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Information for Public Health Officials

How to Submit a Sample for Testing

Serum antibody tests for Q fever are available through some commercial and state public health labs. Whenever possible samples should be submitted to these parties for routine diagnostic testing. However, if state or commercial options are not available, or if further testing is required for confirmation, specimens may be submitted to the Centers for Disease Control and Prevention (CDC) for immunofluorescence antibody assay (IFA), immunohistochemistry (IHC), or polymerase chain reaction (PCR) testing. Private citizens may not directly submit specimens to CDC for testing. If you feel that diagnostic testing is necessary, consult your healthcare provider or state health department.

State Health Departments

State health departments and state public health laboratories may submit specimens to the CDC for Q fever testing. To coordinate specimen submission, please call 404-639-1075 during business hours (8:00 – 4:30 EST).

US Healthcare Providers

US healthcare providers should not submit specimens for testing directly to CDC. CDC policy requires that specimens be submitted through or with the approval of the state health department. Please contact your state health department for assistance with specimen submission and reporting of an infected patient. For general questions about Q fever or other rickettsial diseases, please call 1-800-CDC-INFO (1-800-232-4636). If you have questions about a suspect case, please first consult your state health department. Healthcare providers requiring an epidemiologic consultation on rickettsial diseases may also call 404-639-1075 during business hours (8:00 – 4:30 EST) or 770-488-7100 after hours.

Non-US Healthcare Providers

Non-US healthcare providers should consult CDC prior to submitting specimens for testing. For general questions about Q fever, please call 1-800-CDC-INFO (1-800-232-4636). If you would like to discuss a suspect rickettsial case with CDC, please call 404-639-1075 during business hours (8:00 – 4:30 EST) or 770-488-7100 after hours.

Laboratory Response Network

Laboratory testing plays the largest role in diagnosing patients Q fever and other bio-threat agents. The Laboratory Response Network (LRN) is a national network of local, state, and federal public health, food testing, veterinary diagnostic, and environmental testing laboratories that provide the laboratory infrastructure and capacity to respond to biological and chemical terrorism, and other public health emergencies.

The LRN was created through a partnership with the Department of Health and Human Services and the CDC, the Federal Bureau of Investigation (FBI), and the Association of Public Health Laboratories (APHL). This network links state and local public health laboratories in all states with clinical, military, veterinary, and agricultural labs as well as labs that test water and food. Together, these labs can quickly identify biological threats, including Q fever.

Which Laboratories Conduct the Tests?

Once specimens are collected, they are sent to a laboratory for testing. Each laboratory in the LRN has a different role in the testing of the specimen.
Sentinel labs: At this time, local clinical laboratories do not regularly perform testing for the presence of Coxiella burnetii, the bacteria that causes Q fever. Specimens requiring these tests are sent to a reference laboratory for testing.
Reference labs: Public health laboratories in state health departments and in large metropolitan areas can test for the presence of C. burnetii. If C. burnetii is present in a diagnostic sample (called a presumptive positive), the specimens are then sent to a national laboratory for confirmation.
National labs: CDC laboratories can conduct more sophisticated tests to confirm and describe the strain of C. burnetii in order to confirm infection with C. burnetii.

Surveillance Case Definition

Q fever is a nationally notifiable condition, and all Q fever cases should be reported to your state or local health department according to local laws. As of January 1, 2009, Q fever infections are reported under distinct reporting categories (acute and chronic Q fever) described in the 2009 Q fever surveillance case definition.

2009 Q Fever Case Definition

Case Report Form

For confirmed and probable cases of Q fever that have been identified and reported through the National Notifiable Disease Surveillance System, states are also encouraged to submit additional information using the CDC Case Report Form (CRF). This form collects additional important information that may not otherwise be reported to CDC, including how the diagnosis was made, and whether the patient was hospitalized or died. If a different state-specific form is already used to collect this information, this information may be submitted to CDC in lieu of a CRF.

2010 CDC Case Report Form[PDF – 3 pages]

Contact Information

How to Contact the Rickettsial Zoonoses Branch at CDC

The public and health care providers should first call 1-800-CDC-INFO (1-800-232-4636) with questions regarding Q fever and other rickettsial diseases. If a consultation with a CDC scientist specializing in rickettsial diseases is advised, your call will be appropriately forwarded.

For Questions About Select Agent Notification

C. burnetii is a select agent subject to the select agent regulations found in 42 CFR Part 73. For questions regarding a suspected select agent event please contact the Division of Select Agents and Toxins, 404-718-2000 (after hours 404-488-7100) or lrsat@cdc.gov. If intentional release is suspected, please contact CDC Emergency Operations Center (404-488-7100) and local law enforcement.

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