Infection occurs sporadically or as outbreaks. Outbreaks are more common among workers on duck or poultry farms, and in abattoirs and processing plants.[5]Harkinezhad T, Geens T, Vanrompay D. Chlamydia psittaci infections in birds: a review with emphasis on zoonotic consequences. Vet Microbiol. 2009 Mar 16;135(1-2):68-77.
http://www.ncbi.nlm.nih.gov/pubmed/19054633?tool=bestpractice.com
[6]Gaede W, Reckling KF, Dresenkamp B, et al. Chlamydia psittaci infections in humans during an outbreak of psittacosis from poultry in Germany. Zoonoses Public Health. 2008 May;55(4):184-8.
http://www.ncbi.nlm.nih.gov/pubmed/18387139?tool=bestpractice.com
Between 25 and 50 cases are confirmed in England and Wales each year.[7]Public Health England. Guidance: psittacosis. December 2017 [internet publication].
https://www.gov.uk/guidance/psittacosis
There have typically been fewer than 10 confirmed cases reported in the US each year since 2010, with 5 cases reported in 2017.[8]Centers for Disease Control and Prevention. National notifiable infectious diseases: weekly tables. 2018 [internet publication].
https://wwwn.cdc.gov/nndss/infectious-tables.html
An outbreak was reported among workers at two poultry slaughter plants in Virginia and Georgia during August to October 2018 (13 confirmed cases).[9]Centers for Disease Control and Prevention. Multistate psittacosis outbreak among poultry plant workers, 2018. 11 February 2019 [internet publication].
https://www.cdc.gov/pneumonia/atypical/psittacosis/surveillance-reporting/outbreaks/2018-poultry-multistate-investigation.html
One meta-analysis found that approximately 1% of cases of community-acquired pneumonia were due to Chlamydia psittaci, with a range between 0% and 6.7%.[10]Hogerwerf L, DE Gier B, Baan B, et al. Chlamydia psittaci (psittacosis) as a cause of community-acquired pneumonia: a systematic review and meta-analysis. Epidemiol Infect. 2017 Nov;145(15):3096-105.
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/chlamydia-psittaci-psittacosis-as-a-cause-of-communityacquired-pneumonia-a-systematic-review-and-metaanalysis/DF3BB3083E9AF3A76EC1979769696FB1
http://www.ncbi.nlm.nih.gov/pubmed/28946931?tool=bestpractice.com
A Dutch study identified C psittaci by polymerase chain reaction of sputum as a cause of community-acquired pneumonia in 4.8% of cases.[11]Spoorenberg SM, Bos WJ, van Hannen EJ, et al. Chlamydia psittaci: a relevant cause of community-acquired pneumonia in two Dutch hospitals. Neth J Med. 2016 Feb;74(2):75-81.
http://www.ncbi.nlm.nih.gov/pubmed/26951352?tool=bestpractice.com
Reporting may be limited by the fact that clinical differentiation of illness caused by C psittaci and illness caused by other organisms, especially Chlamydophila pneumoniae, can be difficult.
Approximately 5% to 8% of birds are infected withC psittaci, and 465 avian species are susceptible to this organism, most commonly psittacine (parrot-type) birds, especially budgerigars and cockatiels.[1]Schlossberg D. Chlamydophila (chlamydia) psittaci (psittacosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases, 6th ed. Philadelphia, PA: Churchill Livingston; 2005:2256-8.[12]Vanrompay D, Harkinezhad T, van de Walle M, et al. Chlamydia psittaci transmission from pet birds to humans. Emerg Infect Dis. 2007 Jul;13(7):1108-10.
http://wwwnc.cdc.gov/eid/article/13/7/07-0074_article
http://www.ncbi.nlm.nih.gov/pubmed/18214194?tool=bestpractice.com
C psittaci strains that infect psittacine birds and poultry are more virulent and can infect humans of all age groups through aerosolised particles or direct contact with infected nasal secretions, faeces, or tissue.[1]Schlossberg D. Chlamydophila (chlamydia) psittaci (psittacosis). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases, 6th ed. Philadelphia, PA: Churchill Livingston; 2005:2256-8.[6]Gaede W, Reckling KF, Dresenkamp B, et al. Chlamydia psittaci infections in humans during an outbreak of psittacosis from poultry in Germany. Zoonoses Public Health. 2008 May;55(4):184-8.
http://www.ncbi.nlm.nih.gov/pubmed/18387139?tool=bestpractice.com