SUMMARY: Q-fever, a rare disease which normally strikes farm animals and the people who work with and around them, has infected hundreds of people in the Netherlands who have no contact with farms. Most people who contract the illness come down with flu-like symptoms or pneumonia for a few weeks, but some are sick for months and a handful have died. Jos van de Sande, an infectious disease expert at the public health department in a Dutch province, said it's not clear why the disease is spreading but that the bacteria may have mutated. "And now Q-fever is spread by the wind, and the whole population can get it."
STORY LINK: http://www.pri.org/health/global-health/outbreak-of-rare-disease-in-the-netherlands1924.html

ANALYSIS:
There are times when common occurrences assume uncommon significance.  Q-fever is rare in humans, but present globally (except in New Zealand).  Caused by the bacterium Coxiella burnetii, it prompts an unusual reaction among the public for multiple reasons:  it is seldom seen, it has a mysterious name, it has been a reportable disease in the United States since 1999, and it is officially listed as a bioterrorism concern.  Analysis of this outbreak must occur through two lenses:  that of the local phenomenon and that of the potential broader ramifications.  

For the first six years of the last decade, between 5 and 20 cases of Q-fever were reported annually in the Netherlands.  In the first half of 2007 that figure jumped to 63.  At that time, epidemiological investigation revealed only sporadic cases and family clusters related to direct animal contact.  This matched the historic manifestation of the disease.  The number grew to 200 cases annually until 2009, when the count exceeded 2000.  

Absent the specific details of the Dutch outbreak, it is impossible to postulate the contributory causes.  It is significant to note that only about one-half of all people infected with C. burnetii show signs of clinical illness.  It is possible that increased sophistication in diagnosis prompted by clinical education and highlighting of this disease improved detection of an already present contagion.  The media report also highlights growth in Dutch livestock farming and of goat farms in particular, goats being a primary reservoir of Q-fever.  To fully understand the interaction of human and environment, it is important to put the two into perspective.  The Netherlands is approximately the size of Connecticut and Massachusetts combined, with 60 percent more population than those two states.  This means there is a very congested region where urban and agricultural areas exist in close proximity.  There are multiple avenues of infection.  The CDC explains:

"Organisms are excreted in milk, urine, and feces of infected animals. Most importantly, during birthing the organisms are shed in high numbers within the amniotic fluids and the placenta.  The organisms are resistant to heat, drying, and many common disinfectants.  These features enable the bacteria to survive for long periods in the environment.  Infection of humans usually occurs by inhalation of these organisms from air that contains airborne barnyard dust contaminated by dried placental material, birth fluids, and excreta of infected herd animals.  Humans are often very susceptible to the disease, and very few organisms may be required to cause infection."

This paints a picture of exposure by proximity.  The bacteria can travel up to a kilometer in the wind.  Fortunately, Q-fever is treatable with antibiotics.  

A more ominous possibility exists that the sudden rise in cases is a result of human intervention:  bioterrorism.  Q-fever is listed as a potential bioterrorism agent because it is highly infectious – illness can be caused by a single cell – and relatively resistant to heat and drying.  It typically takes from 2-3 week to become ill following exposure.  Whether naturally occurring or of human origin, this and every other outbreak demands monitoring and attentiveness.  Being aware of an outbreak can help prevent exposure.  Responsive human resources policies, personal and workplace hygiene, and, if recommended by a physician, vaccination can minimize the impact of this disease.

- Donald A. Donahue, DHEd, Executive Director, Center for Health Policy and Preparedness