Dutch expert sees parallels to Q fever outbreaks

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When pathologist Thijs Kuiken seems at what’s occurring within the U.S. response to the H5N1 fowl flu outbreak in dairy cows, he’s reminded of a troublesome interval within the Netherlands, the place he lives, again within the late aughts.

Giant goat and sheep farms within the nation have been hit with outbreaks of what’s referred to as Q fever yearly from 2007 to 2010. The illness, brought on by the bacterium Coxiella burnetii, primarily impacts ruminants — sheep, goats, and cows. However individuals can contract it too. Some don’t get sick. Some have flu-like sickness and get better. However some develop continual Q fever syndrome, a debilitating situation. Hundreds of people within the Netherlands nonetheless endure from the situation as a consequence of the 2007-2010 epidemics.

H5N1 is a virus that scientists worry may sooner or later set off a pandemic; Q fever is a bacterial illness that when current in an surroundings can result in vital numbers of infections in individuals. However the similarity Kuiken sees is how, in each circumstances, the preliminary inclination is to deal with these occasions in animals as an financial downside for the agricultural sector, fairly than as an agricultural downside that would have massive human well being penalties as nicely.

“My total concern about this outbreak is that it’s being handled an excessive amount of as an financial downside and too little as a public well being and an animal well being downside,” mentioned Kuiken, who works within the division of viroscience at Erasmus Medical Heart in Rotterdam.

Kuiken is among the influenza consultants STAT spoke to for an article final week analyzing the response to the H5N1 outbreak in cows thus far. He and others fear concerning the lack of urgency within the U.S. response and the obvious absence of a complete plan for driving the virus out of cattle. Agriculture Secretary Tom Vilsack believes the reply is better biosecurity on farms. However with the variety of affected farms persevering with to rise — the determine hit 139 in 12 states on the finish of final week and people are the farms the place farmers truly allowed testing to happen — there isn’t any sense that the tide is popping. (The USDA’s rely was 133 on Friday, which didn’t embrace the 2 newest detections in Iowa and 4 latest in Colorado.)

Letting H5N1 develop into established in cows would give the virus an opportunity to adapt to a mammalian species, growing the chance it could purchase mutations that will assist it develop into able to spreading to and amongst individuals.

The response to the Q fever outbreaks was related, Kuiken mentioned: “Originally it was handled primarily as an financial downside and an issue of the dairy goat sector and was handled by the ministry of agriculture.”

Contaminated animals shed massive quantities of the micro organism of their milk, urine, feces, and placentas; the infections induced “abortion storms” on farms with pregnant animals, Kuiken mentioned. The micro organism wafted off the farms within the wind. “There have been individuals who would cycle by these farms and develop into contaminated.” However the areas of affected farms weren’t publicly disclosed, for privateness causes. (Sound acquainted?) “So even when individuals have been involved that they could get contaminated and wished to avoid these areas, they didn’t know the place they have been,” he mentioned.

Ultimately the nation’s well being minister stepped in to demand that the outbreaks be handled additionally as a human well being downside. “It actually was an necessary lesson for the veterinary and medical authorities,” Kuiken mentioned.

At current within the H5N1 outbreak, management over the response lies firmly within the palms of the U.S. Division of Agriculture. Although there have been quite a few stories of sick farmworkers — many greater than the three who’ve examined optimistic for H5N1 on this outbreak thus far — few have been examined. The Facilities for Illness Management and Prevention reported Friday that at the least 53 individuals have been examined for the virus because the outbreak was first detected. That determine was 51 on the finish of the week earlier than final.

Efforts to attempt to get a deal with on how many individuals might have been contaminated have been stymied as a result of in lots of circumstances farmers have refused to permit public well being employees on their properties to speak to and check their employees. However lastly, there’s been a breakthrough on this entrance: Well being authorities in Michigan are conducting a small serology examine, with the cooperation of an undisclosed variety of farms in that state. Taking part employees are filling in questionnaires describing their encounters with cows and their each day duties, and are giving a blood pattern that might be analyzed for antibodies to the virus. The CDC is collaborating with Michigan on the examine.

One other examine that’s getting underway is a component two of a Meals and Drug Administration effort to evaluate the chance H5N1 virus poses to business milk manufacturing. In early Could the company reported that of almost 300 store-bought milk samples, about 1 in 5 contained fragments of fowl flu viruses, however the viruses had been killed by pasteurization. (The FDA and USDA released a preprint — a examine that hasn’t but gone by peer evaluation — on Friday exhibiting that business pasteurization strategies cut back virus in milk to undetectable ranges.)

Half two of the milk examine will concentrate on some milk merchandise the primary iteration didn’t check, Don Prater, the FDA’s performing director of the Heart for Meals Security and Utilized Diet, advised journalists final week. They embrace: cream cheese, aged uncooked milk cheese, butter, and ice cream. Outcomes are some weeks off, he mentioned.

Coming sooner — today, in fact — USDA will begin taking purposes for an help plan to compensate farmers for misplaced earnings on account of lowered milk manufacturing in H5N1-infected cows. With cash to cowl losses truly on the desk, it’s hoped farmers will lastly see a cause to check animals they believe are contaminated with the virus.