Q Fever and Pneumonia in an Area with a High Livestock Density: A Large Population-Based Study

Concerns about public health risks of intensive animal production in the Netherlands continue to rise, in particular related to outbreaks of infectious diseases. The aim was to investigate associations between the presence of farm animals around the home address and Q fever and pneumonia. Electronic medical record data for the year 2009 of all patients of 27 general practitioners (GPs) in a region with a high density of animal farms were used. Density of farm animals around the home address was calculated using a Geographic Information System. During the study period, a large Q fever outbreak occurred in this region. Associations between farm exposure variables and pneumonia or ‘other infectious disease’, the diagnosis code used by GPs for registration of Q fever, were analyzed in 22,406 children (0–17 y) and 70,142 adults (18–70 y), and adjusted for age and sex. In adults, clear exposure-response relationships between the number of goats within 5 km of the home address and pneumonia and ‘other infectious disease’ were observed. The association with ‘other infectious disease’ was particularly strong, with an OR [95%CI] of 12.03 [8.79–16.46] for the fourth quartile (>17,190 goats) compared with the first quartile (<2,251 goats). The presence of poultry within 1 km was associated with an increased incidence of pneumonia among adults (OR [95%CI] 1.25 [1.06–1.47]). A high density of goats in a densely populated region was associated with human Q fever. The use of GP records combined with individual exposure estimates using a Geographic Information System is a powerful approach to assess environmental health risks.

[1]  J. Vercoulen,et al.  The health status of Q-fever patients after long-term follow-up , 2011, BMC infectious diseases.

[2]  Steve Wing,et al.  Air Pollution, Lung Function, and Physical Symptoms in Communities Near Concentrated Swine Feeding Operations , 2011, Epidemiology.

[3]  Kyle Steenland,et al.  A Practical Guide to Dose-Response Analyses and Risk Assessment in Occupational Epidemiology , 2004, Epidemiology.

[4]  R. Ewert,et al.  [International classification of primary care]. , 1992, Zeitschrift fur arztliche Fortbildung.

[5]  B. Schimmer,et al.  The use of a geographic information system to identify a dairy goat farm as the most likely source of an urban Q-fever outbreak , 2010, BMC infectious diseases.

[6]  W. Tunnicliffe,et al.  Post-infection fatigue syndrome following Q fever. , 1998, QJM : monthly journal of the Association of Physicians.

[7]  D. Raoult,et al.  Natural history and pathophysiology of Q fever. , 2005, The Lancet. Infectious diseases.

[8]  R. Burnett,et al.  Long-term exposure to ambient air pollution and risk of hospitalization with community-acquired pneumonia in older adults. , 2010, American journal of respiratory and critical care medicine.

[9]  N. Nagelkerke,et al.  In search of hidden Q-fever outbreaks: linking syndromic hospital clusters to infected goat farms , 2010, Epidemiology and Infection.

[10]  J. Maurer.  Long-Term Exposure to Ambient Air Pollution and Risk of Hospitalization with Community-acquired Pneumonia in Older Adults , 2011 .

[11]  Robert A. Verheij,et al.  Development of a case-based system for grouping diagnoses in general practice , 2008, Int. J. Medical Informatics.

[12]  P. Droogers,et al.  Q fever in The Netherlands: the role of local environmental conditions , 2011, International journal of environmental health research.

[13]  L. Portengen,et al.  Endotoxin exposure and atopic sensitization in adult pig farmers. , 2005, The Journal of allergy and clinical immunology.

[14]  B. Schimmer,et al.  The 2007–2010 Q fever epidemic in The Netherlands: characteristics of notified acute Q fever patients and the association with dairy goat farming. , 2012, FEMS immunology and medical microbiology.

[15]  Evans K Mr,et al.  A large outbreak of Q fever in the West Midlands: windborne spread into a metropolitan area? , 1998, Communicable disease and public health.

[16]  Y. V. van Duynhoven,et al.  Q fever in the Netherlands: an update on the epidemiology and control measures. , 2010, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[17]  M. Nielen,et al.  Reduction of Coxiella burnetii Prevalence by Vaccination of Goats and Sheep, the Netherlands , 2011, Emerging infectious diseases.

[18]  Kaijie Fang,et al.  Effects of Inhaled Ambient Particulate Matter on Pulmonary Antimicrobial Immune Defense , 2003, Inhalation toxicology.

[19]  T. Lam,et al.  Prevalence of Coxiella burnetii infection in Dutch dairy herds based on testing bulk tank milk and individual samples by PCR and ELISA , 2011, Veterinary Record.

[20]  D. Nowak,et al.  Environmental Exposure to Confined Animal Feeding Operations and Respiratory Health of Neighboring Residents , 2007, Epidemiology.

[21]  F Nistal de Paz,et al.  [Q fever]. , 1994, Medicina clinica.

[22]  D. Raoult,et al.  The Q fever epidemic in The Netherlands: history, onset, response and reflection , 2010, Epidemiology and Infection.

[23]  B. Bentsen.  International classification of primary care. , 1986, Scandinavian journal of primary health care.

[24]  Y. V. van Duynhoven,et al.  Investigation of a Q fever outbreak in a rural area of The Netherlands , 2009, Epidemiology and Infection.

[25]  W. J. Pape,et al.  Outbreak of Q fever associated with a horse-boarding ranch, Colorado, 2005. , 2007, Vector borne and zoonotic diseases.

[26]  G Pritchard,et al.  Q fever outbreak in Cheltenham, United Kingdom, in 2007 and the use of dispersion modelling to investigate the possibility of airborne spread. , 2010, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[27]  L. Petersen,et al.  Changing epidemiology of Q fever in Germany, 1947-1999. , 2001, Emerging infectious diseases.

[28]  J. Kline,et al.  Health Effects of Airborne Exposures from Concentrated Animal Feeding Operations , 2006, Environmental health perspectives.