Tan Tabita, Heller Jane, Firestone Simon, Stevenson Mark, Wiethoelter Anke
Gulbali Institute, School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, VIC 3010, Australia.
One Health. 2023 Dec 27;18:100667. doi: 10.1016/j.onehlt.2023.100667. eCollection 2024 Jun.
Q fever is an important zoonotic disease with a worldwide distribution. Outbreaks of Q fever are unpredictable and can affect many people, resulting in a significant burden on public health. The epidemiology of the disease is complex and substantial efforts are required to understand and control Q fever outbreaks. The purpose of this study was to systematically review previous investigations of outbreaks and summarise important epidemiological features. This will improve knowledge of the factors driving the occurrence of Q fever outbreaks and assist decision makers in implementing mitigation strategies. A search of four electronic databases identified 94 eligible articles published in English between 1990 and 2022 that related to 81 unique human Q fever outbreaks. Outbreaks were reported across 27 countries and mostly in industrialised nations. Documented Q fever outbreaks varied in size (2 to 4107 cases) and duration (4 to 1722 days). Most outbreaks (43/81) occurred in communities outside of traditional at-risk occupational settings and were frequently associated with living in proximity to livestock holdings (21/43). Indirect transmission via environmental contamination, windborne spread or fomites was the most common route of infection, particularly for large community outbreaks. Exposure to ruminants and/or their products were confirmed as the principal risk factors for infection, with sheep (28/81) as the most common source followed by goats (12/81) and cattle (7/81). Cooperation and data sharing between human and animal health authorities is valuable for outbreak investigation and control using public health and veterinary measures, but this multisectoral approach was seldom applied (14/81). Increased awareness of Q fever among health professionals and the public may facilitate the early detection of emerging outbreaks that are due to non-occupational, environmental exposures in the community.
Q热是一种重要的人畜共患病，在全球范围内均有分布。Q热疫情不可预测，可影响众多人群，给公共卫生带来重大负担。该疾病的流行病学情况复杂，需要付出巨大努力来了解和控制Q热疫情。本研究的目的是系统回顾以往对疫情的调查，并总结重要的流行病学特征。这将增进对驱动Q热疫情发生因素的了解，并协助决策者实施缓解策略。对四个电子数据库进行检索后，共识别出1990年至2022年期间以英文发表的94篇符合条件的文章，这些文章涉及81起独特的人类Q热疫情。疫情报告涵盖27个国家，且大多发生在工业化国家。有记录的Q热疫情规模（2至4107例）和持续时间（4至1722天）各不相同。大多数疫情（43/81）发生在传统高危职业环境以外的社区，且常常与居住在靠近牲畜养殖场的地方有关（21/43）。通过环境污染、空气传播或污染物进行的间接传播是最常见的感染途径，尤其是对于大型社区疫情而言。接触反刍动物及其产品被确认为感染的主要风险因素，其中绵羊（28/81）是最常见的传染源，其次是山羊（12/81）和牛（7/81）。人类和动物卫生当局之间的合作与数据共享对于使用公共卫生和兽医措施进行疫情调查和控制很有价值，但这种多部门方法很少得到应用（14/81）。提高卫生专业人员和公众对Q热的认识，可能有助于早期发现社区中因非职业性环境暴露导致的新出现疫情。
