Understanding Q fever burden

Physical and mental health burden (P11)

[1] [T]here's acute and chronic […] people can get out of breath really easily. They can get the Q fever fatigue syndrome, endocarditis, hepatitis all those significant health impacts. Also, mood impacts, so mental health can be impacted. I know that [senior office holder] has had depression brought on from his Q fever experience.

Workforce and economic burden (P1)

[2] I think the compensation claims that I've seen … relate to abattoir workers, they tend to have much more vulnerable contracts. So I think impact on casual workforce in agriculture would be quite dramatic because it's potentially a number of weeks, and for people who are casually employed that's a substantial amount of salary loss.

Risk factors (P15)

[3] [Q] fever bacteria is excreted in large numbers in birthing products of animals. But also in feces and urine of those animals that it can, apart from coming in direct contact with the feces, birthing products and urine. That these can also be aerosolized.

(P5)

[4] I don't actually know the details of exactly how it's transmitted from the animal to the human. I don't know whether it has to being injured by an animal or whether just contact with the infected meat, for example, of a slaughtered cow.

Effective surveillance

Underreporting (P15)

[5] I think that there's a huge underestimation of [how] many people might be affected by Q fever in a year.

Usefulness of animal data (P9)

[6] I think I would have some doubts about the effectiveness of animal surveillance.

(P13)

[7] [S]etting up a surveillance system in animals just to get to find out what's happening in humans. I don't think it's warranted because we already have a surveillance system in humans that works quite well.

(P4)

[8] If you're looking for early warning signs of an increase in environmental contamination, or incidences of Q fever in unusual animals, maybe that would be quite useful for example.

Integrated surveillance (P4)

[9] [Y]ou'll never get rid of it because there's too many different intermediate hosts. And I would want to know what … to what purpose would such dual surveillance be put or how could you make use of that surveillance?

Event-based surveillance (P7)

[10] [I]f you had an outbreak, in a farm, you could then start looking into that area in the human population. On the other side, if you had a couple of people coming in with Q fever, then you could start doing something in that area and in the animal population to find out where did this Q fever actually originate from.

Role of general practitioners and other stakeholders

Diagnostic complexities (P1)

[11] The disease itself is difficult. I've had conversations with the clinical pathologists, microbiologists, and they will tell you that they often diagnose Q fever because they've ruled out other causes of illness.

(P12)

[12] [T]here'd be very few GPs that would be capable of making the correct diagnosis. So no doubt, we will be missing a few cases of Q fever ….

Knowledge and self-awareness (P5)

[13] I think that many people in the medical profession's awareness of Q fever would be very low […] I wasn't taught specifically about most zoonoses at all, like infectious diseases played a very small part in the curriculum.

(P16)

[14] So I think awareness is probably one thing is that a lot of GPs maybe just don't know about it or don't think about it.

Promotion of vaccination (P3)

[15] [I]f you promoted it via Livestock SA and SA Health, they had little posters up in doctor's surgeries in the country. I think your healthcare providers being the doctor surgeries and so on, that's where we said about they should have posters promoting the fact that you should get checked and vaccinated.

Key partners (P14)

[16] [T]he key partner would be SA Health, health protection, Biosecurity SA, and then the big groups where you're more likely to get workers who are going to get Q fever. So Livestock SA, and probably the meat-processing corporation, sheep producers […] unfortunately, the college of general practitioners and the college of rural and remote medicine are sort of in competition. So you probably need to involve both of those. I was going to add, SafeWork SA would be another of those high profile partners.

Barriers and enablers of vaccination

Access to a trained general practitioner (P14)

[17] [T]he other potential barrier is access. So there are a limited number of rural GPs, and we know there's rural GP shortage and therefore there's turnover. So there's the GPs with experience in you know, screening and vaccinating for Q fever is constantly changing.

Complexities of screening tests (P10)

[18] I think one of the big problems is that … you've got to have a test. You don't know whether you've had it, or you could get it. And it takes some time for that test to come back. People in regional areas live a long way from doctors in a lot of cases. So there's that time-lapse between the test and getting the result back. And then if you're positive, and if you've had it, you don't have to have the vaccination. But if you come out where you should be vaccinated, then there's another time-lapse ….

Adverse reactions following vaccination (P9)

[19] I read about the reactions to the vaccines. I've thought about it. And I'm still undecided as to whether or not I'll ever finally get vaccinated.

P (1)

[20] I've also heard anecdotally that many GPs are not happy providing the vaccination because of the potential for the local adverse reactions that tends to put them off.

Vaccination costs (P11)

[21] [C]ost is a main one. So people having to pay over $500 to get vaccinated. The perception of cost is another one, people thinking that they have to pay over $500.

(P10)

[22] [T]he problem as I see it is that a lot of those people are casual workers. [O]f course, if people can't work, they're on social security benefits and that's a cost of the government. I believe, if there was a subsidy program that would help to eliminate those costs to the government.

Mandatory vaccination (P2)

[23] I think people in the meat working industry for example, and perhaps veterinary students, for example, they would actually have an awareness, because it's been required as a pre requisite to have a vaccine to do your work.

(P8)

[24] So our general guidance as a safety regulator is you try and prevent disease, so we would expect people moving stock and handling animals to all be Q fever vaccinated.

Education (P6)

[25] If [farmers] were educated, I believe that they would take [the vaccine] up. And with education then people at least can make an educated decision on it.

An integrated approach

Stakeholder communication (P13)

[26] [W]e do have … meetings, regular meetings with primary industries and department of environment. So at a government level … there is that interaction across the departments to make sure that we are aware of what's happening.

Sectoral connectedness (P3)

[27] Look, the potential is there to be able to bridge gaps between various organisations and link stuff together, whether you actually have to form a completely separate organisation if you like to deliver, or would you simply need to provide links between all those concerns.

Defining roles and responsibilities (P8)

[28] [W]e only see the workplace reports or the human reports and mostly related to workplace, so I don't even know if my reports are filtered by SA health … but we have not had any meetings to discuss what our different roles are.

Funding and priorities (P16)

[29] I think along with that probably comes things like funding and resourcing problems. So funding for health or funding for agriculture and they don't necessarily overlap. So that would be other … and sort of different sectors having different priorities ….

Multi-disease framework (P2)

[30] [O]bviously, there's more conditions to be focused on rather than just Q fever alone. [S]o perhaps if you've got three, four or five diseases, that we say okay, we want to take a collective approach to creating an awareness and control prevention strategies for these in the human population, you've got more strings to your bow so to speak – perhaps a multipronged approach ….

Increased Q fever awareness

Targeted intervention (P7)

[31] [Y]ou would need to have a campaign basically to make people aware of that […] so that would have to be targeted towards producers, towards doctors and probably also actually people in the risk areas. So in rural areas, you would have to target everyone there.

Misinformation (P12)

[32] You now have idiots … who run the anti-vax campaigns on social media. And unfortunately many of the less educated people who work in abattoirs, for example are prone to pick up those misinformation misleading and inaccurate statements on social media and won't get the vaccinations accordingly.

Health promotion and media (P2)

[33] There was some press last week about children of a farming family … contracted Q fever and the ongoing problem several years down the tracks, so it's only through that sort of media attention and publicity that there's going to be increased awareness of the risk.