Q fever is a disease caused by the bacteria Coxiella burnetii. This bacteria naturally infects some animals, such as goats, sheep, and cattle. C. burnetii bacteria are found in the birth products (i.e. placenta, amniotic fluid), urine, feces, and milk of infected animals. People can get infected by breathing in dust that has been contaminated by infected animal feces, urine, milk, and birth products. Some people never get sick; however, those who do usually develop flu-like symptoms including fever, chills, fatigue, and muscle pain.

People get infected by breathing in dust that has been contaminated by infected animal feces, urine, milk, and birth products that contain Coxiella burnetii. Direct contact (e.g. touching, being licked) with an animal is not required to become sick with Q fever. People may also get sick with Q fever by eating contaminated, unpasteurized dairy products. Rarely, Q fever has been spread through blood transfusion, from a pregnant woman to her fetus, or through sex.

People at risk for Q fever infection

Certain professions are at increased risk for exposure to C. burnetii, including veterinarians, meat processing plant workers, dairy workers, livestock farmers, and researchers at facilities housing sheep and goats. People working in these areas may need to take extra precautions.

Bioterrorism

• A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops.
• C. burnetii, the bacteria that causes Q fever, has been described as a potential bioterrorism agent.
• C. burnetii is a select agent subject to the select agent regulations found in 42 CFR Part 73.
• C. burnetii is a highly infectious agent, in some cases requiring less than 10 bacteria to make you sick.
• C. burnetii is extremely resistant to heat, drying, and many common disinfectants.
• People get infected by breathing in contaminated dust.
• C. burnetii has been previously weaponized for use in biological warfare and is considered a potential terrorist threat.
• We do not know if or when a bioterrorism attack might occur. However, federal agencies have worked for years with health departments across the country to plan and prepare for any such attack.

About 5 out of 10 people infected with Coxiella burnetii will get sick. Illness typically develops 2-3 weeks after being exposed to the bacteria. Signs and symptoms of Q fever may include:

• Fever
• Chills or sweats
• Fatigue (tiredness)
• Headache
• Muscle aches
• Nausea, vomiting, or diarrhea
• Chest pain
• Stomach pain
• Weight loss
• Non-productive cough

Symptoms can be mild or severe. People who develop severe disease may experience infection of the lungs (pneumonia) or liver (hepatitis).

Women who are infected during pregnancy may be at risk for miscarriage, stillbirth, pre-term delivery, or low infant birth weight.

Chronic Q fever

A very small percentage of people (less than 5 out of 100) who become infected with C. burnetiibacteria develop a more serious infection called chronic Q fever. Chronic Q fever develops months or years following initial Q fever infection. People with chronic Q fever often develop an infection of one or more heart valves (called endocarditis). People with endocarditis may experience night sweats, fatigue, shortness of breath, weight loss, or swelling of their limbs. A healthcare provider will need to perform a series of tests to diagnose endocarditis.

Chronic Q fever is serious and can be deadly if not treated correctly. Chronic Q fever infection requires months of antibiotic treatment. Chronic Q fever is more likely to occur in people with heart valve disease, blood vessel abnormalities, or in people with weakened immune systems. Women infected during pregnancy may also be at risk for developing chronic Q fever.

• The symptoms of Q fever are similar to many other diseases, often making diagnosis difficult. See your healthcare provider if you develop symptoms after spending time with or near animals—particularly sheep, goats, and cattle—or in areas where these animals may have been.
• Your healthcare provider may order blood tests to look for Q fever or for other diseases.
• Laboratory testing and reporting of results can take several weeks, so your healthcare provider may start antibiotic treatment before results are available.

• Most people who are sick with Q fever will recover without antibiotic treatment.
• However, for people who develop Q fever disease, treatment with 2 weeks of doxycycline antibiotic is recommended.

Chronic Q fever

• A life-threatening infection, requiring several months of antibiotic treatment.
• Treated with a combination of antibiotics including doxycycline and hydroxychloroquine for several months.

• Q fever vaccines are not available in the United States.
• Reduce your risk of getting Q fever by avoiding contact with animals, especially while animals are giving birth. Animals can be infected with Coxiella burnetii and appear healthy.
• Do not consume raw milk or raw milk products.
• If you have been diagnosed with Q fever and have a history of heart valve disease, blood vessel abnormalities, a weakened immune system, or are pregnant, talk to your healthcare provider about your risk for developing chronic Q fever.

What is Q fever?

• Q fever is a disease in people and animals caused by the germ (bacteria) Coxiella burnetii.
• In animals, the disease is also known as coxiellosis (pronounced cox·e·el·low·sis).

What are the symptoms of Q fever in animals?

• Infected animals usually appear healthy.
• Infected, pregnant animals may experience abortions late in pregnancy.

Who is at risk?

Anyone who has contact with animals infected with Q fever bacteria, especially people who work on farms or with animals. Examples of high-risk jobs include:

• Livestock farmers
• Slaughterhouse workers
• Veterinarians
• Animal or laboratory researchers

How is it spread?

Q fever is most commonly spread to people by infected farm animals, including goats, cattle, and sheep.

People can get Q fever by:

• Touching feces, urine, milk, or blood from an infected animal.
• Breathing in dust that contains Q fever bacteria.
• Touching a newborn animal or birthing products (placenta, birth fluids) from an infected animal.
• Drinking raw (unpasteurized) milk.

What are the signs and symptoms of Q fever in people?

About half of people infected with Q fever bacteria will get sick with a flu-like illness. People may feel sick 2–3 weeks after contact with the bacteria.

Signs and symptoms can include:

• High fever
• Feeling tired
• Chills or sweats
• Headache
• Muscle aches
• Cough
• Nausea, vomiting, or diarrhea
• Chest pain

What is chronic Q fever?

A very small number of people with Q fever (less than 1 out of 20) develop a more severe illness called chronic Q fever. Chronic Q fever can result in infection of heart valves (called endocarditis). Symptoms may not appear until months or years after exposure.

Chronic Q fever is more likely to occur in people:

• With heart valve or blood vessel disease,
• With weakened immune systems,
• Who were pregnant when they first had Q fever.

Take steps to reduce your exposure.

• There is no vaccine to prevent infection in the United States.
• Avoid contact with infected animals during birthing when possible. If you assist in animal deliveries or have contact with birth products, protect yourself by wearing:

  • Gloves

  • Eye protection (e.g., goggles)
  • Protective clothing (e.g., coveralls and boots)
  • Masks (an N95 or higher respirator is the most effective type of mask for protecting against Q fever bacteria)
  • Talk to your healthcare provider about whether it is safe for you to wear a mask or respirator.
  • Additional Occupational Safety and Health Administration requirements may apply. Talk to your employer.
• Shower and change your clothes and shoes after working with animals.
• Eat and drink only pasteurized milk and milk products (cheese, cream, butter).

What should I do if I am worried about Q fever?

• Contact your healthcare provider if you think you might have Q fever or if you are at risk for chronic Q fever. If you work or have worked with farm animals, make sure to tell your healthcare provider.
• Contact your veterinarian if you think your animals might have Q fever.