First report of an outbreak of "Q" fever IN an abattoir from Argentina.

In late October 2021, one of the veterinarians and the occupational physician of a bovine and swine abattoir from Entre Ríos Province, Argentina were alerted about workers with atypical pneumonia symptoms, raising suspicious of a possible Q fever outbreak. An outbreak epidemiological investigation was carried out. Analysis was based on the description of the study population, according to gender, age, symptoms, and position within the abattoir, as well as on outbreak epidemic curve and its probable origin. Cases of Q fever in the workers were confirmed by serology. Measurements of the association between the evaluated variables and the risk of exposure were investigated and calculated as attack rates. The outbreak occurred between October and November 2021, symptomatically affecting 11 workers, out of a total exposed population of 49 individuals. The index case was a 33-year-old male who started with symptoms on 27 October 2021, and the outbreak extended for at least 17 days. Workers in the clean zone of the slaughter floor had a 4.68 times higher risk of contracting Q fever than people located in other areas. Importantly, two pregnant cows were slaughtered a few days before the outbreak began, which could have been the origin of the outbreak. The present study demonstrates the urgent need to consider Q fever when diagnosing abortive diseases of ruminants in Argentina, as well as in zoonotic disease epidemiological surveillance to inform all actors of the health system.

Prevalence of Work-Related Musculoskeletal Symptoms in Veterinary Surgeons-A Cross-Sectional Survey.

OBJECTIVES: The aim of this study was to determine the prevalence of work-related musculoskeletal symptoms (MSS) in veterinary surgeons using an online survey. STUDY DESIGN: An online survey was distributed to 1,031 diplomates of American College of Veterinary Surgeons. Responses were collected with data regarding surgical activities, experience with various types of MSS in 10 different body sites and attempts to reduce MSS. RESULTS: Two hundred and twelve respondents (21% response rate) completed the distributed survey in 2021. Ninety-three per cent of respondents had experienced MSS associated with surgery in at least one body part, with the neck, lower back and upper back frequently affected. Musculoskeletal discomfort and pain worsened with prolonged surgical hours. Forty-two per cent of them suffered from chronic pain persisting longer than 24 hours after surgeries. Musculoskeletal discomfort was common regardless of practice emphasis and procedure types. Forty-nine per cent of respondents with musculoskeletal pain had taken medication, 34% sought physical therapy for MSS and 38% ignored the symptoms. Over 85% of respondents showed more than some concern regarding career longevity due to musculoskeletal pain. CLINICAL SIGNIFICANCE: Work-related MSS are common in veterinary surgeons, and the results of this study warrant longitudinal clinical studies to determine risk factors and attention to workplace ergonomics in veterinary surgery.

Ergonomic assessment of veterinarians during performance of bovine reproductive examinations.

OBJECTIVE: To identify and quantify potential ergonomic hazards associated with routine reproductive examinations of cattle. SAMPLE: 7 bovine veterinarians. PROCEDURES: Each veterinarian was observed and videotaped during 2 bovine reproductive examination appointments. During each appointment, a force-matching protocol was used to estimate the entry force used by the veterinarian to insert an arm into a cow's rectum. Veterinarian posture and repetitive movements and the work environment were assessed and quantified during review of the video recordings. Descriptive data were generated. RESULTS: Of the 14 appointments observed, 9 and 5 involved examination of beef and dairy cows, respectively. For all veterinarians, an arm inclination ≥ 60° was observed during most reproductive examinations. The number of examinations performed per hour ranged from 19.1 to 116.8. The estimated entry force ranged from 121 to 349 N. During all 9 appointments involving beef cows, the veterinarian participated in other tasks (eg, operating overhead levers, opening gates, or assisting with cattle handling) that represented ergonomic hazards. CONCLUSIONS AND CLINICAL RELEVANCE: Results confirmed that reproductive examination of cattle exposes veterinarians to various ergonomic hazards involving awkward positions and repetitive and forceful exertions that can contribute to musculoskeletal discomfort and injury, particularly of the upper extremities (neck, shoulders, upper back, arms, elbows, wrists, and hands). Veterinarians frequently participated in other tasks during reproductive examination appointments that exposed them to additional ergonomic hazards. Risk mitigation strategies should prioritize minimizing exposure of veterinarians to tasks not directly associated with the reproductive examination procedure to decrease their overall ergonomic hazard burden.

[Reducing the impact of COVID-19 on radiation oncology units of developing countries: A rapid review and expert consensus]. / Reduciendo el impacto de COVID-19 sobre la radioterapia oncológica en países en desarrollo: revisión rápida y consenso de expertos.

OBJECTIVE: To generate recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources. METHODS: We did a rapid review of the literature, searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified Delphi method, the consensus was reached among 14 certificated radio-oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed. RESULTS: A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection. Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible. CONCLUSIONS: We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.

OBJETIVO: Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados. MÉTODOS: A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento. RESULTADOS: Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible. CONCLUSIÓN: Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19.

Risk factors associated with work-preventing musculoskeletal discomfort in the upper extremities of bovine practitioners.

OBJECTIVE: To identify risk factors associated with work-preventing musculoskeletal discomfort (MSKD) in the upper extremities (defined as neck, shoulders, upper back, arms, elbows, wrists, and hands) of bovine practitioners. SAMPLE: 116 members of the Western Canadian Association of Bovine Practitioners. PROCEDURES: Data from a previously described cross-sectional survey of western Canadian bovine practitioners underwent further analysis. The survey, developed to glean information about MSKD in bovine practitioners, was a modified standardized Nordic questionnaire that included questions regarding personal and work characteristics and incidence and location of MSKD during the preceding 12 months along with perceptions about most physically demanding tasks. Logistic regression was used to identify factors associated with work-preventing upper extremity MSKD. RESULTS: 18 of 116 (15.5%) respondents indicated they had experienced work-preventing upper extremity MSKD during the preceding 12 months. The final multivariable regression model indicated that practice type (mixed animal vs primarily [> 50%] bovine; OR, 3.20; 95% CI, 0.96 to 10.67), practitioner height (OR, 0.93; 95% CI, 0.87 to 0.99), and number of veterinarians in the practice (OR, 1.32; 95% CI, 1.05 to 1.66) were significantly associated with the odds of work-preventing upper extremity MSKD. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that reproductive examination of cattle was not a significant risk factor for upper extremity MSKD in bovine practitioners. Further research into the effects of biomechanical, organizational, and psychosocial workplace factors on the development of MSKD in bovine practitioners is necessary to help inform prevention strategies to foster career longevity in this increasingly diverse practitioner group.

Reduciendo el impacto de COVID-19 sobre la radioterapia oncológica en países en desarrollo: revisión rápida y consenso de expertos / Reducing the impact of COVID-19 on radiation oncology units of developing countries: a rapid review and expert consensus

OBJETIVO: Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados. MÉTODOS: A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento. RESULTADOS: Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible. CONCLUSIÓN: Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19.

OBJECTIVE: To generate recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources. METHODS: We did a rapid review of the literature, searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified Delphi method, the consensus was reached among 14 certificated radio-oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed. RESULTS: A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection. Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible. CONCLUSIONS: We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.

Participatory probabilistic assessment of the risk to human health associated with cryptosporidiosis from urban dairying in Dagoretti, Nairobi, Kenya.

We carried out a participatory risk assessment to estimate the risk (negative consequences and their likelihood) from zoonotic Cryptosporidium originating in dairy farms in urban Dagoretti, Nairobi to dairy farm households and their neighbours. We selected 20 households at high risk for Cryptosporidium from a larger sample of 300 dairy households in Dagoretti based on risk factors present. We then conducted a participatory mapping of the flow of the hazard from its origin (cattle) to human potential victims. This showed three main exposure pathways (food and water borne, occupational and recreational). This was used to develop a fault tree model which we parameterised using information from the study and literature. A stochastic simulation was used to estimate the probability of exposure to zoonotic cryptosporidiosis originating from urban dairying. Around 6 % of environmental samples were positive for Cryptosporidium. Probability of exposure to Cryptosporidium from dairy cattle ranged from 0.0055 for people with clinical acquired immunodeficiency syndrome in non-dairy households to 0.0102 for children under 5 years from dairy households. Most of the estimated health burden was born by children. Although dairy cattle are the source of Cryptosporidium, the model suggests consumption of vegetables is a greater source of risk than consumption of milk. In conclusion, by combining participatory methods with quantitative microbial risk assessment, we were able to rapidly, and with appropriate 'imprecision', investigate health risk to communities from Cryptosporidium and identify the most vulnerable groups and the most risky practices.

Prevalence of types of methicillin-resistant Staphylococcus aureus in turkey flocks and personnel attending the animals.

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) have been isolated from a number of livestock species and persons involved in animal production. We investigated the prevalence of LA-MRSA in fattening turkeys and people living on farms that house fattening turkeys. Eighteen (90%) of 20 investigated flocks were positive for MRSA, and on 12 of the farms 22 (37·3%) of 59 persons sampled were positive for MRSA. People with frequent access to the stables were more likely to be positive for MRSA. In most flocks MRSA that could be assigned to clonal complex (CC) 398 were detected. In five flocks MRSA of spa-type t002 that is not related to CC398 were identified. Moreover, other methicillin-resistant Staphylococcus spp. were detected on 11 farms and in eight people working on the farms.

Lung cancer risk in workers in the meat and poultry industries--a review.

Laboratory and in vivo studies in primates, and serological evidence in humans, indicate that food animal oncogenic viruses show potential for causing cancer in humans. However, until fairly recently, supporting analytic epidemiologic studies have been lacking and have concentrated on lung cancer. We conducted an extensive Medline search and reviewed 60 studies investigating lung cancer risk in highly exposed workers in the meat and poultry industries. The overwhelming majority of studies of different designs (including all the cohort mortality and cancer incidence studies) indicate at least a 30% excess risk of lung cancer in meat and poultry plant workers, even after controlling for smoking. Evidence points to food animal oncogenic microorganisms as one of the main causes. This has important public health implications because the general population is also widely exposed. Studies carried out thus far have not had sufficient statistical power to investigate other potentially carcinogenic exposures within the industries. Thus, large studies that can adequately control for occupational and non-occupational confounding factors are needed, so that the possible role of food animal oncogenic viruses in the occurrence of human lung cancer can be clearly defined.

Biological agents as occupational hazards - selected issues.

There are two main groups of biological agents regarded as occupational hazards: allergenic and/or toxic agents forming bioaerosols, and agents causing zoonoses and other infectious diseases. Bioaerosols occurring in the agricultural work environments comprise: bacteria, fungi, high molecular polymers produced by bacteria (endotoxin) or by fungi (ß-glucans), low molecular secondary metabolites of fungi (mycotoxins, volatile organic compounds) and various particles of plant and animal origin. All these agents could be a cause of allergic and/or immunotoxic occupational diseases of respiratory organ (airways inflammation, rhinitis, toxic pneumonitis, hypersensitivity pneumonitis and asthma), conjunctivitis and dermatitis in exposed workers. Very important among zoonotic agents causing occupational diseases are those causing tick-borne diseases: Lyme borreliosis, anaplasmosis, babesiosis, bartonellosis. Agricultural workers in tropical zones are exposed to mosquito bites causing malaria, the most prevalent vector-borne disease in the world. The group of agents causing other, basically not vector-borne zoonoses, comprises those evoking emerging or re-emerging diseases of global concern, such as: hantaviral diseases, avian and swine influenza, Q fever, leptospiroses, staphylococcal diseases caused by the methicillin-resistant Staphylococcus aureus (MRSA) strains, and diseases caused by parasitic protozoa. Among other infectious, non-zoonotic agents, the greatest hazard for health care workers pose the blood-borne human hepatitis and immunodeficiency viruses (HBV, HCV, HIV). Of interest are also bacteria causing legionellosis in people occupationally exposed to droplet aerosols, mainly from warm water.

Low rate of methicillin-resistant coagulase-positive staphylococcal colonization of veterinary personnel in Hong Kong.

Elevated rates of methicillin-resistant Staphylococcus aureus (MRSA) carriage have been reported in veterinary personnel, suggesting an occupational colonization risk. Hong Kong veterinary personnel (n = 150) were sampled for coagulase-positive staphylococci (CPS) nasal colonization. Risk factors for colonization were assessed by questionnaire. Isolates were identified and antibiotic susceptibility determined. All CPS isolates were investigated for mecA carriage, SCCmec type and PVL genes. Two subjects were colonized with methicillin-resistant CPS: one with MRSA (spa type t002 (CC5), SCCmec type II) and one with methicillin-resistant Staphylococcus pseudintermedius (MRSP) (MLST type ST71, SCCmec type II-III). MLST type ST71 S. pseudintermedius strain is the predominant MRSP clone circulating in dogs in Europe and in Hong Kong. The low MR-CPS colonization rate may be associated with low levels of large animal exposure or low rates of MRSA colonization of companion animals in Hong Kong. Colonization with non-aureus CPS, which may cause human infection, must also be considered in veterinary personnel.

Medical surveillance of search dogs deployed to the World Trade Center and Pentagon: 2001-2006.

In response to the terrorist attacks of September 11, 2001, at the World Trade Center and Pentagon, almost 50,000 rescue workers and approximately 300 search and rescue dogs participated in rescue and recovery operations. The dogs were exposed to the same hazards as the human workers, but did not have any of the personal protective gear. This prospective double cohort observational study compared annual medical history, blood biochemical and hematologic results, and thoracic radiographic findings in 95 search and rescue dogs that responded to the terrorist attacks at the World Trade Center or the Pentagon on September 11, 2001, to a control group of 55 search and rescue dogs that were not involved in the 9/11 response. Compared to controls, the deployed search dogs demonstrated mild changes in blood work and a higher incidence of radiographic cardiac abnormalities. Species differences may explain the lack of pulmonary findings in the dogs. These dogs may provide early evidence of nonpulmonary complications of the 9/11 response. Continued surveillance of all responders is warranted.

Bartonellosis: an emerging infectious disease of zoonotic importance to animals and human beings.

OBJECTIVE: To provide a review of clinically relevant observations related to Bartonella species as emerging pathogens in veterinary and human medicine. DATA SOURCES: Literature as cited in PubMed and as generated by each of the authors who have contributed to various aspects of the clinical understanding of bartonellosis. HUMAN DATA SYNTHESIS: Important historical and recent publications illustrating the evolving role of animal reservoirs as a source of human infection. VETERINARY DATA SYNTHESIS: Comprehensive review of the veterinary literature. CONCLUSIONS: In addition to inducing life-threatening illnesses, such as endocarditis, myocarditis, and meningoencephalitis and contributing to chronic debilitating disease, such as arthritis, osteomyelitis, and granulomatous inflammation in cats, dogs, and potentially other animal species; pets and wildlife species can serve as persistently infected reservoir hosts for the transmission of Bartonella spp. infection to veterinary professionals and others with direct animal contact.

Pathology and toxicology findings for search-and-rescue dogs deployed to the September 11, 2001, terrorist attack sites: initial five-year surveillance.

A long-term surveillance study was conducted on 95 search-and-rescue (S&R) dogs deployed to the September 11, 2001, terrorist attack sites; an additional 55 nondeployed S&R dogs served as controls. After 5 years of surveillance, 32% of the deployed dogs have died and 24% of the nondeployed dogs. The mean age at the time of death in these 2 groups of dogs is not significantly different. Causes of death in both groups of dogs include inflammatory, degenerative, and proliferative conditions. No primary pulmonary tumors have been identified to date nor has any significant level of toxicant been found in the tissues from these dogs using assays for general organic compounds and metals or, specifically, for polychlorinated biphenyls. However, significant numbers of both deployed and nondeployed dogs have evidence of inhaled matter as demonstrated by the presence of anthracotic pigments or refractile particulate matter in pulmonary tissue. Although S&R activities in response to the 9/11 terrorist attacks exposed dogs to a wide variety of potentially toxic compounds, to date, these dogs do not appear to suffer from higher mortality or increased pulmonary disease compared with nondeployed dogs. To the authors' knowledge, the current survey represents the first long-term and large-scale survey of the pathology and toxicology of S&R dogs deployed to a major disaster site.

Medical and behavioral surveillance of dogs deployed to the World Trade Center and the Pentagon from October 2001 to June 2002.

OBJECTIVE: To evaluate early medical and behavioral effects of deployment to the World Trade Center, Fresh Kills Landfill, or the Pentagon on responding search-and-rescue (SAR) dogs. DESIGN: Prospective double cohort study. ANIMALS: The first cohort included SAR dogs responding to the September 11, 2001, terrorist attacks (deployed), and the second cohort included SAR dogs trained in a similar manner but not deployed (controls). Enrollment occurred from October 2001 to June 2002. PROCEDURE: Dogs were examined by their local veterinarians; thoracic radiographs and blood samples were shipped to the University of Pennsylvania for analysis. Handlers completed medical and training histories and a canine behavioral survey. RESULTS: Deployed dogs were older and had more search experience than control dogs. Serum concentrations of globulin and bilirubin and activity of alkaline phosphatase were significantly higher in deployed dogs, independent of age and training. Despite significant differences in several blood parameters, values for both groups were within reference ranges. No pulmonary abnormalities were detected on radiographs, and no significant differences in behavior or medical history were detected between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Within the first year following the September 11 attacks, there was no evidence that responding dogs developed adverse effects related to their work. Mild but significantly higher serum concentrations of globulin and bilirubin and activity of alkaline phosphatase in deployed dogs suggested higher antigen or toxin exposure. These dogs will be monitored for delayed effects for at least 3 years.

[Occupational bio hazards: current issues]. / Biologiczne czynniki zagrozenia zawodowego--aktualne problemy.

Over the last decade, there was noted a large advancement of knowledge on living organisms and their products posing a potential occupational risk. Novel risk factors, often new to science, were identified, the role and significance of already known factors better comprehended, and occupational groups endangered by biological hazards more thoroughly recognized. Novel viruses and prions, emerging in different parts of the world, may pose a particular threat to health and life of health care workers, agriculture workers and veterinarians. A new coronavirus (SCoV) that evoked a rapid outbreak of disease described as severe acute respiratory syndrome (SARS) in the first half of 2003 may serve as an example. The disease was particularly common among health care workers. Previously discovered zoonotic viruses, Nipah virus in pigs and Hendra virus in horses, may be a cause of fatal encephalitis in animal farmers. Hantaviruses (Puumala, Hantaan, Sin Nombre and others) infecting field rodents may be a cause of hemorrhagic fever with renal syndrome (HFRS) or pulmonary syndrome (HPS) in farmers and laboratory workers. Prions responsible for inducing a zoonotic variant of Creutzfeldt-Jakob disease (vCJD) are considered to be a potential cause of work-related infections in agricultural and health care workers, however, this assumption has not as yet been supported by any conclusive evidence. In many countries, blood-borne occupational infections with hepatitis C virus (HCV) is the major epidemiological problem among health care workers, mostly because no vaccine against this virus has been produced to date. Vaccinations effectively restricted the number of occupational infections with hepatitis B virus (HBV), and work-related infections with human immunodeficiency virus (HIV) causing acquired immunodeficiency syndrome (AIDS) are very rare. Hazardous bioserosols, occurring in many work environments, pose an occupational health hazard of particular importance. Many new biological factors present in organic dusts that may induce work-related allergic and immunotoxic diseases among farmers and workers of the agricultural and wood industries have been identified. Droplet aerosols, which are generated from water, oils, oil-water emulsions and other liquids in various work environments, may contain infectious agents (Legionella spp.) as well as allergic and/or toxic agents. It has been shown that allergens and endotoxins produced by Gram-negative bacteria occurring in oil mist from metalworking fluids may cause occupational respiratory diseases in workers of the metallurgic industry.

Risk of transmission of leptospirosis from infected cattle to dairy workers in southern Israel.

BACKGROUND: Leptospirosis is a zoonotic disease that occurs worldwide, found predominantly in agricultural workers, port workers and dairy workers. OBJECTIVE: To investigate the risk of disease transmission to dairy workers following an outbreak in 1999 of Leptospirosis hardjo in the dairy herds of two kibbutzim in southern Israel. METHODS: A seroepidemiologic survey of all the dairy workers from these two kibbutzim was conducted, including individual interview and examination. Data were collected on the presence of clinical symptoms of leptospirosis during the previous month. One month later the medical personnel on the two kibbutzim were contacted in order to determine if any worker had subsequently developed clinical signs or symptoms of leptospirosis. All dairy workers had blood drawn for serology. Those workers whose initial serology had been borderline for leptospirosis had a repeated serology test between 2 and 4 weeks later. Doxycycline was given prophylactically to all dairy workers on one kibbutz only. RESULTS: Either with or without chemoprophylaxis, no dairy workers exposed to herds infected with Leptospira hardjo showed evidence of seroconversion or disease. This indicated a low risk of transmission of this serovar from cows to dairy workers. CONCLUSION: Since human illness with leptospirae can cause illness associated with significant morbidity, we recommend that physicians make an informed decision regarding doxycycline prophylaxsis for dairy workers exposed to cattle herds infected with Leptospira hardjo.

Antibiotic resistance of Escherichia coli isolated from poultry workers, patients and chicken in the eastern province of Saudi Arabia.

The prevalence of antibiotic-resistant Escherichia coli isolates from faecal samples from 117 poultry industry workers, 100 patients and119 healthy chicken were compared. Resistance of E. coli chicken isolates to ampicillin, chloramphenicol, gentamicin, spectinomycin, tetracycline and trimethoprim + sulphamethoxazole (TMP + SMX) (range 57% - 99.1%) were significantly higher than those isolated from patients (range 21.9% - 71.4%) and workers (range 35% - 71.8%). However, for drugs not used in poultry, such as amoxicillin + cluvalanate (AMX + CLV), ceftazidime and nitrofurantoin, resistance rates of chicken isolates (range 0% - 2.6%) were significantly lower than those of patient isolates (range 8.7% - 30%). Resistance to spectinomycin reached 96% in E. coli chicken isolates and 71% in organisms isolated from humans. Use of this drug in Saudi Arabia is mostly limited to veterinary purposes. Multidrug resistance is alarmingly high in all groups but was highest in chicken isolates (77.4%). Serotyping of E. coli isolates showed that 27% of the organisms isolated from patients were overlapping with 10.9% of the chicken isolates, indicating the possibility of chicken being a source of the resistance pool for humans. We therefore call for the banning of antibiotics in the poultry industry as growth promoters and recommend that their use be restricted to treating infections.

An explosive outbreak of Q-fever in Jedl'ové Kostol'any, Slovakia.

An explosive epidemic of Q-fever that occurred at Jedl'ové Kostol'any (Nitra District) in April 1993, had an unusual mode of transmission, unprecedented in Slovakia. The submitted case-reports can be very instructive for both health workers and the lay public. The bulk of infection was spread in the local pub through contaminated garments of animal attendants assisting abortions and births of goats in a large capacity breeding centre of Gemersan Co. By their repeated visits to the local pub the infection most probably spread to other guests by aerosol. A total of 113 persons (103 males, 10 females) contracted Q-fever. Out of them 95 were infected by contact with the goat attendants (84%), and 18 were occupational diseases after direct contact with the infected goats. The human epidemic of Q-fever facilitated to trace an ongoing epizootic of coxiellosis in the herd of goats of Gemersan breed. In order to stop further spread of infection among humans and to contain the outbreak of coxiellosis among animals extensive epidemic and epizootic measures were taken.