Journal Article

A Large Q Fever Outbreak in an Urban School in Central Israel

Ziva Amitai, Michal Bromberg, Michael Bernstein, David Raveh, Avi Keysary, Dan David, Silvio Pitlik, David Swerdlow, Robert Massung, Sabine Rzotkiewicz, Ora Halutz and Tamy Shohat

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 11, pages 1433-1438
Published in print June 2010 | ISSN: 1058-4838
Published online June 2010 | e-ISSN: 1537-6591 | DOI:
A Large Q Fever Outbreak in an Urban School in Central Israel

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Background. On 28 June 2005, numerous cases of febrile illness were reported among 322 students and employees of a boarding high school located in an urban area in central Israel. Subsequent investigation identified a large outbreak of Q fever which started 2 weeks earlier. We describe the investigation of this outbreak and its possible implications.

Methods. We conducted a case-control study to identify risk factors for Q fever disease. Environmental sampling was conducted to identify the source and the mode of transmission of Coxiella burnetii the infectious agent.

Results. Of 303 individuals, 187 (62%) reported being ill between 15 June and 13 July 2005. Serological evidence for C. burnetii infection was evident in 144 (88%) of the 164 tested individuals. Being a student, dining regularly at the school dining room, and boarding at school during a June religious holiday and the preceding weekend were all significant risk factors for contracting Q fever. C. burnetii DNA was detected using polymerase chain reaction on samples from the school dining room's air conditioning system, supporting contribution of the air conditioning system to the aerosol transmission of the infectious agent.

Conclusions. We report a large outbreak of Q fever in an urban school, possibly transmitted through an air conditioning system. A high level of suspicion for C. burnetii infection should be maintained when investigating point source outbreaks of influenza-like disease, especially outside the influenza season.

Journal Article.  3699 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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