Primary prevention
Vaccination is a preventative measure practised in several countries.[2][38] In Australia there is a government-supported vaccination programme.[5][47] The whole-cell vaccine in use has a 5-year efficacy of >95%.[48][49][50] When available, vaccination is recommended for livestock handlers, abattoir workers, people in contact with unpasteurised dairy products, veterinarians, and laboratory personnel who work with the organism.[5] Pre-vaccination screening is required and includes history, skin test, and serology. Individuals who have previously been exposed to Coxiella burnetii should not receive the vaccine, because severe reactions, localised to the area of the injected vaccine, may occur.
One systematic review found that Henzerling phase I vaccine effectively prevented acute Q fever in individuals responsible for handling animals (or their products) and in those working in the abattoir but not directly exposed to animals. However, this systematic review also reported that there were systematic biases present in the data included in the review, and the evidence may not be sufficiently robust to extrapolate the effect of the vaccination.[51]
For people at risk of development of persistent focalised infection (e.g., pregnancy, pre-existing valvulopathy or vasculopathy, or immunocompromised status as a result of HIV infection or cancer chemotherapy), unpasteurised milk and contact with products of parturition should be avoided. Patients with significant valvulopathy or vasculopathy should have a professional reclassification. In laboratories, C burnetii must be cultured at a biosafety level 3 category, because of the organism's significant infectivity and potential for use as a weapon of bioterrorism.[2][52]
Secondary prevention
Coxiella burnetii infection is a notifiable disease in the US; however, reporting is not required in many other countries.
Use of prophylactic antibiotics following exposure is not widely recommended, as there appears to be a narrow window of efficacy for preventive effect. However, if the timing of exposure can be assured, risk-benefit analyses have suggested that the use of post-exposure prophylaxis in pregnant women and high-risk populations may be warranted after mass exposure events such as through bioterrorism.[110] Post-exposure prophylaxis is not recommended for routine exposure in healthy populations. Health Protection Agency (UK): CBRN incidents - clinical management & health protection Opens in new window
Use of this content is subject to our disclaimer