Q fever vaccination

These long-lasting indicators of cell-mediated immunity develop in most individuals after natural infection, but are also seen after immunization,90,93 although to a lesser extent. Conversion from a negative lymphocyte proliferative response to a positive was observed in 11 (85%) of 13 of the individuals vaccinated.93 In the same study, only 5 (38%) of 13 of vaccinated subjects seroconverted, and 31 (60%) of 52 developed a positive skin test following vaccination. Therefore, although the whole cell Q fever vaccine used in the Australian abattoirs confers protection, there does not appear to be a measurable response reliably associated with protective immunity. 

Although an effective Q fever vaccine is licensed in Australia, all Q fever vaccines used in the United States are currently investigational. Certain groups of individuals should be considered for vaccine prophylaxis, including the following ... 

Research efforts are currently underway to develop a Q fever vaccine that is safe to administer to anyone, including Q fever-immune individuals. The residue of C burnetii organisms following chloro-form-methanol extraction (CMR vaccine) has been tested for safety in nonimmune volunteers97 and is currently being tested for safety in Q fever-immune individuals. Antibiotic prophylaxis of Q fever has been tested with a tetracycline, as was discussed in the treatment section of this chapter. 

Diagnosis of Q fever is performed by serologic testing. Treatment with tetracyclines is effective. Prevention is possible with a formalin-killed, whole-cell vaccine, but prior skin testing to exclude immune individuals is necessary to avoid severe local reactions to the vaccine. A Q fever vaccine is licensed in Australia, but not in the United States, where all Q fever vaccines are investigational. 

Shapiro RA, Siskind V, Schofield FD, Stallman N, Worswick DA, Marmion BP. A randomized, controlled, doubleblind, cross-over, clinical trial of Q fever vaccine in selected Queensland abattoirs. Epidemiol Infect. 1990 104 267-273. 

Benenson AS. Q fever vaccine Efficacy and present status. In Smadel JE, ed. Symposium on Q fever by the Committee on Rickettsial Diseases. Washington, DC Armed Forces Epidemiology Board 1959 47-60. 

Izzo AA, Marmion BP, Worswick DA. Markers of cell-mediated immunity after vaccination with an inactivated, whole-cell Q fever vaccine. J Infect Dis. 1988 157 781-789. 

Bell JF, Lackman DB, Meis A, Hadlow WJ. Recurrent reaction at site of Q fever vaccination in a sensitized person. Milit Med. 1964 124 591-595. 

Luoto L, Bell JF, Casey M, Lackman D. Q fever vaccination of human volunteers, I The serologic and skin-test response following subcutaneous injections. Am J Hyg. 1963 78 1-15. 

Q fever vaccines in the United States are still investigational, although an effective vaccine, Q-Vax, is licensed in Australia. 

New Q fever vaccine (IND) available from Fort Detrick, use should be limited to those at high risk, no demonstrated sensitivity to Q fever antigen... 

Bacterial vaccines of restricted availability include anthrax, botulism, plague, Q fever, typhus and tularaemia vaccines. 

F. Vaccination. Vaccination is the preferred method of biological defense. Fully licensed vaccines are currently available for anthrax, cholera, plague and smallpox. Vaccines for botulinum toxoid, Q fever, Rift Valley fever, tularemia, and VEE currently exist as IND products and would be available only under protocol with informed consent, therefore would not be readily available on the battlefield. No vaccine is currently available either FDA licensed or under IND status, for glanders, brucellosis, Staphylococcus enterotoxin B, ricin, or T-2 mycotoxins. 

Q Fever can be diagnosed from blood tests and treated by antibiotics. Effective vaccines are available for preventing its occurrence. The use of this organism either in any warfare or bio-terrorism so far is not known. The organism however, has the potential of becoming a bio-weapon. 

Diagnosis of SEB intoxication may be difficult in the early stage because certain other diseases such as influenza, Q Fever, tularemia or plague may manifest similar symptoms. Treatment should include supportive care. Oxygenation, hydration and ventilator to help breathing may be needed in severe intoxication. Antibiotics may be effective. Currently there is no vaccine to protect humans from this toxin. 

The potential of C burnetii as a biological warfare threat is directly related to its infectivity. It has been estimated that 50 kg of dried, powdered C burnetii would produce casualties a rate equal to that of similar amounts of anthrax or tularemia organisms.14 Q fever has been evaluated as a potential biological warfare agent by the United States,15 but munitions and stocks (except that required for vaccine research) were publicly destroyed by executive order of President Richard M. Nixon between May 1971 and May 1972.16... 

Q fever can be prevented by immunization. Vaccine prophylaxis for Q fever has been studied and used almost since the discovery that the responsible organism could be propagated in the yolk sac of eggs. Immunization with formalin-killed C burnetii confers protection against Q fever in laboratory personnel,89 abattoir workers,90,91 and human volunteers experimentally exposed to aerosolized C burned.92 In Australian abattoir workers, the results of efficacy studies were impressive a single injection of 30 pg of vaccine antigen (Q-Vax, manufactured by CSL Ltd., Parkville, Victoria, Australia) conferred protective immunity that began 2 weeks after immunization and persisted for at least 5 years.90 Protection depends primarily on cell-mediated immunity, the presence of which may be detected by positive skin test reactions and in vitro... 

Marmion BP, Ormsbee RA, Kyrkou M, et al. Vaccine prophylaxis of abattoir-associated Q fever Eight years experience in Australian abattoirs. Epidemiol Infect. 1990 104 275-287. 

Lackman DB, Bell EJ, Bell JF, Pickens EG. Intradermal sensitivity testing in man with a purified vaccine for Q fever. Am J Publ Health. 1962 52 87-93. 

Fries LF, Waag DM, Williams JC. Safety and immunogenicity in human volunteers of a chloroform-methanol residue vaccine for Q fever. Infect Immun. 1993 61 1251-1258. 

A vaccine for Q fever has been developed and has successfully protected humans in occupational settings in Australia. How-ever, this vaccine is not commercially available in the United States. Persons wishing to be vaccinated should first have a skin test to determine a history of previous exposure. Individuals who have previously been exposed to C. burnetii should not receive the vaccine because severe reactions, localized to the area of the injected vaccine, may occur. A vaccine for use in animals has also been developed, but it is not available in the United States. 

Viral Hemorrhagic Fevers AHF Candid 1 vaccine (x-protection torBHF)(IND) Ribavirin (CCHF/ arenaviruses) 30 mg/kg IV initial dose 15 mg/kg IVq 6 h times4d 7.5 mg/kg IV q 8 h times 6 d NA Aggressive supportive care and management ot hypotension very important. 

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