Question

On saturday May 19th, Buckeye County Health Department Staff are continuing to perform phone interviews with affected individuals. The hospital reports 3 new cases today: 2 students and 1 staff member from Northside Elementary School. The superintendent of Buckeye County School District contacts Buckeye County Health Department to discuss whether or not the school should be closed until a cause can be determined. On sunday May 20th, Preliminary analysis of the data from the initial phone interviews reveals that all cases, including those at the hospital, are limited to the individuals at the school, nursing home and surrounding neighborhood. The hospital reports 1 new case and the nursing home reports 2 new cases today. No cause has yet been identified. The PIO prepares a press release describing what is happening and what steps are being taken to investigate and control the outbreak. On monday May 21st at 9:00 AM , Buckeye School District elects to close Northside Elementary School pending further investigation. The hospital and nursing home report all cases are negative for the most common causes of atypical pneumonia (see note above). Buckeye County Health Department (BCHD) conducts a conference call with the State Health Department (SHD) and Ms. Dolor, the IP from Smallsville Hospital to determine what additional samples should be submitted for further testing and where they should be sent. After reviewing the histories and the consensus of the expert opinions, they decide to perform additional tests for Francisella tularensis, Hantavirus and Coxiella burnetti. Ms. Dolor agrees to collect the samples that the experts recommend and ship them overnight to the corresponding lab. On wednesday May 23rd at 11:00 AM, The hospital reports two new cases today; no new cases have been identified at the nursing home or elementary school. You also received a call from the SHD reporting the results of the additional tests for the first 6 patients: All six were positive for Q-Fever (Coxiella burnetii) on PCR. Q-Fever is a nationally notifiable disease in the US, so the BCHD and the SHD contact the Centers for Disease Control and Prevention (CDC) to report these cases and to request assistance in continuing the epidemiologic investigation. The PIO prepares another press release. Because Q-Fever is a Zoonotic disease associated with agriculture as well as a designated Class B Bioterrorism agent, the Buckeye County Health Department and the SHD deliberate about who else should be involved in the investigation and response. On wednesday, May 23 at 11:30 am BCHD, SHD, State Animal Health Office (SAHO), Local Law Enforcement, Federal Bureau of Investigation (FBI), CDC and United States Department of Agriculture (USDA) conduct a conference call. The decision is made to have each agency investigate the possible source of the outbreak most relevant to their area of expertise.  BCHD, with support from SHD and CDC, will focus on the patients and explore possible foodborne and occupational sources of exposure.  The Local Law Enforcement and the FBI will investigate possible bioterrorism or a criminal act as the source of exposure.  SAHO, in conjunction with USDA‐APHIS‐VS, will investigate any link to agriculture and test the hypothesis that this outbreak is the result of airborne contamination from nearby farms.

Question: NOW THAT Q-FEVER HAS BEEN IDENTIFIED AS THE LIKELY CAUSE OF THE OUTBREAK, WHAT FURTHER STEPS SHOULD EACH AGENCY INVOLVED WITH THE OUTBREAK INVESTIGATION TAKE?

1.) Steps to be taken by Public Health Agencies (BCHD, SHD, CDC):

2.) Steps to be taken by Law Enforcement Agencies (Local Law Enforcement, FBI):

3.) Steps to be taken by Agricultural Agencies (SAHO, USDA‐APHIS‐VS):

Answer 1

1. Steps to be taken by public health agencies are :-

- Educate the people on various topics like :-

- sources of infection

- proper disposal of birth products like fetus ,placenta etc of infected animals

- restrict access to barns and laboratories where infected ani.als are present

- Hand hygiene

- properly cooked meals including non veg and avoiding cooking non-veg during this outbreak .

- vaccination for those who come in contact with infected animal like sheep ,goats etc to prevent Q fever.

2. Steps to be taken by law enforcement are :-

-vaccnation as legal right of individuals

-treatment for Q - fever to everyone without discrimination.

- strict law against slaghterhouse ,if they cut and sell infected animals

- no slaghterhouse without licence

- policies and plan developed for the prope functionin of animal farms

3. Steps to be taken by agricultural agenies are :-

- proper immunization of animals against various disease.

- proper hygiene mantainace of farm houses

- proper licence and training to individuals to take care of animals.

-providing quality animals for takecaring and domestic purpose.