{"id":10190,"date":"2025-03-01T14:03:04","date_gmt":"2025-03-01T19:03:04","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan227\/"},"modified":"2025-03-02T00:49:23","modified_gmt":"2025-03-02T05:49:23","slug":"dhan227","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan227\/","title":{"rendered":"php\/alerts\/dhan227 ~  Division of Public Health &#8211; &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan227.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->227 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->May 13, 2010 11:10 am <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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For\n\n\n  information from the Division of Public Health, contact the Bureau of Epidemiology at 1-888-295-5156.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Summary\n\n\n<\/h3>\n\n\n<p>\n\n\n  <em>Increasing reports of Q fever among deployed U.S.military personnel due to endemic transmission in Iraq, as well as a large ongoing\n\n\n  outbreak of Q fever in the Netherlands, may place travelers to these regions at risk for infection. Healthcare providers in the United\n\n\n  States should consider Q fever in the differential diagnosis of persons with febrile illness, pneumonia or hepatitis who have recently\n\n\n  been in Iraq or the Netherlands. Physicians are encouraged to submit samples for proper laboratory testing and contact the CDC for\n\n\n  consultation if needed. Q fever cases in travelers should be promptly reported to proper authorities.<\/em>\n\n\n<\/p>\n\n\n<h3>\n\n\n  Background\n\n\n<\/h3>\n\n\n<p>\n\n\n  Since Operation Iraqi Freedom commenced in 2003, over 200 cases of acute Q fever have been reported among U.S. military personnel\n\n\n  deployed to Iraq. Since several of these cases were identified after returning to the U.S. or when they were no longer serving on active\n\n\n  military duty, a heightened awareness for Q fever infection occurring in military personnel and civilian contractors is necessary to\n\n\n  ensure prompt diagnosis and appropriate treatment. Q fever is endemic in the Middle East, and transmission may be influenced by hot,\n\n\n  dusty conditions and livestock farming practices which may facilitate windborne spread.\n\n\n<\/p>\n\n\n<p>\n\n\n  In addition, a large number of Q fever cases have occurred in the Netherlands since 2007, with over 3,700 human cases reported through\n\n\n  March 2010. Infected dairy goat farms are believed to be the source of the outbreak, and the majority of human cases have been reported\n\n\n  in the southern region of the country. To date, no imported cases of Q fever have been reported among American travelers returning home\n\n\n  from the Netherlands.\n\n\n<\/p>\n\n\n<p>\n\n\n  Because travelers to these countries may have a higher likelihood of exposure to Q fever, the CDC Rickettsial Zoonoses Branch advises\n\n\n  that physicians evaluate travelers returning from Iraq (particularly military personnel and civilian contractors) and the Netherlands\n\n\n  with febrile illness, pneumonia or hepatitis for potential Q fever infection. Probable and confirmed cases should be reported to their\n\n\n  local or state health department.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Q Fever Illness\n\n\n<\/h3>\n\n\n<p>\n\n\n  Q fever is a zoonotic disease with both acute and chronic phases caused by the pathogen <em>Coxiella burnetii<\/em>. The primary mode of\n\n\n  transmission to humans is inhalation of aerosols or dust contaminated by infected animals, most commonly cattle, sheep or goats. Direct\n\n\n  animal contact is not required for transmission to occur as the organism may be spread by dust or wind. Infections via ingestion of\n\n\n  contaminated dairy products and human-to-human transmission via sexual contact have rarely been reported. Q fever does occur in the\n\n\n  United States, but fewer than 200 cases are reported annually.\n\n\n<\/p>\n\n\n<p>\n\n\n  Although asymptomatic infections may occur, an unexplained febrile illness, sometimes accompanied by pneumonia and\/or hepatitis, is the\n\n\n  most common clinical presentation. Illness onset typically occurs within 2\u20133 weeks after exposure. The mortality rate for acute Q\n\n\n  fever is low (1\u20132%) and the majority of persons with mild illness recover spontaneously within a few weeks although antibiotic\n\n\n  treatment will shorten the duration of illness and lessen the risk of complications. Chronic Q fever is uncommon (<1% of acutely\n\n\n  infected patients) but may cause life-threatening heart valve disease (endocarditis). Patients with pre-existing heart valve disorders,\n\n\n  pregnant women, and immunosuppressed persons are at increased risk for developing chronic Q fever. A Q fever vaccine is not commercially\n\n\n  available in the United States and antibiotic prophylaxis is not recommended.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Recommendations\n\n\n<\/h3>\n\n\n<p>\n\n\n  Physicians seeing a patient \u2013 particularly military personnel or a civilian contractor &#8211; who has an illness consistent with Q fever\n\n\n  and who has traveled to Iraq or the Netherlands in the 30 days prior to illness onset should perform appropriate laboratory testing.\n\n\n  Serologic testing should be requested for IgG and IgM antibodies against <em>C. burnetii<\/em> Phase I and II antigen using indirect\n\n\n  immunofluorescence assay (IFA). PCR assays may be conducted on whole blood samples in the early stages of illness and prior to initiation\n\n\n  of antibiotic therapy.\n\n\n<\/p>\n\n\n<p>\n\n\n  Serologic evidence of a fourfold rise in IgG Phase II antibody by indirect immunofluorescence assay (IFA) between paired sera taken 2-4\n\n\n  weeks apart is the gold standard for diagnosis of acute infection. A single high serum Phase II IgG titer by IFA (\u2265 1:128) is\n\n\n  considered evidence of probable infection. IgM testing alone should not be used for serodiagnosis as false positives may occur. Treatment\n\n\n  should not be delayed while awaiting laboratory results. Doxycycline (100mg twice a day for 2-3 weeks) is the treatment of choice for\n\n\n  acute Q fever.\n\n\n<\/p>\n\n\n<p>\n\n\n  <em>Whenever possible, physicians should submit paired acute and convalescent serum samples to facilitate optimal diagnostic testing<\/em>\n\n\n<\/p><br>\n\n\n<table class=\"table table-condensed table-hover\">\n\n\n  <tbody>\n\n\n    <tr>\n\n\n      <th scope=\"col\">\n\n\n        Type of sample\n\n\n      <\/th>\n\n\n      <th scope=\"col\">\n\n\n        Interval from onset of symptoms to specimen collection\n\n\n      <\/th>\n\n\n      <th scope=\"col\">\n\n\n        Type of Analysis\n\n\n      <\/th>\n\n\n    <\/tr>\n\n\n    <tr>\n\n\n      <td>\n\n\n        \u00a0Acute \u2013 whole blood\n\n\n      <\/td>\n\n\n      <td>\n\n\n        \u00a01-7 days (prior to antibiotic therapy)\n\n\n      <\/td>\n\n\n      <td>\n\n\n        \u00a0PCR\n\n\n      <\/td>\n\n\n    <\/tr>\n\n\n    <tr>\n\n\n      <td>\n\n\n        \u00a0Acute \u2013 serum\n\n\n      <\/td>\n\n\n      <td>\n\n\n        \u00a01-7 days\n\n\n      <\/td>\n\n\n      <td>\n\n\n        \u00a0IFA for Phase I and II IgG and IgM\n\n\n      <\/td>\n\n\n    <\/tr>\n\n\n    <tr>\n\n\n      <td>\n\n\n        \u00a0Convalescent \u2013 serum\n\n\n      <\/td>\n\n\n      <td>\n\n\n        \u00a021-35 days\n\n\n      <\/td>\n\n\n      <td>\n\n\n        \u00a0IFA for Phase I and II IgG and IgM\n\n\n      <\/td>\n\n\n    <\/tr>\n\n\n  <\/tbody>\n\n\n<\/table><br>\n\n\n<h3>\n\n\n  Reporting\n\n\n<\/h3>\n\n\n<p>\n\n\n  Q fever is a nationally notifiable disease. All suspect cases of Q fever should be promptly reported to the Delaware Division of Public\n\n\n  Health, Bureau of Epidemiology at 888-295-5156. An investigation will be completed by an epidemiologist including complete clinical and\n\n\n  laboratory information as well as a complete travel history.\n\n\n<\/p>\n\n\n<h3>\n\n\n  More Information\n\n\n<\/h3>\n\n\n<ul>\n\n\n  <li>Additional information about Q fever is available at: <a href=\"http:\/\/www.bt.cdc.gov\/agent\/qfever\/clinicians\/index.asp\" title=\"http:\/\/www.bt.cdc.gov\/agent\/qfever\/clinicians\/index.asp\">http:\/\/www.bt.cdc.gov\/agent\/qfever\/clinicians\/index.asp<\/a>\n\n\n  <\/li>\n\n\n  <li>CDC\u2019s toll-free information line, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day\n\n\n  <\/li>\n\n\n  <li>CDC\u2019s Rickettsial Zoonoses Branch: (404) 639-1075\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  ************************************\n\n\n<\/p>\n\n\n<p>\n\n\n  You are receiving this email because you are a registered member of the Delaware Health Alert Network. If you are not a member and would\n\n\n  like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a>\n\n\n<\/p><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #227 May 13, 2010 11:10 am Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10190","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10190","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10190"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10190\/revisions"}],"predecessor-version":[{"id":11366,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10190\/revisions\/11366"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10190"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}