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Email received December 10 2009 from Dr Ruth Watkins, BSc Hons, MSc, MBBS, MRCP, MRCPath

Dear Mary

I feel really angry about the killing of 20 000 pregnant goats and sheep at dairy farms in the Netherlands- it resembles FMD in that a vaccine Coxevac made by Ceva in France, inactivated phase 1 Coxiella burnetii organisms, has been available and is effective if given before pregnancy in preventing Q fever infection, and if not completely blocking infection then preventing shedding particularly in products of conception. Whilst France may allow its use the Netherlands and the UK have not so when the outbreak first occurred in the Netherlands the vaccine was not allowed- there has been delay in allowing its use in the Netherlands and it is still prohibited in the UK.

In watching one of the recent climate change TV programmes and the efforts being made in Chicago to go green, the new mayor says "To be ready one needs to be early". This sums it up I think. The EU is always unready, partly because it has obstructive rules in place against vaccines, in which economic interests play a major part, and then late, it takes drastic action to kill thousands of animals as though we still lived in medieval times. So not-green!

I doubt the coxevac vaccine would be prohibitively expensive, I believe only one dose may be required as it would be locally over-reactive in the skin to give a second dose, the immunity must be T helper cell type to kill intracellular organisms (similar to TB). I haven't read the Ceva data sheet in French! If Coxevac were to be licensed in the UK individual owners could give the vaccine to their ruminant livestock, obviously visitor petting farms and indoor dairy goat and sheep farms should be encouraged, if not regularly screened for infection (bulk milk Q fever PCR or screening the humans living on the farm by serology), and possibly cats and dogs used for breeding might be vaccinated. As I have mentioned before vaccination is advised and given to laboratory workers who grow up the organism and for animal laboratories where ruminants are kept inside ie for immunglobulin production etc.

Certainly the Q fever outbreak must be contained and controlled, and I would fear to go to the Netherlands to Brabant in case I should become one of the thousands of infected people.

It would seem the test for antibodies in animals is not reliable if based on the reference Nine Mile Q fever organism rather than a ruminant derived strain, and as shedding may be intermittent, it is problematic and expensive to screen individual animals by PCR on an infected farm. Any negative animal if unvaccinated could already be infected and I presume the female adult goats are all now pregnant, so vaccination now would be too late to prevent infection of this pregnancy. Therefore 2010 would be no different to 2009. Why didn't vaccination start in 2007 when the outbreak was first documented? Also the vaccination programme promptly carried out before the does were put to the billies in autumn of 2007? And if not then why not in 2008 before the autumn? All goats and sheep outside while the barn is water cleaned and all dust wetted and removed and collected for disposal in long held manure heaps perhaps (actually the environmentally hardy form of Q fever is rather resistant to any disinfectant). This is where delays in product licensing and economic arguments of huge bureacracies seem to be fatally flawed in Northern Europe. I am not sure what you think about this.

There is worrying news that humans can harbour the West Nile Virus for several years after infection and may develop renal failure as a consequence of kidney damage by the virus, they are PCR positive in the urine (report on promed from the USA). The good news is that whilst there is I believe an animal vaccine (I am not sure if it is released yet for general use ie in horses) there should also be a vaccine for humans in the pipeline too.

At last the sun, the rain has stopped after 6 weeks and I must go out to clean the hen house poor dears.

Ruth