Q-fever in Germany

The following review of Q-fever in Germany is abstracted from the Gideon e-book series. [1,2] (Primary references available on request).
Time and Place:
Q-fever was first recognized in Germany in 1947.
- Reporting was instituted in West Germany in 1962, and in East Germany in 1979. The two systems were combined in 1991.
- Most cases are reported in Bavaria, Baden-Wurttemberg, Rhineland-Palatinate, Hesse, Northrhine-Westphalia, and Thuringia.
- Hesse has experienced the greatest increase in incidence since 1990.

Outbreaks peak during spring to summer, and may be related to urbanization.
- 40 outbreaks were reported during 1947 to 1999. Sheep were implicated in 24 of the outbreaks, and cattle in six.
- Two laboratory outbreaks (in 1947 and 1948) were reported during 1947 to 1999.

Reported rates of Q-fever in Germany are summarized in the following graph:

Additional notes:
1. The mean rate was 0.08 per 100,000 during 1979 to 1989; 0.14 per 100,000 during 1990 to 1999 (0.31 in Baden Wurttemberg).
2. Three cases of travel-associated Q-fever were reported in Germany – acquired in Sri Lanka, Sudan and the Sahara desert (2007 publication).

Prevalence surveys:
0% of rodents and Ixodes ricinus ticks in Stuttgart (2008 publication)
1.9% of Ixodes ricinus in central Germany, often in association with Borrelia, Babesia or spotted fever-group rickettsiae (2006 to 2007)

Seroprevalence surveys:
22% of blood donors are seropositive (nationwide, 1983 to 1986)
22% of military personnel (1985 to 1987)
0% of Vietnamese refugees in Germany (1980 publication)
12% of cattle in the southern Bavarian foothills
0.9% of 10.2% of sheep in Baden-Wuerttemberg (2004 publication)

The average number of cattle reported herds infected with Q-fever was 71 per year during 1971 to 1979; 328 during 1980 to 1989; 303 during 1990 to 1998.

Notable outbreaks:
1947 (publication year) – An outbreak of presumed Q-fever was reported in Munich.
1947 to 1948 – An outbreak (326 cases, 7 fatal) was reported among members of a farming community in Remmingsheim.
1948 – Outbreaks (1,500 cases, estimated) were reported in villages near Tubingen.
1949 to 1950 – An outbreak (100 cases) was reported in Stuttgart.
1951 (publication year) – An outbreak was reported in Zuzenhausen.
1951 – An outbreak (6 cases) was reported among members of a single household in Munich.
1966 – An outbreak was associated with a slaughterhouse in Hamburg.
1973 – An outbreak was reported in Simmerath/Eifel.
1982 (publication year) – An outbreak (12 cases) was reported at a Pathology Institute in Tubingen.
1989 – An outbreak (16 cases) in Vorderpfalz was associated with sheep contact.
1992 – An outbreak (80 cases) was reported among staff from a veterinary institute in Berlin.
1993 – An outbreak (121 cases) was reported in Hessen.
1994 – An outbreak was reported in Dusseldorf.
1996 – An outbreak (60 cases) in the Rollshausen area (Lohra, Hessen) was associated with infected sheep.
1997 – An outbreak (105 confirmed cases) at a university was associated with proximity to sheep.
1999 – An outbreak (81 cases) in Dortmund was associated with proximity to sheep.
2000 to 2001 – An outbreak (68 clinical cases) was reported in Hochsauerland and Nordhessen.
2002 – An outbreak (72 cases, 1 fatal) was reported in Hesse.
2003 – An outbreak (299 cases) was associated with a contaminated ewe in farmer’s market in Soest (North Rhine-Westphalia).
2005 – An outbreak (331 cases, 188 laboratory-confirmed) in Jenna was related to proximity to sheep.
2009 (publication year) – An outbreak (5 cases) was reported among researchers working with sheep.

References:
1. Berger SA. Infectious Diseases of Germany, 2011. 488 pp. Gideon E-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-germany/
2. Berger SA. Q-fever: Global Status, 2011. 73 pp. Gideon E-books, http://www.gideononline.com/ebooks/disease/q-fever-global-status/

Update: Posted in ProMED

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