| Table. Documented Q fever outbreaks in Germany, 1948-1999 |
|
|
Outbreak location
|
Year
|
No. of persons infected |
Sex
|
Animal implicated
|
Possible contributing
factors |
|
|
Rottweil, Baden-Württemberg
(1)
|
5/99-8/99
|
76 symptomatic; 42
confirmed (CF;IFT)a;
|
26 M, 16 F
|
Sheep
|
Sheep close to
community sports
center; outdoor lambing;
shearing of sheep
|
|
Stetten, Baden-Württemberg
(1)
|
6/99-10/99
|
118 symptomatic; 39
confirmed (CF, IFT)
|
59 M, 59 F
|
Sheep
|
Public demonstration of
sheep shearing
|
|
Dettenhausen, Baden-Württemberg
(1)
|
10/98-10/99
|
13 symptomatic; 12
confirmed (CF, IFT)
|
10 M, 3 F
|
Sheep
|
Flock of sheep close to
housing area
|
|
Ebersberg, Bavaria
(2)
|
7/99-8/99
|
19 breeding center
employees - 9 confirmed
(ELISA); unknown no.
of visitors from Bavaria
|
7 M; 2 F
|
Sheep
|
Increased abortion rate
among sheep; open
house at breeding center
|
|
Miltenberg County,
Bavaria (3)
|
5/99-7/99
|
~100 symptomatic; 40
confirmed (CF)
|
23 M; 17 F
|
Sheep
|
Outdoor lambing and
shearing of sheep; dry,
windy weather
|
|
Dortmund, Northrhine-Westphalia
(4)
|
5/99-8/99
|
81 symptomatic; 62
confirmed (IFT, ELISA)
|
46 M, 35 F
|
Sheep
|
Inclusion of products of
conception in manure in
partially open barn;
subsequent spread over
nearby pastures; wind
conditions
|
|
Freiburg, Baden-Württemberg
(5)
|
5/98-9/98
|
101 confirmed (ELISA,
IFT)
|
N/A
|
Sheep
|
Outdoor lambing,
shearing of sheep, dry
weather, wind
conditions
|
|
Giessen, Hesse (6)
|
4/97-8/97
|
68 confirmed (ELISA,
CF); of these, 47
symptomatic
|
N/A
|
Sheep
|
Exposure to infected
sheep kept at veterinary
school during lambing
season; dry, windy
weather
|
|
Rollshausen, Hesse
(7,8)
|
1/96-6/96
|
35 confirmed (ELISA)
|
Attack rate: M=F
|
Sheep
|
Sheep situated near
housing area; outdoor
lambing; dry weather;
wind conditions
|
|
Düsseldorf, Northrhine-Westphalia
(9)
|
6/94-7/94
|
18 symptomatic; 14
confirmed (CF)
|
13 M, 5 F
|
Sheep
|
Sheep located near urban
area; dry, hot weather
|
|
Oberscheid, Hesse
(10)
|
9/93-12/93
|
105 confirmed (ELISA;
IFT; CF)
|
N/A
|
Sheep
|
Sheep flock positive for
C. burnetii in vicinity
|
|
Sontra, Northern Hesse
(11,12)
|
8/93-9/93
|
84 military recruits
confirmed (CF, ELISA);
of these, 43 symptomatic
|
All M
|
Sheep
|
Contamination of
military training grounds
with infected sheep
placentas
|
|
Dortmund, Northrhine
Westphalia (13)
|
1/93-3/93
|
97 confirmed (IFT, CF)
|
60 M; 37 F
|
Sheep
|
Sheep farm in densely
settled area; dry windy
weather
|
|
Berlin (14,15)
|
3/92-6/92
|
80 confirmed (CF)
|
45 M, 35 F
|
Sheep
|
Sheep located in urban
area; dry weather
conditions
|
|
Ludwigshaven,
Rheinland-Palatinate (16)
|
4/89-11/89 (biphasic)
|
16 confirmed (CF); large
no. of undetected cases
|
13 M; 3 F
|
Sheep
|
Weather conditions;
seasonal tick activity
|
|
Meiningen County,
Southern Thuringia (17)
|
8/82-7/83
|
156 symptomatic;
unknown no. confirmed
by CF
|
M>F
|
Uncertain
|
High proportion of
diseased worked in
animal husbandry
|
|
Northern Baden, Baden-Württemberg
(18,19)
|
8/78-10/78
|
89 symptomatic, 69
confirmed (CF)
|
48 M; 21 F
|
Sheep
|
Migration of sheep
through town; possibly
wind conditions and
seasonal tick activity
|
|
Munich, Bavaria (20)
|
2/77-4/77
|
15 confirmed (CF)
|
6M; 9F
|
Sheep
|
Contact with sheep flock
or its shepherd in
working clothes
|
|
Simmerath, Eifel ,
Rhineland-Palatinate (21)
|
5/73-7/73
|
44 confirmed (CF); 25
asymptomatic
|
N/A
|
Sheep
|
Dry, warm, windy
weather; working on
fields on which sheep
had grazed
|
|
Town E., Baden-Württemberg
(22)
|
11/72-6/73
|
58 symptomatic; 43
confirmed (CF)
|
30 M; 13 F
|
Sheep
|
Migration of sheep
through town
|
|
Hamburg (23)
|
11/66-4/67
|
10 abattoir employees;
|
N/A
|
Cattle
|
Slaughter of cattle
|
|
Munich, Bavaria (24)
|
1/64-2/64
|
249 confirmed (CF)
|
N/A
|
Sheep
|
Sheep (postpartum) with
presumed infection
treated in veterinary
clinic; dry, frosty
weather
|
|
Niederrhein, Northrhine-Westphalia
(25,26)
|
5/58-8/58
|
515 symptomatic; 400
confirmed (CF)
|
460 M; 55 F
|
Cattle
|
Participation at an
animal fair; 5 cattle
positive for C. burnetii;
1 seropositive cow
aborted
|
|
Obernau, Bavaria
(27)
|
1/54-5/54
|
~200 symptomatic;
29/34 tested sera
positive (CF)
|
N/A
|
Sheep
|
Daily herding of sheep
through town during
exceptionally dry winter
months
|
|
Grosshau and
Brandenberg, Northwest
Eifel, Rhineland
Palatinate (28)
|
3/53-6/53
|
107 symptomatic; of 9/9
sera tested positive (CF)
|
M>F
|
Sheep
|
Grazing of sheep near
housing area; migration
of several herds through
outbreak area
|
|
Ahrtal, Baden-Württemberg
(29)
|
2/52-4/52
|
198 symptomatic; 61/70
tested sera positive (CF)
|
182 M; 16 F
|
Sheep
|
Outdoor lambing; spread
through prevailing wind
|
|
Schwaikheim, Northern
Württemberg (30)
|
2/50-5/50
|
~250; confirmed in
unspecified no. of
|
M=F
|
Cattle, possibly goats
|
Symptomatic disease in
seropositive animals;
|
|
Zuzenhausen, Baden-Württemberg
(31)
|
12/49-4/50
|
150 symptomatic; 100
confirmed (CF)
|
M > F
|
Cattle
|
Shedding of C. burnetii
in milk; Ixodes ricinus
ticks caught in the area
found to be infected
|
|
Neulussheim, Baden-Württemberg
(31)
|
6/50
|
120 symptomatic; 82
confirmed (CF)
|
M > F
|
Cattle
|
Shedding of C. burnetii
in milk?
|
|
Unterambringen &
Kirchhofen, Baden-Württemberg (29)
|
2/50
|
~ 200 symptomatic,
diagnosis not described
|
N/A
|
Sheep
|
Proximity to sheep
flocks during lambing
season
|
|
Stuttgart, Baden-Württemberg
(32)
|
11/49
|
70 abattoir employees;
diagnosis not described
|
N/A
|
N/A
|
Slaughtering of animals
|
|
Esslingen, Baden-Württemberg
(33)
|
4/49
|
28 abattoir employees;
17/17 sera tested
positive (CF)
|
N/A
|
Cattle
|
Slaughtering of cattle
|
|
Stetten, Baden-Württemberg
(34)
|
10/48-12/48
|
98 confirmed (CF)
|
M > F
|
Unknown
|
Rural community;
animal contact; possible
spread among factory
workers by mutual use
of on-call beds
|
|
Frankfurt/Main, Hesse
(35)
|
10/48-11/48
|
38 hospital employees
and patients; 33
confirmed (CF or by
animal transmission)
|
N/A
|
--
|
Contact with an index
patient with laboratory-acquired Q fever, whose
sputum contained C.
burnetii
|
|
Baisingen, Baden-Württemberg
(36)
|
3/48-5/48
|
~ 50 symptomatic; 3 of
4 tested sera positive
(CF)
|
N/A
|
Unknown
|
Rural community, mild
preceding winter
|
|
Düsseldorf, Northrhine-Westphalia
(37)
|
2/48-8/48
|
23 symptomatic
laboratory workers; 19
confirmed by CF or by
animal transmission
|
7 M; 16 F
|
--
|
Laboratory work with
Herzberg strain of C.
burnetii
|
|
Dettenhausen, Baden-Württemberg
(36)
|
1/48-3/48
|
~ 300 symptomatic; 9
out of 10 tested sera
positive (CF)
|
N/A
|
Unknown
|
Rural community; mild
winter
|
|
Dettingen, Baden-Württemberg
(36)
|
12/47-3/48
|
~ 1,200 symptomatic; 11
of 12 tested sera positive
(CF)
|
N/A
|
Unknown
|
Rural community; mild
winter
|
|
Remmingsheim, Baden-Württemberg
(36)
|
11/47-2/48
|
326 symptomatic; 32/34
tested convalescent sera
positive (CF)
|
N/A
|
Unknown
|
Farming community;
mild winter
|
|
Hamburg (38)
|
11/47-2/48
|
13 symptomatic
laboratory workers; 9
confirmed by animal
transmission
|
M > F
|
--
|
Laboratory contact with
"Herzberg" strain of C.
burnetii
|
|
IFT = immunofluorescence test; ELISA = enzyme-linked immunosorbent assay; CF = complement fixation; N/A = not available.
a IFT is slightly less sensitive than ELISA, but more sensitive than CF.
|
