Q fever epidemic in Hungary, April to July 2013

M Gyuranecz; K M Sulyok; E Balla; T Mag; A Balázs; Z Simor; B Dénes; S Hornok; P Bajnóczi; H M Hornstra; T Pearson; P Keim; A Dán

doi:10.2807/1560-7917.ES2014.19.30.20863

Surveillance and outbreak reports Open Access

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Q fever epidemic in Hungary, April to July 2013
M Gyuranecz^1,2 , K M Sulyok^1,2 , E Balla³ , T Mag³ , A Balázs³ , Z Simor⁴ , B Dénes⁵ , S Hornok⁶ , P Bajnóczi⁴ , H M Hornstra⁷ , T Pearson⁷ , P Keim⁷ , A Dán⁵
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Affiliations: ¹ Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Budapest, Hungary ² These authors contributed equally to this article ³ National Center for Epidemiology, Budapest, Hungary ⁴ Government Office for Baranya County, Pécs, Hungary ⁵ Veterinary Diagnostic Directorate, National Food Chain Safety Office, Budapest, Hungary ⁶ Faculty of Veterinary Science, Szent István University, Budapest, Hungary ⁷ Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, United States

Correspondence:
M Gyuranecz
m.gyuranecz gmail.com
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Citation style for this article: Gyuranecz M, Sulyok K M, Balla E, Mag T, Balázs A, Simor Z, Dénes B, Hornok S, Bajnóczi P, Hornstra H M, Pearson T, Keim P, Dán A. Q fever epidemic in Hungary, April to July 2013. Euro Surveill. 2014;19(30):pii=20863. https://doi.org/10.2807/1560-7917.ES2014.19.30.20863 Received: 11 Oct 2013

Abstract

We investigated a Q fever outbreak with human patients showing high fever, respiratory tract symptoms, headache and retrosternal pain in southern Hungary in the spring and summer of 2013. Seventy human cases were confirmed by analysing their serum and blood samples with micro-immunofluorescence test and real-time PCR. The source of infection was a merino sheep flock of 450 ewes, in which 44.6% (25/56) seropositivity was detected by enzyme-linked immunosorbent assay. Coxiella burnetii DNA was detected by real-time PCR in the milk of four of 20 individuals and in two thirds (41/65) of the manure samples. The multispacer sequence typing examination of C. burnetii DNA revealed sequence type 18 in one human sample and two manure samples from the sheep flock. The multilocus variable-number tandem repeat analysis pattern of the sheep and human strains were also almost identical, 4/5-9-3-3-0-5 (Ms23-Ms24-Ms27-Ms28-Ms33-Ms34). It is hypothesised that dried manure and maternal fluid contaminated with C. burnetii was dispersed by the wind from the sheep farm towards the local inhabitants. The manure was eliminated in June and the farm was disinfected in July. The outbreak ended at the end of July 2013.