Q-Fever and Coxiellosis

Coxiella burnetii is the bacteria that causes coxiellosis in goats and Q-fever in humans, and although it is not super common, all goat owners need to be aware of it so that they can prevent their goats and themselves from being infected.

Coxiellosis in goats is highly infectious and can cause abortion storms in herds. Humans can be infected via aerosols (like COVID), birth secretions, feces, and raw milk. This disease can be especially bad in pregnant women.

In this episode, I am talking to infectious disease expert Dr. Charles Gaiser from the USDA about the transmission, symptoms, diagnosis, prevention, and treatment of this devastating disease.

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Transcript

Introduction  0:03 
For the love of goats! We are talking about everything goat. Whether you're a goat owner, a breeder, or just a fan of these wonderful creatures, we've got you covered. And now, here is Deborah Niemann.

Deborah Niemann  0:18 
Hello, everyone, and welcome to today's episode. This is going to be extremely interesting, I think, for a lot of people. I know it will be for me. Thankfully, I have absolutely no personal experience with Q fever, which is the topic of today. And, we are joined by Dr. Chuck Gaiser, Small Ruminant Epidemiologist for the USDA and the Animal Plant Health Inspection Service. And, he does a lot of other cool stuff. So, I'm gonna go ahead and say welcome to the show, and tell us a little more about what you do.

Charles Gaiser  0:49 
Thank you, Deborah! Basically, I'm a Small Ruminant Health Epidemiologist with the sheep and goat team under the Ruminant Health Center for Veterinary Services under USDA. And, my primary job is involved with scrapie eradication, which is a disease we talked about previously, I think. And then also with other diseases, such as TB, brucellosis, and the disease we're talking about today, coxiellosis—or Q fever in humans—and any One Health or zoonotic-type disease that involves small ruminants.

Deborah Niemann  1:23 
Okay. So, let's just jump right into this. And, I have read about this disease, but my knowledge is, like, an eighth of a teaspoon compared to your gallons of knowledge. So I'm just gonna let you jump right in and tell us what is Coxiella burnetii, Q fever, and why should we care about it?

Charles Gaiser  1:45 
Okay, well, Coxiella burnetii, or... It was originally found in humans in Australia in the 1930s, where it was called "quarry fever" or Q fever. So, Coxiella burnetii causes Q fever in humans or coxiellosis in animals. It is a small intracellular bacterium. It is ubiquitous in the U.S. It is found worldwide. A small, cellular version of it is very resistant. It is highly infectious. Only 1 to 10 organisms can produce infection. It can be spread in dust, manure, air. It is zoonotic. And, it can be found in all ruminants, most other domestic animals, and even wild animals, and even in birds. All of that makes it very difficult to control. It is also classified as a bioterrorism agent, and therefore is a select agent which is controlled, so it's difficult to work with this agent in the laboratory and requires a special biosafety level 3 laboratory to even culture it.

Deborah Niemann  2:52 
Yeah, that was one of the things I was reading about it. I was so shocked when I saw that some labs refuse to do testing for it, because it's so dangerous to work with.

Charles Gaiser  3:02 
Yes, definitely. And that's the same situation with most of our animal diseases that are classified as bioterrorism agents or select agents. And that includes brucellosis, which is, you know, around the Greater Yellowstone area as a primary cause of disease in elk and in cattle. But again, it's very difficult to work with. And that's what makes it difficult to develop different vaccines and diagnostic tests and other things for this disease.

Deborah Niemann  3:29 
So, when you look at this in the vet textbooks, it is in the chapters on abortion, because that seems to be, like, the main symptom, is that your goats will abort. So, can you tell us a little bit more about that?

Charles Gaiser  3:43 
Yes. They should be included in any abortion screening that you do in a herd or a flock. And basically, it can cause abortions. We primarily hear about it when a... Let's say somebody... You have an existing herd, and somebody brings in a new addition—or new multiple additions—to the herd. And, all of a sudden, the next year, you have an abortion storm where multiple animals abort. So, you have brought that disease into the herd. And basically, the animals themselves, the does, may not show any clinical signs of disease besides abortion. And in some cases, they may not even be shedding the organism after the abortion. But the primary tissues that are loaded with this bacteria are the placenta, the aborted fetus, and any birthing fluids that are associated with the aborted fetus.

Deborah Niemann  4:38 
So, it sounds to me like this is a really good reason you should always be wearing gloves when you are delivering baby goats.

Charles Gaiser  4:45 
I agree. And, one of the control measures or management measures we'll talk about is the need to have a separate birthing area for your pregnant does. Have fresh bedding in those areas. After they deliver, immediately remove the placenta and any contaminated bedding. If there is an abortion, submit the placenta and the aborted fetus for testing to determine what the cause of the abortion is. They can also produce some weak kids that may not show any other signs besides being weak and slow producers.

Deborah Niemann  5:22 
So, it's possible that the doe is not going to just completely abort. And you know, like, if she's pregnant with two or three kids, she may not just completely abort and lose all three of them; she may carry to term and then deliver one or two live kids, as well as a mummified kid that died 2 to 4 weeks earlier?

Charles Gaiser  5:41 
That's possible. But usually, if they have a heavy load of bacteria, and it's in the placentas, they will most likely lose all of the fetuses. So, that's possible. But it depends on when they have the active infection, and at what point that infection occurred within the fetuses.

Deborah Niemann  6:00 
Okay. And I want to stress here that you said that, for somebody to get a positive diagnosis on this, that they have to submit both the fetus and the placenta. Because that was one of the things I was reading, that if you submit only the fetus, in this case, you may not get a diagnosis, because the answer is going to be in the placenta.

Charles Gaiser  6:18 
The best diagnostic tissue for this disease is a placenta, because that's where the billions of bacteria are found in the cotyledons within the placenta, and that is probably the best tissue for diagnosing the disease.

Deborah Niemann  6:35 
Okay. So, how is this then transmitted between goats? Like, if you bring in a new goat, how are they going to give it to your other goats? Can it give it to them before they kid?

Charles Gaiser  6:47 
Yes. Theoretically, yes. We anticipate that there's a large number of animals, or does, that could actually have the disease—harbor the disease—and not be spreading it at a certain time, and only shed the bacteria at particular times. Testing can be difficult, but they normally are spread at delivery. So, when they're kidding, that is the most common time that it's spread. It can be aerosolized; it can be ingested. You know, it's common, especially if they're commingled—animals are commingled—that they may go over and, you know, lick on a new kid or whatever. So, those are all ways that it can be spread. And, it can be spread in the air. This is a very resistant bacteria. Once the bedding material, or once there's dust and dirt in the environment, and that is aerosolized, it can be blown to adjacent farms. In a study done in Netherlands, where they had a large outbreak of this disease, they found that the bacteria could actually travel 5 kilometers away in the air.

Deborah Niemann  7:46 
Wow, that is incredible. Like, the more you tell me, or the more I've read about this, it's just mind-blowing to me that, like, this problem isn't more pervasive. Because one of the things I saw, too, in the reading was that sheep are shown to shed the organism in feces for up to 5 months and in milk for 4 months.

Charles Gaiser  8:07 
Yes. Yes. In most cases, you know, we look at... In goats, we look at it particularly that it's... You're looking at, probably, 3 weeks after delivery, they're probably still spreading it in the vaginal fluids that are coming out and possibly in the milk. And so, it can be spread in the milk. And there are bulk milk-tank testing that can be done to determine if that bacteria is anywhere within your herd. So, that's a good way to screen. And it's also a screening test that can be done with ELISA tests, where you test a percentage of the herd to determine if the disease is there. The problem is that it's an intracellular bacteria, and it may not be shedding all the time; it may not always be present. And so, diagnosis is not always perfect—except in the aborted fetus and placenta, and especially if the diagnostic lab you're using can conduct PCR testing of those tissues, which is much more accurate. Actually looks for the antigen, or the bacteria itself.

Deborah Niemann  9:05 
So, thinking about the fact that this is in milk, and it's zoonotic, can people get it from drinking raw milk from an infected goat?

Charles Gaiser  9:13 
Yes. Yes, ma'am. Yes, ma'am. And that is one of the reasons... I know there's a lot of controversy with raw-milk products. And we know, in most states, that Public Health rules prohibit the sale of raw milk, or for only certain specific purposes. Pasteurization will kill the coxiellosis. And it will kill other diseases, such as listeria, TB, brucellosis, other diseases that can be transmitted in milk. So that's why, you know, when Public Health occurred at the turn of the 20th century, when pasteurization was invented, it really decreased the amount of disease that was spread in milk. So, it's really one of those big success stories for Public Health in the United States and in the world.

Charles Gaiser  9:36 
So, let's talk a little bit about Q fever in people, then.

Charles Gaiser  10:02 
Okay.

Deborah Niemann  10:04 
So, if somebody did get it, what kind of symptoms does a human get when they get Q fever?

Charles Gaiser  10:11 
Well, it's usually if they get any symptoms at all. It can be subclinical or asymptomatic. And we think that as many as half the people that get the disease will not even show symptoms. But those that do show symptoms will have flu-like symptoms that usually occur 2 to 6 weeks after they are exposed to the bacteria. And the flu-like symptoms include things like fever, headache, chills, sweats, and fatigue. And the symptoms usually last for about 10 to 14 days. Now, if you have symptoms, about 30 to 50% of those people with symptoms will develop pneumonia, also. And lastly, of those people with symptoms, probably less than 5% will develop a chronic disease with endocarditis, hepatitis, arthritis, osteomyelitis, and chronic pneumonia. So, it can be a long-term chronic disease as well, but luckily, only in about 5% of those that show clinical signs.

Deborah Niemann  11:15 
Ew. That sounds really horrible. So, for the most part, you know, I was thinking, like, as I was reading about this again in the vet textbooks, I was feeling, like, you know, "We're doing good." You know, like, I've had a closed herd since 2005. I know my goats are healthy and stuff—until I read that this disease can also be transmitted by ticks.

Charles Gaiser  11:37 
Yes, it can be transmitted by ticks. It can be transmitted by wild rodents and other animals around your premises. You know, if you have barn cats—can be transmitted by cats. But, all these animals we're talking about—including the ticks—they have to have a source.

Deborah Niemann  11:51 
Right.

Charles Gaiser  11:51 
So, if you don't have a positive source around you, then you're pretty safe. And maintaining a closed herd is one of the good management ways to do this. If you haven't had any abortion issues in your herd, and you have a closed herd, then that's one of the best things you can do to prevent it from entering into your facility and into your herd.

Deborah Niemann  12:11 
Okay. Wow, this is, like, one of the most incredible diseases that I think I've ever learned about—like, in any species, not just goats. But the fact that, like, it can go across so many different species. And it's not just mammals, even. You know, it can be insects, like ticks. And...

Charles Gaiser  12:30 
Yeah.

Deborah Niemann  12:31 
So, I think everybody probably understands by now why we need to care about this disease. And we've talked about a few things that you can do. What have you to say is, like, the most important thing that people do to make sure that they don't ever have any personal experience with this disease?

Charles Gaiser  12:48 
Well, let's go over some control things that you can use within your herd. We mentioned, you know, a closed herd. Good biosecurity. You know, if you're going to have to add any animals to your herd, be sure that they're quarantined initially. Get them from a reliable source, and especially if there's someone that you know has been testing their herd and looks out for coxiellosis and has not had any positive cases in their herd. So, that would be an excellent source. If you have infected animals, you know, you need to manage them properly. Keep them separate from the other animals. If they are positive, make sure they're milked last. Make sure when they kid that they're downwind from all the other animals that are just gestating animals, or animals that are susceptible to disease. And, you know, maintain excellent and stringent hygiene with people that visit your farm. That's something else, you know.

Charles Gaiser  13:43 
And, the primary thing that I think you can do to manage this disease within your particular herd, especially if you don't know the status of that herd, is to have a separate kidding area—potentially enclosed and potentially with the animals separated—with clean bedding material. Good and closed ventilation for that facility. And then, remove any birthing materials, contaminated bedding materials, burn those or compost them for 90 days at least. And then, after they leave that particular kidding facility or kidding area, then clean that out. Wash it down with some detergent, and there are a few disinfectants that will help. Now, one of the things you don't want to do, is you don't want to kick up a lot of dust. Because, we mentioned before that this agent can be transmitted in dust and can travel long areas. So, we use a light misting water to keep the dust down, and before we clean the area up. So, those are all things that help. Now in humans, who are the most susceptible to the disease? And of course, those high-risk people are immunocompromised people, just like with COVID, and those individuals that are pregnant. If somebody is pregnant, they have to take extra precautions or either not get involved in working in the kidding area for those goats. Extra precautions, we're talking about gloves, eye protection, masks. And, after you leave the facility, before you take that mask and gloves off, take that outer garment off, or coveralls, and wash them so that you don't bring anything into the house.

Deborah Niemann  15:25 
Wow. You know, it never occurred to me that you would need to do anything more than just wear gloves when attending a birth to keep yourself safe. But I mean, you've already explained all the reasons why, because this disease can be transmitted not just through skin, but, like, in the air and everything.

Charles Gaiser  15:43 
Yeah. Primarily through inhalation, is a primary means of transmission.

Deborah Niemann  15:47 
Wow. So, can it go through your skin? Or do you have to have a cut or something on the skin?

Charles Gaiser  15:55 
I am not sure about that. I mean, we do wear gloves, and I know it can go through mucous membranes, which is why we wear eye protection, but I would definitely assume that it does. And I would wear protection and maintain good personal hygiene—hand hygiene—to make sure that it doesn't enter the body that way. I did not read where it can actually actively enter through a cut. But you do have to maintain excellent hand hygiene, which includes gloves, like you're saying; and after the gloves are removed, wash your hands as well.

Deborah Niemann  16:22 
Yeah. I'm very conscientious now about cuts, because my husband got a really severe infection when he caught himself one time butchering chickens—you know, totally healthy chickens! And a few days later, or it was a week later, like, he's got this red streak running up his arm, and he had to be on antibiotics for an extended period of time. So after that, I've been very adamant about, like, you know, the importance of wearing gloves at goat births.

Charles Gaiser  16:57 
Definitely. We've come a long way, and you know, personal protection is very important nowadays. I remember, I graduated from high school back in 1978. And it wasn't very long before that that people were doing barehanded surgeries, barehanded palpations, barehanded delivery of calves, and etc. so we've come a long way. And we understand the importance of personal protection.

Deborah Niemann  17:21 
Yeah, it's funny that you mentioned that, because I remember telling my husband recently, you know, when I was a little girl, I remember, like, I think I was in fourth grade or so when I first learned about germs. And then, going to the dentist and having him put his bare hands in my mouth, and telling my mother I was concerned about the germs, you know, because, "Didn't he just have his hands in somebody else's mouth?" And my mother said, "Oh, no, don't worry about it. He washes his hands."

Charles Gaiser  17:46 
That was a... You were a very smart young lady. And of course, now they wear gloves, they wear masks, they put plastic on the back of the chairs, they have plastic on the dental instruments, etc. So, they they take a lot of precautions now.

Deborah Niemann  17:59 
Yeah, it's amazing how far we've come in terms of our understanding of how germs can be transmitted and disease can be transmitted.

Charles Gaiser  18:07 
And I think, you know, COVID has been a good one to open everybody's eyes on the spread of disease and how it's spread.

Deborah Niemann  18:13 
Yeah, exactly. This conversation makes me so happy that I have had goats since 2002 and I've had a closed herd since 2005. Because, you know, I still feel pretty confident that—knock on wood—I will not see this at any point. But it also... It's really scary to me, because goats have gotten so popular in the last 5 years. I get so many emails from people who just buy some goats off of Craigslist from somebody who maybe had them for a couple of years, knows nothing about them. I mean, I just get some of the craziest emails from people. And it's like, you know, they don't know anything about disease testing; they bought from somebody who doesn't know anything about diseases, and who knows who they bought from. So, it's just really scary to think of how easily diseases can get transmitted. I know when I got started in 2002, I joined Yahoo Groups, and goats also were not very popular back then. And everybody on those Yahoo Groups was, like, so cognizant of the possibility—especially of CAE, but also Johne's and CL and stuff, and of testing and everything. And now, I just feel like the pendulum has swung so far in the other direction. You know, I was just emailing last night with somebody who bought a goat that has some problems, and I'm like, "You really need to get all these goats tested for disease," and he's like, "Oh, no, they look healthy."

Charles Gaiser  19:45 
Yeah. Or, buy them from reputable producers. You know, people you know. People that have good biosecurity in their own herd. And, you may pay a little extra, but it's safe. And, we just had an incident where an animal that was positive for scrapie—which is one of the primary program diseases I work with—that was purchased in another state by a dealer, transferred multiple states away, sold on Craigslist, ended up at multiple people's homes as it moved from home to home. And, you know, finding those animals that could have been exposed to scrapie when we ended up with one positive animal is is very difficult. And scrapie is just an insidious, slow-growing disease, but not near as common as the other diseases we're talking about and that you mentioned: CAE, CL, Johne's, and all those other diseases. So, biosecurity works with all those diseases.

Deborah Niemann  20:38 
Yeah, and if you're listening right now, and you have not heard the scrapie episode, I really recommend that you go listen to that, because that's the thing that makes it basically impossible for most of us to sell goats to somebody in another country, because we still have scrapie in this country. You know, and we were so close. I think when I saw you speak at the ADGA conference in 2017, you said that we had gone 3 years at that point with no recorded cases. And I was so excited, you know, because like, after 7 years, we can export animals. And...

Charles Gaiser  21:11 
I think, it may have been 2 years. But yes, those last few cases are the ones that are the most difficult to find. And this is one disease we're trying to eradicate. Just like brucellosis and tuberculosis and bovine tuberculosis are, those are diseases we're trying to eradicate from the United States. So, we're trying to find those last few cases. And once we find those cases, and we get them eradicated, then we open up export to the rest of the world. In many cases, because our animals have those diseases, and because they're not eliminated, it restricts our ability to export.

Deborah Niemann  21:45 
Yeah. So, our conversation today about Q fever and Coxiella burnetii, it's just been super informative. And, I think just really underscores the importance of not buying a $50 goat off of Craigslist, or even—this guy I was emailing with yesterday spent $300 on an unregistered goat from a very shady guy. And so, it's just really... You know, I was originally happy that goats were becoming more popular, because I thought, "Oh, this will get us more attention in the veterinary community. Hopefully we'll get more research and stuff." But then, you know, it's like the popular dog syndrome; you start to see more problems.

Charles Gaiser  22:26 
Right. And you know, we have large dairies that are developing in the U.S. And you know, I think if you could ever talk to one of those large dairies, and just talk about how that industry is growing in the United States... There are dairies now that are milking 9,000 animals. And it's amazing to see those operations. But you know, there's a shortage of animals. Right now, you know, the price is up, and they're having difficulty meeting the demand for those animals—sheep and goats. So from my side, with small ruminants, we know that goats are definitely an industry that's growing, but still not enough to meet the demand that's out there.

Deborah Niemann  22:59 
Wow. When you said "9,000," you mean goat dairies with 9,000?

Charles Gaiser  23:03 
Yes, ma'am.

Deborah Niemann  23:04 
Wow! I had not heard that some of them had gotten that big. I... Last I had heard of the biggest one, I heard it was low thousands. But that's just huge. And that makes it really hard to keep track. I can't even... comprehend—

Charles Gaiser  23:17 
Imagine? Yes.

Deborah Niemann  23:18 
—how you keep track.

Charles Gaiser  23:19 
And how do you get enough animals? I mean, in most cases, we can't import the animals into United States right now, because a lot of those animals are restricted. So, we're importing semen to try to get the genetics. And, I know that the dairy industry is really pushing to improve our genetics. So, there's always a push for that.

Deborah Niemann  23:38 
Yeah. Wow, this has been so interesting. Do you have any final thoughts on Coxiella burnetii, or...?

Charles Gaiser  23:47 
Well, I think we've covered, you know, how to control it within your particular environment, those individuals that are most susceptible, and how to prevent it in those individuals that are most susceptible. In almost every state, Coxiella burnetii is a reportable disease. But, because it's reportable—and it's also reportable internationally at the OIE. And for humans it's reportable, if humans get it as well. So, what we do in Veterinary Services is, if we hear about a positive test, we have a guidance document that tells folks—tells our regulatory personnel—that, you know, we can assist in educating the people, and maybe helping them to set up a management program to decrease the spread of disease within their particular herd, and also things they can do to protect themselves. And a lot of times, Public Health will get involved with that as well. Again, depends a lot on the state. It depends on state rules on how they respond. Some states may have it as a reportable disease but don't respond to it, whereas other states may conduct a full-blown investigation and traceouts for any animals that came into the herd or went out of the herd. And, an example: Colorado was very active in investigating any outbreak they had. And, I think Public Health will get more involved when you have... Let's say you're in a state where the sale of raw milk is legal, or where you have multiple species of animals on the same premises that could be a source or a spread for that disease as well. So, those are all things to look for.

Charles Gaiser  25:18 
How are we finally going to be able to eliminate this disease and control it? We probably need a good human vaccine and a good animal vaccine. There is a good animal vaccine in Europe. But so far, they have not had an interest in moving that into the United States. There is a good human vaccine in Australia. Again, the same situation. Someone has to produce that. We have gone to our Agricultural Research Service, and they are looking into studies right now on: Are there some genetics that can protect goats or sheep or cattle from coxiellosis? Also, we have asked them in their five-year plan, could they develop a vaccine for animals? But, even if you develop a vaccine, as you've seen, goats and sheep are considered a small production group compared to cattle, pigs, and poultry. So, a lot of the companies that develop vaccines or that produce vaccines may not find it economically feasible to do so. But in this case, since it involves so many species and almost all ruminants, I would think there'd be a market. So, if we can develop a vaccine in the United States, and we can find someone to produce it, I think that will be a big plus for eliminating this disease from United States—or at least controlling it.

Deborah Niemann  26:37 
Yeah. Well, if you've got dairies with thousands of goats on them, I would think they would be the ones who would be really interested in that.

Charles Gaiser  26:44 
Oh, definitely.

Deborah Niemann  26:45 
Because, I mean, this could be really devastating for them to all of a sudden have all of their goats aborting.

Charles Gaiser  26:51 
And the goat industry has told us this is a priority for them, to get a vaccine to control coxiellosis.

Deborah Niemann  26:57 
Yeah. And one thing, too, I just realized we had not mentioned is that treatment with antibiotics is really not that helpful.

Charles Gaiser  27:05 
Yes. We know that this disease is susceptible; you can control a large abortion storm if the animal is not already infected far enough to where it will abort. Tetracycline, oxytet, all the different tetracyclines are effective to some degree, but they may not eliminate the disease, and in most cases, they are not recommended—because you can produce resistance. We always worry about antibiotic resistance. It doesn't eliminate the disease. But, in some large outbreaks, your herd veterinarian may want to try that to slow down the spread of the disease. But again, not very effective and not recommended.

Deborah Niemann  27:46 
Okay. Thank you so much. This has been an amazing episode. I learned so much. And I'm so grateful that, you know, I started in goats when I did and was surrounded by people who took infectious disease really seriously. Thank you so much. 

Charles Gaiser  28:03  
Well, thank you for the chance to speak with you again. And, you always run a very professional podcast, and you're spreading the word to the producers in the field, and we really appreciate it. Thanks for everything that you do as well.

Deborah Niemann  28:17  
And that's it for today's show. If you haven't already done so, be sure to hit the "subscribe" button so that you don't miss any episodes. To see show notes, you can always visit ForTheLoveOfGoats.com, and you can follow us on Facebook at Facebook.com/LoveGoatsPodcast. See you again next time. Bye for now!

Transcribed by https://otter.ai