METHODS: A commercial NPWT device (control) and three h-NPWT devices, with 0, 3, and 6 meters of additional tubing using the hospital-wall suction (groups 1, 2, and 3 respectively), were applied sequentially to a commercial NPWT dressing on a silicone skin substrate and set to run at a continuous pressure of -125 mmHg. The pressure within the wound space was monitored at 10 second intervals for 24 h. The process was repeated five times for each group. RESULTS: The commercial NPWT device produced an average pressure variance of 3.02 mmHg, and the h-NPWT produced average variances of 4.38, 4.24 and 4.20 mmHg for groups 1, 2 and 3, respectively. All groups produced an average pressure within 0.15 mmHg of -125 mmHg over the 24-hour period, and the h-NPWT systems produced the smallest range with all values remaining within a ±5% variation from -125 mmHg. CONCLUSION: The h-NPWT system achieved negative pressures that were comparable to those of a commercial control NPWT device. The addition of tubing between the skin substrate and the canister did not affect the pressure applied at the wound site. CLINICAL SIGNIFICANCE: The h-NPWT device tested in this study can be considered as an alternative for negative wound therapy when a commercial device cannot be used.

Positive Airway Cultures in Dogs and Cats Receiving Mechanical Ventilation for Tick Paralysis.

Animals with tick paralysis often require mechanical ventilation (MV) but previous publications have identified knowledge gaps regarding the development of bacterial pneumonia, and the specific pathogens involved. The objectives of this study were to describe the clinical course and culture and susceptibility profiles of bacteria isolated from airway samples of dogs and cats mechanically ventilated for tick paralysis that had positive airway cultures. Medical records were reviewed, and cases included if they had a positive airway sample culture during MV for tick paralysis. Twenty-four dogs and two cats were included. Most (85%) received empirical antimicrobials before airway sampling. The most common organisms isolated included Staphylococcus spp. (11), Klebsiella spp. (9), Enterococcus faecalis (8), Escherichia coli (6), Enterococcus faecium (3), Pseudomonas aeruginosa (4), and Mycoplasma spp. (3). Evidence of aspiration pneumonia was present in 22/25 (88%) cases that had thoracic radiographs performed. Seventy-seven percent of cases received antimicrobials to which the cultured bacteria were susceptible during hospitalisation. The median duration of MV was 4 days (range 1-10). Most (77%) survived to discharge, 19% were euthanised, and one died. In a multivariable logistic regression analysis it was identified that selection of antimicrobials to which the causative bacteria are susceptible was associated with survival to discharge (Odds ratio 45.8, p = 0.014; 95%CI 1.98-14,808), as was length of MV, with every day an animal is ventilated associated with a 4.7 times increased chance of survival (p = 0.015; 95% CI 1.21-78.4).

A Scoping Review of the Global Distribution of Causes and Syndromes Associated with Mid- to Late-Term Pregnancy Loss in Horses between 1960 and 2020.

Equine pregnancy loss is frustrating and costly for horse breeders. The reproductive efficiency of mares has significant implications for a breeding operation's economic success, and widespread losses can have a trickle-down effect on those communities that rely on equine breeding operations. Understanding the causes and risks of equine pregnancy loss is essential for developing prevention and management strategies to reduce the occurrence and impact on the horse breeding industry. This PRISMA-guided scoping review identified 514 records on equine pregnancy loss and described the global spatiotemporal distribution of reported causes and syndromes. The multiple correspondence analysis identified seven clusters that grouped causes, syndromes, locations and pathology. Reasons for clustering should be the focus of future research as they might indicate undescribed risk factors associated with equine pregnancy loss. People engaged in the equine breeding industry work closely with horses and encounter equine bodily fluids, placental membranes, aborted foetuses, and stillborn foals. This close contact increases the risk of zoonotic disease transmission. Based on this review, research is required on equine abortion caused by zoonotic bacteria, including Chlamydia psittaci, Coxiella burnetii and Leptospira spp., because of the severe illness that can occur in people who become infected.

Expression of Carboxypeptidase A3 and Tryptase as Markers for Lymph Node Metastasis of Canine Cutaneous Mast Cell Tumors.

Detection of metastatic mast cell tumors (MCTs) in lymph nodes is a critical factor for treatment, prognosis, and clinical management. Presence/absence of mast cells in the lymph nodes cannot be used as a sole parameter to determine metastasis due to the inability to differentiate neoplastic from non-neoplastic/inflammatory mast cells. While cytologic and histopathologic classifications for assessment of metastatic MCTs based on the numbers and distribution of mast cells have been developed, inconsistency between the clinical interpretation of these grading schemes and actual metastatic status occurs. The aim of this study is to identify a novel diagnostic tool to accurately predict overt metastatic mast cell tumors in lymph nodes. We investigated the possibility of using RT-qPCR to detect mRNA expression of mast cell-specific genes in lymph nodes with different stages of MCT metastatic classification. We are able to establish a highly sensitive and discriminating RT-qPCR measuring Carboxy peptidase A3 (CPA3) and tryptase mRNA expression and identify the cut-off values with high sensitivity and specificity for overt metastatic MCTs in lymph nodes. An area of future interest would be to expand our analysis of the extent to which cut-off values for these markers in correctly identifying disease status, as well as predicting clinical outcomes and survival times. This would offer valuable information regarding the practical applicability of this technique and may enable us to improve our standards of detection metastasis, including possibility of molecular analysis of cytologic specimens obtained from suspicious nodes subjected to surgical excision.

Identifying scenarios and risk factors for Q fever outbreaks using qualitative analysis of expert opinion.

Q fever is an important zoonotic disease perceived to be an occupational hazard for those working with livestock. Outbreaks involving large numbers of people are uncommon, but the increasing case incidence coupled with changing environmental and industry conditions that promote transmission of Q fever has raised concerns that large and serious outbreaks could become more frequent. The aim of this study was to use expert opinion to better understand how large Q fever outbreaks might occur in an Australian context and to document factors believed to be drivers of disease transmission. Focus groups were conducted with human and animal health professionals across several Australian states. All discussions were recorded, transcribed verbatim and imported into NVIVO for thematic analysis. Four anthropogenic risk factors (disease awareness, industry practices, land use, human behaviour) and three ecological risk factors (physical environment, agent dissemination, animal hosts) emerged from the data. Analysis of expert opinions pointed to the existence of numerous scenarios in which Q fever outbreaks could occur, many of which depict acquisition in the wider community outside of traditional at-risk occupations. This perception of the expansion of Q fever from occupational-acquisition to community-acquisition is driven by greater overarching economic, political and socio-cultural influences that govern the way in which people live and work. Findings from this study highlight that outbreaks are complex phenomena that involve the convergence of diverse elements, not just that of the pathogen and host, but also the physical, political and socioeconomic environments in which they interact. A review of the approaches to prevent and manage Q fever outbreaks will require a multisectorial approach and strengthening of community education, communication and engagement so that all stakeholders become an integrated part of outbreak mitigation and response.

Semi-quantitative food safety risk profile of the Australian red meat industry.

In 2017-18, the Australian red meat (beef, sheep and goat species) industry generated more than $AUD 13 billion in export trade alone and is therefore of substantial importance to the Australian GDP. With both relatively high amounts of domestic red meat consumption and dependence on international markets, food safety risk is constantly reassessed so as to maintain a resilient industry sector. The current study aimed to conduct a food safety risk rating for the Australian red meat industry. In 2002, a food safety risk profile was developed for the Australian red meat industry. It included raw and processed meat products of cattle, sheep and goats and considered microbiological, chemical and physical hazards. The current risk rating was undertaken during 2017 and 2018. The first step was to conduct a hazard characterization, which involved a review of literature and data on foodborne outbreaks, pathogen surveillance and product recalls, and an expert elicitation process with 15 Australian food safety experts. This process identified the Hazard:Product:Process combinations to be considered and the likelihood of contamination at the point of consumption. These likelihood ratings were then combined with hazard severity ratings to qualitatively estimate the relative risk posed by each combination. Combinations with a moderate-to-high risk were included in the semi-quantitative risk rating using Risk Ranger v2, a tool that allows an estimation of the public health risk of hazard: product combinations and a ranking of this risk. The Risk Ranger tool provides a risk ranking (RR), ranging from 0 (no risk) to 100 (every member of the population eats a meal that contains a lethal dose of the hazard every day). STEC E. coli O157 (RR 35-39) and Salmonella spp. (RR 33-37) in undercooked hamburgers and Listeria monocytogenes in ready-to-eat products (RR 35-38) were combinations which had the highest (moderate) risk for the general and susceptible populations. In addition, Toxoplasma gondii in undercooked lamb was identified as posing a high risk among pregnant women (RR 49). The study provides an updated food safety risk profile for the Australian red meat industry which, considering the available information, suggests red meat products do not pose a high food safety risk. The methodology developed in this study provides an easy to implement approach to profile and prioritise food safety risk and relies on data that can generated in most situations.

"Prevention is the biggest success": Barriers and enablers to personal biosecurity in the thoroughbred breeding industry.

Employees in the equine industry are at occupational risk of zoonoses such as Hendra virus and equine chlamydiosis through exposure to infected materials. This study aimed to gain a deeper understanding of the views and experiences of employees, and the key drivers of infection control and personal biosecurity (PB) practices in the Thoroughbred breeding industry. Methods: An exploratory qualitative study was conducted in 2018 in New South Wales, Australia using interviews (9) and small group discussions (7). The 29 participants included veterinarians, veterinary nurses, foaling staff, stud managers and laboratory personnel working in a range of equine medicine settings. Interviews and focus groups were recorded, transcribed and analysed manually by at least two members of the research team. An iterative approach was used to derive themes. Results: Five main themes emerged: (i) greater awareness of current and emerging infectious risks promotes use of Personal Protective Equipment (PPE); (ii) currently available PPE is not comfortable, practical or well-suited to equine reproductive work in Australia's hot climate; (iii) creating supportive environments for PB reduces risk of exposure to infectious materials; (iv) strong leadership is required to implement sustainable change in workplace culture and practices; and (v) policy and economic factors play an important role in adopting biosecurity (BS) and PB measures in the workplace. Personnel working in the Australian Thoroughbred breeding industry face unique zoonotic risks in a challenging physical environment. A qualitative approach provided rich insights into social and physical factors motivating BS and PB in this occupational group. There is an opportunity for collaboration between Public Health services and industry partners to develop and implement strategies most likely to be effective in ensuring consistent uptake of PB measures in the workplace.

Prevalence and antimicrobial resistance of MRSA across different pig age groups in an intensive pig production system in Australia.

This observational study aimed to determine MRSA prevalence using strain-specific real-time PCR at the pig level, stratified by age groupings, within a pig enterprise. A total of 658 samples were collected from individual pigs (n = 618) and the piggery environment (n = 40), distributed amongst five different pig age groups. Presumptive MRSA isolates were confirmed by the presence of mecA, and MALDI-TOF was performed for species verification. All isolates were tested against 18 different antimicrobials. MRSA was isolated from 75.2% (95% CI 71.8-78.6) of samples collected from pigs, and 71% of the MRSA isolates from this source were identified as community-associated (CA)-MRSA ST93, while the remainder were livestock-associated (LA)-MRSA ST398. Amongst environmental isolates, 80% (CI 64.3-95.7) were ST93 and the remainder ST398. All MRSA isolates from pigs and the environment were susceptible to ciprofloxacin, gentamicin, linezolid, mupirocin, rifampicin, sulfamethoxazole-trimethoprim, teicoplanin and vancomycin. Phenotypic rates of resistance were penicillin (100%), clindamycin (97.6%), erythromycin (96.3%), ceftiofur (93.7%), chloramphenicol (81.2%), tetracycline (63.1%) and amoxicillin-clavulanate (63.9%). A low prevalence of resistance (9.2%) was observed against neomycin and quinupristin-dalfopristin. The probability of MRSA carriage in dry sows (42.2%) was found to be significantly lower (p < .001) when compared to other age groups: farrowing sows (76.8%, RR1.82), weaners (97.8%, RR 2.32), growers (94.2%, RR 2.23) and finishers (98.3%, RR 2.33). Amongst different production age groups, a significant difference was also found in antimicrobial resistance for amoxicillin-clavulanate, neomycin, chloramphenicol and tetracycline. Using the RT-PCR assay adopted in this study, filtering of highly prevalent ST93 and non-ST93 isolates was performed at high throughput and low cost. In conclusion, this study found that weaner pigs presented a higher risk for CA-MRSA and antimicrobial resistance compared to other age groups. These findings have major implications for how investigations of MRSA outbreaks should be approached under the One-Health context.

Tumor size as a predictor of lymphatic invasion in oral melanomas of dogs.

OBJECTIVE: To investigate putative associations between oral melanoma size and variables of histologic grade such as mitotic index, nuclear atypia, junctional activity, ulceration, lymphatic invasion, and degree of pigmentation. SAMPLE: 59 samples of oral melanomas from dogs sourced from 6 diagnostic laboratories within Australia. PROCEDURES: The size of each melanoma was microscopically measured, and each sample was evaluated for variables of histologic grade including mitotic index, nuclear atypia, junctional activity, ulceration, lymphatic invasion, and degree of pigmentation by a veterinary pathologist. The association between tumor size and histologic outcomes was then statistically evaluated. RESULTS: A significant relationship was identified between the size of oral melanomas and a single variable of histologic grade, lymphatic invasion, with larger tumors more likely to show lymphatic invasion. Further analysis revealed 2 applicable size thresholds for different clinical scenarios. Results indicated lymphatic invasion can confidently be ruled out for tumors < 6.5 mm in diameter (100% sensitivity) and ruled in for tumors ≥ 24.5 mm in diameter (100% specificity). CONCLUSIONS AND CLINICAL RELEVANCE: An association was found for oral melanomas of dogs between tumor size and lymphatic invasion.

Unravelling animal exposure profiles of human Q fever cases in Queensland, Australia, using natural language processing.

Q fever, caused by the zoonotic bacterium Coxiella burnetii, is a globally distributed emerging infectious disease. Livestock are the most important zoonotic transmission sources, yet infection in people without livestock exposure is common. Identifying potential exposure pathways is necessary to design effective interventions and aid outbreak prevention. We used natural language processing and graphical network methods to provide insights into how Q fever notifications are associated with variation in patient occupations or lifestyles. Using an 18-year time-series of Q fever notifications in Queensland, Australia, we used topic models to test whether compositions of patient answers to follow-up exposure questionnaires varied between demographic groups or across geographical areas. To determine heterogeneity in possible zoonotic exposures, we explored patterns of livestock and game animal co-exposures using Markov Random Fields models. Finally, to identify possible correlates of Q fever case severity, we modelled patient probabilities of being hospitalized as a function of particular exposures. Different demographic groups consistently reported distinct sets of exposure terms and were concentrated in different areas of the state, suggesting the presence of multiple transmission pathways. Macropod exposure was commonly reported among Q fever cases, even when exposure to cattle, sheep or goats was absent. Males, older patients and those that reported macropod exposure were more likely to be hospitalized due to Q fever infection. Our study indicates that follow-up surveillance combined with text modelling is useful for unravelling exposure pathways in the battle to reduce Q fever incidence and associated morbidity.

Differentiation of Community-Associated and Livestock-Associated Methicillin-Resistant Staphylococcus aureus Isolates and Identification of spa Types by Use of PCR and High-Resolution Melt Curve Analysis.

Infections due to methicillin-resistant Staphylococcus aureus (MRSA) are present worldwide and represent a major public health concern. The capability of PCR followed by high-resolution melt (HRM) curve analysis for the detection of community-associated and livestock-associated MRSA strains and the identification of staphylococcal protein A (spa) locus was evaluated in 74 MRSA samples which were isolated from the environment, humans, and pigs on a single piggery. PCR-HRM curve analysis identified four spa types among MRSA samples and differentiated MRSA strains accordingly. A nonsubjective differentiation model was developed according to genetic confidence percentage values produced by tested samples, which did not require visual interpretation of HRM curve results. The test was carried out at different settings, and result data were reanalyzed and confirmed with DNA sequencing. PCR-HRM curve analysis proved to be a robust and reliable test for spa typing and can be used as a tool in epidemiological studies.

Coxiella burnetii seroprevalence in unvaccinated veterinary workers in Australia: Evidence to support Q fever vaccination.

Q fever (caused by Coxiella burnetii) is a serious zoonotic disease that occurs almost worldwide. Occupational contact with animals increases the risk of exposure, and Q fever vaccination is recommended for veterinary workers in Australia. This study aimed to investigate C. burnetii seroprevalence among unvaccinated veterinary workers in Australia and determine factors associated with a positive serological result. During 2014 and 2015, convenience sampling at veterinary conferences and workplace vaccination clinics was undertaken. Participants completed a questionnaire and provided a blood sample for C. burnetii serology. Participants were predominantly veterinarians (77%), but veterinary support staff, animal scientists, and administration workers also participated. Blood samples (n = 192) were analysed by an immunofluorescence assay and considered positive where the phase I or phase II IgG titre was ≥1/50. Seroprevalence was 19% (36/192; 95% CI 14%-25%). A positive serological result was significantly associated with (a) working in outer regional/remote areas (odds ratio [OR] 6.2; 95% CI 1.9-20.8; reference = major cities; p = .009) and (b) having spent more than 50% of total career working with ruminants (OR 4.8; 95% CI 1.7-13.5; reference = <15% of career; p = .025). These findings confirm an increased risk of exposure to C. burnetii compared to the general population, providing new evidence to support Q fever vaccination of veterinary workers in Australia.

A questionnaire study of parasite control in Thoroughbred and Standardbred horses in Australia.

BACKGROUND: Information regarding parasite control practices currently used on Thoroughbred and Standardbred studs in Australia is lacking. Anthelmintic resistance (AR) is a global problem which has implications for equine health and welfare. OBJECTIVES: To identify parasite control practices currently used on horse studs in Australia and investigate the frequency of use of management factors that have been associated with the likelihood of promoting or delaying AR. STUDY DESIGN: Questionnaire study of equine parasite control on Thoroughbred and Standardbred studs in Australia. METHODS: An online questionnaire was emailed to 300 studs in Australia. Information obtained included property details, grazing management, anthelmintic use, non-chemotherapeutic parasite control practices, use of faecal egg counts (FECs) and perceptions of AR. RESULTS: Seventy-five completed questionnaires were received (25% response rate). Macrocyclic lactones (MLs) were the most commonly administered anthelmintics in mares and foals and less than 5% of respondents used targeted treatment regimens. The implementation of pasture hygiene practices was variable. The majority of respondents (97%) considered AR to be important; however, few respondents were aware of the use of FEC reduction tests for monitoring of drug efficacy. MAIN LIMITATIONS: The potential for nonresponse bias was the main limitation of this study. CONCLUSIONS: Parasite control strategies on Australian stud farms remain over-reliant on anthelmintic use. The frequent use of MLs is of concern for the increased selection pressure for AR. There is a lack of awareness of the importance of non-chemotherapeutic strategies in integrated approaches to parasite control aimed at delaying the development of AR. This study highlights the need for greater veterinary involvement in the implementation of more sustainable parasite control practices with greater emphasis placed on surveillance through FEC testing.

Challenges in using serological methods to explore historical transmission risk of Chlamydia psittaci in a workforce with high exposure to equine chlamydiosis.

Introduction: This report describes the challenges encountered in using serological methods to study the historical transmission risk of C. psittaci from horses to humans. Methods: In 2017, serology and risk factor questionnaire data from a group of individuals, whose occupations involved close contact with horses, were collected to assess the seroprevalence of antibodies to C. psittaci and identify risk factors associated with previous exposure. Results: 147 participants were enrolled in the study, provided blood samples, and completed a questionnaire. On ELISA testing, antibodies to the Chlamydia genus were detected in samples from 17 participants but further specific species-specific MIF testing did not detect C. psittaci-specific antibodies in any of these samples. Conclusion: No serological evidence of past C. psittaci transmission from horses to humans was found in this study cohort. There are major challenges in using serological methods to determine the prevalence of C. psittaci exposure.

Bovine brucellosis in Pakistan; an analysis of engagement with risk factors in smallholder farmer settings.

A cross-sectional study was conducted to estimate the seroprevalence of bovine brucellosis in smallholder farms in seven regions in Pakistan, identify herd and individual level risk factors for seropositivity and assess the level of engagement of farmers with risk factors. In total, 1063 cattle and buffalo belonging to 420 herds in seven districts were sampled. The Rose Bengal test (RBT), indirect enzyme-linked immunosorbent assay (I-ELISA) and competitive enzyme-linked immunosorbent assay (C-ELISA) were used for the serological diagnosis of bovine brucellosis on all the serum samples. The associations between herd-and animal-level risk factors and seropositivity were investigated using logistic regression analyses. In addition, herd management practice scores, created to quantify the number of management practices undertaken that pose a risk for Brucella transmission, were calculated and compared between seropositive and negative herds within each district. Overall herd and animal prevalence were estimated to be 16.2% (95% CI, 13-20%) and 8.7% (95% CI, 7.2-10.6%), respectively, across all districts sampled. Herds with a history of last trimester abortion were found to be more likely to be positive than herds without such history (OR = 2.06, 95% CI, 1.09-3.89), providing validation of our findings and identifying that clinical disease is occurring in this region. It was also identified that herds with five to eight buffalo (OR = 3.80, 95% CI, 1.69-8.49), and those with more than eight buffalo (OR = 3.81, 95% CI, 1.51-9.58) were more likely to be positive for Brucella than those with less (one to two and three to four) buffaloes present in the herd. The presence of other domestic animals at the farm and purchasing animals in last year were found to have no association with seropositivity. The findings of this study support the need for the development of targeted intervention strategies specific to the disease status of each district.

Frequency of Adverse Events Following Q Fever Immunisation in Young Adults.

Q fever is a zoonosis of concern in many countries. Vaccination is the most effective means of prevention, and since 1989, Australia has had a licensed Q fever vaccine, Q-VAX®. This vaccine was also used in the Netherlands in 2011 following the largest recorded Q fever outbreak globally. There is a paucity of available data regarding adverse events following immunisation (AEFI) for young adult females. Such data are important for informing future vaccination recommendations both within Australia and internationally. This study collected Q fever vaccine (Q-VAX®) AEFI data in veterinary and animal science students at Australian universities. Students were enrolled at the time of vaccination and were emailed a link to an online AEFI survey one week later. Of the 60% (499/827) that responded, 85% were female and the median age was 18 years. Local injection site reactions (ISRs) occurred in 98% (95%; CI 96⁻99%) of respondents, of which 30% (95% CI 24⁻32%) were severe. Systemic AEFI occurred in 60% (95%; CI 55⁻64%) of respondents within the seven days following immunisation. Medical attention was sought by 19/499 (3.8%) respondents, of whom one sought treatment at a hospital emergency department. Females were more likely than males to experience any local ISR (odds ratio [OR] 9.3; 95% CI 2.5⁻33.8; p < 0.001), ISRs of greater severity (OR 2.5; 95% CI 1.5⁻4.2; p < 0.001), and any systemic AEFI (OR 1.9; 95% CI 1.1⁻3.1; p = 0.016). These safety data suggest that a high frequency of adverse events following immunisation should be expected in young adults, particularly females. However, the consequences of Q fever disease are potentially far more debilitating.

Willingness of veterinarians in Australia to recommend Q fever vaccination in veterinary personnel: Implications for workplace health and safety compliance.

Q fever vaccine uptake among veterinary nurses in Australia is low, suggesting veterinarians are not recommending the vaccination to veterinary personnel. This study aimed to determine the willingness of veterinarians to recommend Q fever vaccination to veterinary personnel and to identify factors influencing Q fever vaccine uptake by veterinary nurses in Australia. An online cross sectional survey targeted veterinarians and veterinary nurses in Australia in 2014. Responses were analysed using multivariable logistic regression. Factors significantly (p<0.05) associated with a willingness to recommend the vaccination, expressed by 35% (95% CI 31-38%) of veterinarians (n = 828), were (1) being very concerned for colleagues regarding Coxiella burnetii (OR 4.73), (2) disagreeing the vaccine is harmful (OR 3.80), (3) high Q fever knowledge (OR 2.27), (4) working within small animal practice (OR 1.67), (5) disagreeing the vaccine is expensive (OR 1.55), and (6) age, with veterinarians under 39 years most likely to recommend vaccination. Of the veterinary nursing cohort who reported a known Q fever vaccination status (n = 688), 29% (95% CI 26-33%) had sought vaccination. This was significantly (p<0.05) associated with (1) agreeing the vaccine is important (OR 8.34), (2) moderate/high Q fever knowledge (OR 5.51), (3) working in Queensland (OR 4.00), (4) working within livestock/mixed animal practice (OR 3.24), (5) disagreeing the vaccine is expensive (OR 1.86), (6) strong reliance on work culture for biosecurity information (OR 2.5), (7) perceiving personal exposure to Coxiella burnetii to be at least low/moderate (OR 2.14), and (8) both agreeing the vaccine is safe and working within a corporate practice structure (OR 4.28). The study identified the need for veterinarians to take greater responsibility for workplace health and safety promotion, and calls for better education of veterinary personnel to raise awareness of the potential for occupational exposure to C. burnetii and improve the perception of the Q fever vaccine as being important, safe and cost-effective.

Emergence of highly prevalent CA-MRSA ST93 as an occupational risk in people working on a pig farm in Australia.

BACKGROUND: The occurrence of livestock-associated (LA) MRSA (ST398) in pig herds has emerged as a threat to occupational safety in many parts of the world. Recently, an outbreak of skin lesions due to MRSA occurred in workers at a pig farm in regional Australia and both the humans and pigs were shown to have a high prevalence of carriage of either the human-strain ST93 or porcine strain ST398. This study closely scrutinises this outbreak to determine factors associated with MRSA carriage amongst the workers. METHODS: Information on potential risk factors was collected from employees by means of a questionnaire. The carriage status of MRSA by workers was assessed by nasal swabs processed using standard laboratory techniques with confirmed isolates subjected to sequence typing. Associations between MRSA carriage in workers and their questionnaire responses were investigated using univariable and multivariable logistic regression. RESULTS: Nasal carriage of MRSA was identified in 60% (31/52) of participants. Workers having contact with pigs had 24 times the odds of MRSA carriage compared to workers with no direct contact (OR 23.6; CI 5.2-172.8). In addition, the probability of MRSA carriage in workers was significantly (P < 0.001) associated with the number of hours in contact with pigs and each hour of contact-time per day increased the risk of MRSA carriage by 1.44 times (CI 1.14-1.96). These associations were significant (P < 0.001) for both strains, ST398 and ST93, present on this farm. Using a multivariable logistic regression model that incorporated human exposure to five different pig age groups (dry sows, farrowing, weaner, grower, and finisher) as fixed effects, a significant (P = 0.027) increased odds of MRSA carriage was found for persons working with farrowing sows compared with those who did not (OR 6.39, CI 1.23-39.36). CONCLUSIONS: This study shows that workers in close contact with pigs on a pig farm where MRSA is present had a higher risk of MRSA carriage as the number of hours of direct contact with pigs increased. Since we have detected a significant association for the human-derived CA-MRSA ST93, similar to the pig-adapted LA-MRSA ST398, we consider ST93 as a potential occupational risk for piggery workers. The risk of MRSA carriage is greatest when working with the farrowing group; therefore, an emphasis is required on personal protective equipment while working in the farrowing house. The study has ramifications for the conduct of surveillance for MRSA in people exposed to pigs.