New Q Fever Warning for US Military Returning from Iraq

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The Centers for Disease Control and Prevention (CDC) has issued a health advisory regarding Q fever, a disease that is endemic in Iraq and other countries in the Middle East, as well as in the Netherlands. The CDC warning comes at a time when there are increasing reports of Q fever among deployed US military personnel who have been in Iraq.

Q fever is a zoonotic disease, which means it can be transmitted from animals to people or, more specifically, it is a disease that normally appears in animals but that can infect people. Some other examples of zoonotic diseases include Lyme disease, rabies, anthrax, and West Nile fever.

Q fever is caused by an organism called Coxiella burnetii, which is carried by goats, cattle, and sheep and deposited into the soil in their feces. The main way humans can get Q fever is by inhaling dust contaminated by infected animals. These animals are common in Iraq, and US military personnel and civilian contractors are routinely exposed to whirling dust in the war region. Direct animal contact is not required for infection to occur, and infection by eating contaminated dairy foods is rare.

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Since Operation Iraqi Freedom started in 2003, more than 200 cases of acute Q fever have been reported among US military personnel who served in Iraq. Some cases were not identified until the individuals had returned home or they were no longer actively serving in the military. The Netherlands is another place where Q fever has been reported, with more than 3,700 human cases documented since 2007. To date, however, there are no reported cases of Q fever among Americans who returned from the Netherlands.

The Rickettsial Zoonoses Branch of the CDC is advising physicians to evaluate anyone who has returned from Iraq or the Netherlands if they have fever, pneumonia, or hepatitis, as these are indications of Q fever infection. The illness typically first appears within 2 to 3 weeks of exposure. The mortality rate for acute Q fever is 1 to 2 percent, and most people who have mild symptoms recover within a few weeks with or without antibiotic treatment, which can reduce the risk of complications and shorten the time of illness.

Chronic Q fever occurs in less than 1 percent of people who have acute disease, but individuals who have a pre-existing heart valve disorder, who are immunosuppressed, or who are pregnant are at increased risk for developing chronic Q fever. No Q fever vaccine is available in the United States.

Anyone who has recently returned from Iraq or the Netherlands, especially US military personnel, and who experiences unexplained fever and/or symptoms of hepatitis or pneumonia should see their physician immediately. Q fever is a nationally notifiable disease, and physicians must submit a CDC Q fever Case Report form to their state health department for all probably and confirmed cases of the illness. Individuals who are interested in learning more about Q fever can visit the CDC website on Q fever.

SOURCE:
Centers for Disease Control and Prevention Health Advisory

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