Primary prevention
Vaccination is a preventive measure practiced in several countries.[2][38] In Australia there is a government-supported vaccination program.[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 unpasteurized dairy products, veterinarians, and laboratory personnel who work with the organism.[5] Prevaccination 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, localized to the area of the injected vaccine, may occur. Vaccination is not commercially available in the US.
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 focalized infection (e.g., pregnancy, pre-existing valvulopathy or vasculopathy, or immunocompromised status as a result of HIV infection or cancer chemotherapy), unpasteurized 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 use of postexposure prophylaxis in pregnant women and high-risk populations may be warranted after mass exposure events, such as through bioterrorism.[112] Postexposure prophylaxis is not recommended for routine exposures in healthy populations.
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