• Scientific/Epidemiologic evidence regarding blood safety: • Bacteremia documented during both acute and chronic
Very low infections, with and without symptoms.
• Public perception and/or regulatory concern regarding • The organism replicates in macrophages. This could result
blood safety: Low to moderate in eventual cell lysis and the dissemination of free bacteria
• Public concern regarding disease agent: Low in plasma.
• Described in 1935 by E. H. Derrick in abattoir workers in • No information on storage stability under blood bank
Australia as a disease of unknown origin and, therefore, conditions
termed “query fever.”
Transmission by Blood Transfusion:
• Isolated in 1937 by Burnet and Freeman who identified the
organism as a Rickettsia species. • A single case of transmission from blood transfusion has
• Cox and Davis isolated the pathogen from ticks in Montana been described. The donor and the recipient both showed
in 1938 and described its transmission. The agent was offi- serological evidence of C. burnetii infection, and the clinical
cially named Coxiella burnetii in 1948. symptoms and their time courses were compatible with the
• No longer regarded as closely related to Rickettsia species. diagnosis of Q fever.
• Classified as Category B bioterrorism agent by the CDC. • Transfusion risk assessments have been published by the
ECDC using the Dutch outbreak in 2008-2009 as the
Common Human Exposure Routes:
model.
• Infection caused by inhalation of aerosols or contaminated • Also reported to have been transmitted by bone marrow
dusts containing air-borne bacteria derived from infected transplantation
Netherlands) started screening blood donations by individ- 6. Centers for Disease Control and Prevention. Q fever—
ual unit PCR in high-incidence areas. The impact of this California. Morb Mortal Wkly Rep MMWR 1977;26:
action is unknown. Current plans are to discontinue testing 86-7.
when the epidemic has passed. 7. Christie AB. Q fever. In: Christie AB, ed. Infectious diseases,
epidemiology and clinical practice. Edinburgh: Churchill
Leukoreduction Efficacy:
Livingstone, 1974:876-91.
• May have efficacy because organism is an obligate intracel- 8. Confer D, Gress R, Tomblyn M, Ehninger G. Hematopoietic
lular bacterium in monocytes/macrophages, although cell- cell graft safety. Bone Marrow Transplant 2009;44:463-5.
free organisms can survive for extended periods. Available from: http://www.nature.com/bmt.
9. European Centre for Disease Prevention and Control.
Pathogen Reduction Efficacy for Plasma Derivatives:
Technical report—Risk assessment on Q fever. Stockholm:
• Unknown, but the bacterium is highly resistant to heat and ECDC, 2010. Available from: http://www.ecdc.
chemical/physical disinfection. evropa.ev/en/publications/Publications/1005_TER_Risk_
Assessment_Qfever.pdf.
Other Prevention Measures:
10. Fournier PE, Raoult D. Comparison of PCR and serology for
• Control measures taken in the Netherlands during the 2007- early diagnosis of acute Q fever. J Clin Microbiol 2003;41:
2010 outbreak include: mandatory small ruminant vaccina- 5094-8.
tion, animal movement restrictions, culling and hygiene 11. Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999;12:
measures. Bulk milk monitoring by PCR is mandatory on 518-53.
farms with more than 50 dairy animals and notification of 12. Klaassen CHW, Nabuurs-Franssen MH, Tilburg JJHC, et al.
residents in affected areas occurs to enable those persons Multigenotype Q fever outbreak, the Netherlands. Emerg
with risk factors to avoid infected farms. Infect Dis 2009;15:613-4.
• Human vaccine is available only in Australia (formalin-inac- 13. McQuiston JH, Holman RC, McCall CL, et al. National sur-
tivated phase I organisms), and its use is recommended for veillance and the epidemiology of human Q fever in the
exposed or high-risk individuals (livestock handlers, abat- United States, 1978-2004. Am J Trop Med Hygiene 2006;75:
toir workers, veterinarians, and laboratory workers) who do 36-40.
not have immunity. 14. Milazzo A, Hall R, Storm P, et al. Sexually transmitted Q
• Adverse effects when vaccine administered in previously fever. Clin Infect Dis 2001;33:399-402.
infected individuals; requires pre-vaccination skin test 15. Musso D, Raoult D. Coxiella burnetii blood cultures from
acute and chronic Q fever patients. J Clin Microbiol 1995;
Suggested Reading
33:3129-32.
1. Anderson AD, Kruszon-Moran D, Loftis AD, et al. Seropreva- 16. Schneeberger PM, Hermans MH, van Hannen EJ, et al. Real-
lence of Q fever in the United States, 2003-2004. Am J Trop time PCR with serum samples is indispensable for early
Med Hyg 2009;81:691-4. diagnosis of acute Q fever. Clin Vacc Immunol 2010;17:286-
2. Anonymous. Comment on Q fever transmitted by blood 90.
transfusion—Can Dis Weekly Rep 1977;3:210. 17. Seitz R. Coxiella burnetii—pathogen of the Q (query) fever.
3. Bossi P, Tegnell A, Baka A, et al. Bichat Guidelines for the Transfus Med Hemother 2005;32:218-26. Available at:
clinical management of Q fever and bioterrorism-related Q http://www.karger.com/tmh.
fever. Euro Surveill 2004; 9:1-5. Available from: http://www. 18. Van der Hoek W, Dijkstra F, Schimmer B, et al. Q fever in the
eurosurveillance.org/ViewArticle.aspx?ArticleId=499. Netherlands: An update on the epidemiology and control
4. Byrne WR. Q fever. In: Sidell FR, Takafugi ET, Franz DR, eds. measures. Euro Surveill 2010;15:25. Available from: http://
Medical aspects of chemical and biological warfare. Wash- www.eurosurveillance.org/ViewArticle.aspx?Article=19520.
ington, DC: TMM Publications, 1997:523-37. 19. Walker DH, Raoult D, Dumler JS, Marrie TJ. Rickettsial dis-
5. Centers for Disease Control and Prevention. Q fever— eases. In: Walker DH, Raoult D, Dumler JS, et al, eds. Harri-
California, Georgia, Pennsylvania, and Tennessee, 2000- son’s principles of internal medicine. 16th ed. New York:
2001. Morb Mortal Wkly Rep MMWR 2002;51:924-7. McGraw Hill, 2004:999-1008.