Implementing wildlife disease surveillance in the Netherlands, a One Health approach.

The surveillance of (emerging) wildlife diseases can provide important, objective evidence of the circulation of pathogens of interest for veterinary and/or public health. The involvement of multiple research institutions in wildlife disease surveillance can ensure the best use of existing knowledge and expertise, but can also complicate or add challenges to the integration of wildlife disease surveillance components into a national programme. Documenting the existing efforts in a country's surveillance of wildlife diseases, including the institutes in which it takes place, provides a basis for policy-makers and authorities to identify gaps and priorities in their current surveillance programmes. This paper describes the wildlife disease surveillance activities taking place in the Netherlands. The authors recommend that, in addition to funding these current activities, surveillance resources should be allocated with the flexibility to allow for additional targeted surveillance, to detect and adequately respond to newly introduced or emerging pathogens. Similar structured overviews of wildlife disease surveillance in other countries would be very useful to facilitate international collaboration.

La surveillance exercée sur les maladies (émergentes) de la faune sauvage permet de réunir des données déterminantes, objectives et probantes sur la présence d'agents pathogènes importants pour la santé animale et/ou publique. La participation de plusieurs instituts de recherche dans les activités de surveillance des maladies de la faune sauvage permet de tirer le meilleur parti des connaissances et de l'expertise disponibles mais, dans certains cas, elle peut aussi se traduire par une complexité ou des difficultés supplémentaires qui compromettent l'intégration des composantes axées sur les maladies de la faune sauvage dans les programmes nationaux de surveillance. La collecte d'informations sur les efforts déployés au niveau national pour surveiller les maladies des animaux sauvages ainsi que sur les institutions chargées de cette surveillance constitue une première étape essentielle pour que les responsables des politiques sanitaires et les autorités puissent identifier les lacunes et les priorités des programmes de surveillance en vigueur. Les auteurs décrivent les activités de surveillance des maladies de la faune sauvage conduites actuellement aux Pays-Bas. Ils recommandent que parallèlement au financement des activités en cours, les ressources destinées à la surveillance soient allouées de manière plus souple afin de couvrir de nouvelles activités ciblées, de détecter les agents pathogènes émergents ou d'introduction récente et de préparer une réponse adéquate. Ils préconisent de réaliser dans d'autres pays des études structurées similaires sur la surveillance des maladies de la faune sauvage afin de faciliter la collaboration internationale.

La vigilancia de enfermedades (emergentes) de la fauna silvestre puede proporcionar importantes elementos de prueba objetivos sobre la circulación de patógenos de interés para la salud pública y/o veterinaria. La participación de numerosos establecimientos de investigación en estas actividades de vigilancia puede garantizar que se haga un uso idóneo de los conocimientos teóricos y técnicos existentes, pero a veces también complica o dificulta la integración en un programa nacional de las tareas de vigilancia de las enfermedades de la fauna silvestre. El hecho de repertoriar las actividades en la materia que se llevan a cabo en un país, incluidos los establecimientos donde tienen lugar, sienta las bases para que las autoridades e instancias de planificación de políticas puedan determinar las carencias y prioridades de los programas de vigilancia que ya tengan en marcha. Tras describir las actividades de vigilancia sanitaria de la fauna silvestre que se llevan a cabo en los Países Bajos, los autores recomiendan que los recursos para fines de vigilancia se asignen de manera flexible para que, además de costear las actividades ya en curso, sirvan para financiar otras labores de vigilancia selectiva que permitan detectar patógenos emergentes o recién introducidos en el país y responder debidamente a ellos. Para facilitar la colaboración internacional sería muy útil contar con estudios estructurados similares, que ofrezcan una visión de conjunto de la vigilancia sanitaria de la fauna silvestre en otros países.

Q fever diagnosis and control in domestic ruminants.

Q fever is a zoonosis caused by the bacterium Coxiella burnetii, a highly infectious agent that can survive in the environment. Therefore, Q fever has a major public health impact when outbreaks occur. Small ruminants are identified as the source in the majority of outbreaks in humans. Accurate diagnosis and effective control strategies are necessary to limit the zoonotic and veterinary impact of Q fever. For this, knowledge of the pathogenesis of Q fever and excretion routes of C. burnetii from infected animals is crucial. Abortions as well as normal parturitions in infected small ruminants are the most important excretion routes of C. burnetii. Excretion of C. burnetii via faeces and vaginal mucus has also been suggested. However, contamination of these samples by bacteria present in the environment may influence the results. This hampers the accurate identification of infected animals by these samples; however, the detection of C. burnetii in milk samples seems not to be influenced by environmental contamination. Q fever in animals can be detected by direct (immunohistochemistry and PCR) and indirect (complement fixation test (CFT), enzyme- linked immunosorbent assay (ELISA) and indirect immunofluorescence assay (IFA) methods. A combination of both direct and indirect methods is recommended in current protocols to detect Q fever on herd level. For the control of Q fever in domestic animals, vaccination with a phase 1 C. burnetii whole cell inactivated vaccine is reported to be effective in preventing abortion and reducing bacterial shedding, especially after several years of administration. Vaccination might not be effective in already infected animals nor in pregnant animals. Furthermore, the complicated vaccine production process, requiring biosafety level 3 facilities, could hamper vaccine availability. Future challenges include the development of improved, easier to produce Q fever vaccines.

Tularaemia in a brown hare (Lepus europaeus) in 2013: first case in the Netherlands in 60 years.

Tularaemia has not been reported in Dutch wildlife since 1953. To enhance detection, as of July 2011, brown hares (Lepus europaeus) submitted for postmortem examination in the context of non-targeted wildlife disease surveillance, were routinely tested for tularaemia by polymerase chain reaction (PCR). Francisella tularensis subspecies holarctica infection was confirmed in a hare submitted in May 2013. The case occurred in Limburg, near the site of the 1953 case. Further surveillance should clarify the significance of this finding.

The Q fever epidemic in The Netherlands: history, onset, response and reflection.

The 2007-2009 human Q fever epidemic in The Netherlands attracted attention due to its magnitude and duration. The current epidemic and the historical background of Q fever in The Netherlands are reviewed according to national and international publications. Seroprevalence studies suggest that Q fever was endemic in The Netherlands several decades before the disease was diagnosed in dairy goats and dairy sheep. This was in 2005 and the increase in humans started in 2007. Q fever abortions were registered on 30 dairy goat and dairy sheep farms between 2005 and 2009. A total of 3523 human cases were notified between 2007 and 2009. Proximity to aborting small ruminants and high numbers of susceptible humans are probably the main causes of the human Q fever outbreak in The Netherlands. In general good monitoring and surveillance systems are necessary to assess the real magnitude of Q fever.

Cluster of botulism among Dutch tourists in Turkey, June 2008.

In June 2008, three Dutch tourists participating in a mini-cruise in Turkey needed urgent repatriation for antitoxin treatment because of symptoms of botulism. Because there was a shortage of antitoxin in the Netherlands, an emergency delivery was requested from the manufacturer in Germany. An outbreak investigation was initiated into all nine cruise members, eight of whom developed symptoms. C. botulinum type B was isolated in stool culture from four of them. No other patients were notified locally. Food histories revealed locally purchased unprocessed black olives, consumed on board of the ship, as most likely source, but no left-overs were available for investigation. C. botulinum type D was detected in locally purchased canned peas, and whilst type D is not known to be a cause of human intoxication, its presence in a canned food product indicates an inadequate preserving process. With increasing tourism to areas where food-borne botulism is reported regularly special requests for botulism antitoxin may become necessary. Preparing an inventory of available reserve stock in Europe would appear to be a necessary and valuable undertaking.

[Botulism in dairy cattle in 2008: symptoms, diagnosis, pathogenesis, therapy, and prevention]. / Botulisme bij melkkoeien anno 2008: symptomatologie, diagnostiek, pathogenese, therapie en preventie aan de hand van een catastrofaal verlopen casus.

Botulism affects about 20 dairy herds a year in the Netherlands. This article describes the dramatic outcome of botulism in a dairy herd. The main clinical symptoms in this herd were increased lying down, slight ataxia of the hind legs, and a high mortality (98%). The diagnosis is difficult to establish in adult cattle, and for this reason the clinical and laboratory findings, differential diagnosis, therapy, and preventive measures are discussed. On the basis of this outbreak, previous experience with botulism, and cases described in literature, it is suggested that presence of 'free-range" poultry could contaminate grazing pastures with botulism neurotoxins, causing clinical problems in cattle. If there is an increased risk of contamination of the pasture and/or silage with botulinum neurotoxins, vaccination should be considered to prevent substantial economic and emotional damage.

[Two horses with neurological symptoms: could this be equine botulism?]. / Twee paarden met neurologische verschijnselen: is botulisme in het spel?

Symptoms, diagnosis and therapy of equine botulism are discussed by the presentation of two detailed reports of horses with neurological symptoms and the results of laboratory investigations over the period 2003-2008 in the Netherlands. In addition a brief summary of the available literature is presented. Prevailing symptoms of botulism in horses include paralysis of the tongue, salvation, dysphagia and paresis and paralysis of the skeletal muscles, as well as signs of colic. Symptoms and prognosis vary with the amount of botulinum neurotoxin (BoNT) involved. For early clinical diagnosis of botulism thorough investigation of the facial nerves is important, for instance by the use of the 'Tongue Stress Test'. Laboratory results often remain negative, probably due to the sampling time, the high sensitivity of horses for botulinum neurotoxin or treatment with antitoxins. Most clinical cases in horses are caused by botulinum neurotoxin B (BoNT/B). For therapy to be successful antiserum needs to be administered in the earliest possible stage of the disease and this should be supported by symptomatic therapy. Botulism is a feed-related intoxication caused by either carcasses in the roughage or BoNT/B production after poor conservation of grass silage. This is the main source of botulism in horses due to the popularity of individually packed grass silage as feed for horses. As long as no vaccine is available in the Netherlands quality control of silage and haylage is strictly recommended in order to reduce the risk of botulism in horses.

Pooling of genital swabs for detection by PCR of Taylorella equigenitalis, the cause of contagious equine metritis.

BACKGROUND: Sets of genital swabs are routinely taken from horses to screen for the presence of Taylorella equigenitalis, the cause of contagious equine metritis. Typically, two to four different sites are swabbed at a time and tested by culture or PCR. OBJECTIVES: This study explored the feasibility of pooling these swabs for a single PCR test per animal instead of testing each swab individually. STUDY DESIGN: In vitro. METHODS: PCR signal strengths (Ct values) from 149 historical PCR positive genital swabs, together with historical data on the number of swabs in a set expected to be positive, were used to assess the suitability of pooling for screening horses for T. equigenitalis infection in the population at large. Twenty-four sets of four equine genital swabs were tested. The sets were prepared in the laboratory using one or more swabs positive for T. equigenitalis from naturally infected cases. Positive and negative swabs were selected to reflect a typical range of PCR Ct values expected in field cases of T. equigenitalis infection. These pools were tested by an established PCR to assess the impact and suitability of a PCR test on pooled swabs compared to individual swab testing, by comparing the Ct values. RESULTS: Pooling one positive swab with three negative swabs produced a small drop in Ct value but all pools were still clearly positive. MAIN LIMITATIONS: Large numbers of field positive horses are not available, but the proof of concept approach with laboratory prepared pools shows the method is applicable to field cases. CONCLUSIONS: It was concluded that pooling of swabs would confer no appreciable drop in the ability to detect a positive animal compared to individual swab testing; pooling is therefore a suitable alternative to individual swab testing with reduced costs. The Summary is available in Spanish - see Supporting Information.

Finding the service you need: human centered design of a Digital Interactive Social Chart in DEMentia care (DEM-DISC).

Community dwelling people with dementia and their informal carers experience a lot of problems. In the course of the disease process people with dementia become more dependent on others and professional help is often necessary. Many informal carers and people with dementia experience unmet needs with regard to information on the disease and on the available care and welfare offer, therefore they tend not to utilize the broad spectrum of available care and welfare services. This can have very negative consequences like unsafe situations, social isolation of the person with dementia and overburden of informal carers with consequent increased risk of illness for them. The development of a DEMentia specific Digital Interactive Social Chart (DEM-DISC) may counteract these problems. DEM-DISC is a demand oriented website for people with dementia and their carers, which is easy, accessible and provides users with customized information on healthcare and welfare services. DEM-DISC is developed according to the human centered design principles, this means that people with dementia, informal carers and healthcare professionals were involved throughout the development process. This paper describes the development of DEM-DISC from four perspectives, a domain specific content perspective, an ICT perspective, a user perspective and an organizational perspective. The aims and most important results from each perspective will be discussed. It is concluded that the human centered design was a valuable method for the development of the DEM-DISC.

High-resolution melting PCR analysis for rapid genotyping of Burkholderia mallei.

Burkholderia (B.) mallei is the causative agent of glanders. A previous work conducted on single-nucleotide polymorphisms (SNP) extracted from the whole genome sequences of 45 B. mallei isolates identified 3 lineages for this species. In this study, we designed a high-resolution melting (HRM) method for the screening of 15 phylogenetically informative SNPs within the genome of B. mallei that subtype the species into 3 lineages and 12 branches/sub-branches/groups. The present results demonstrate that SNP-based genotyping represent an interesting approach for the molecular epidemiology analysis of B. mallei.

Review of ICT-based services for identified unmet needs in people with dementia.

Some of the needs that people with dementia and their informal carers currently perceive as insufficiently met by regular care and support services might be alleviated, or even be met, using modern Information and Communication Technology (ICT). The study described in this paper was designed to provide an insight into the state of the art in ICT solutions that could contribute to meet the most frequently mentioned unmet needs by people with dementia and their informal carers. These needs can be summarized as (1) the need for general and personalized information; (2) the need for support with regard to symptoms of dementia; (3) the need for social contact and company; and (4) the need for health monitoring and perceived safety. Databases that were searched include: PubMed, Cinahl, Psychinfo, Google (Scholar), INSPEC and IEEE. In total 22 websites and 46 publications were included that satisfied the following criteria: the article reports on people with dementia and/or their informal carers and discusses an ICT-device that has been tested within the target group and has proven to be helpful. Within the first need area 18 relevant websites and three studies were included; within the second need area 4 websites and 20 publications were included. Within the third and fourth need area 11 and 12 publications were included respectively. Most articles reported on uncontrolled studies. It is concluded that the informational websites offer helpful information for carers but seem less attuned to the person with dementia and do not offer personalized information. ICT solutions aimed at compensating for disabilities, such as memory problems and daily activities demonstrate that people with mild to moderate dementia are capable of handling simple electronic equipment and can benefit from it in terms of more confidence and enhanced positive effect. Instrumental ICT-support for coping with behavioral and psychological changes in dementia is relatively disregarded as yet, while support for social contact can be effectively realized through, for example, simplified (mobile) phones or videophones or (entertainment) robots. GPS technology and monitoring systems are proven to result in enhanced feelings of safety and less fear and anxiety. Though these results are promising, more controlled studies in which the developed ICT solutions are tested in real life situations are needed before implementing them in the care for people with dementia. It is recommended that future studies also focus on the integration of the current techniques and solutions.

[Antibiotic resistance in Escherichia coli O157 isolated between 1998 and 2003 in The Netherlands]. / Antibioticumresistentie bij Escherichia coli O157 geïsoleerd tussen 1998 en 2003 in Nederland.

Little is known about the antibiotic resistance of E. coli O157 in The Netherlands. In this study, 218 human and 247 nonhuman samples, isolated between 1998 and 2003, were tested for antimicrobial resistance. About 5.5% of E. coli O157 isolates from human samples were resistant, as were about 4.00% of E. coli O157 isolates from non-human samples. These figures are lower than those reported in the literature. Class I integrons were found in six multiresistant isolates. This type of integron is also found in commensal E. coli in food animals and Salmonella spp. One of the integron-positive isolates contained the beta-lactamase bla(TEM-1b) and an extended spectrum beta-lactamase (ESBL), which belongs to the group 2 CTX-M enzymes. This is the first report of these beta-lactamases in E. coli O157 isolated from chicken.

Involvement of matrix metalloproteinases in chronic Q fever.

OBJECTIVES: Chronic Q fever is a persistent infection with the intracellular Gram-negative bacterium Coxiella burnetii, which can lead to complications of infected aneurysms. Matrix metalloproteinases (MMPs) cleave extracellular matrix and are involved in infections as well as aneurysms. We aimed to study the role of MMPs in the pathogenesis of chronic Q fever. METHODS: We investigated gene expression of MMPs through microarray analysis and MMP production with ELISA in C. burnetii-stimulated peripheral blood mononuclear cells (PBMCs) of patients with chronic Q fever and healthy controls. Twenty single nucleotide polymorphisms (SNPs) of MMP and tissue inhibitor of MMP genes were genotyped in 139 patients with chronic Q fever and 220 controls with similar cardiovascular co-morbidity. Additionally, circulating MMPs levels in patients with chronic Q fever were compared with those in cardiovascular controls with and without a history of past Q fever. RESULTS: In healthy controls, the MMP pathway involving four genes (MMP1, MMP7, MMP10, MMP19) was significantly up-regulated in C. burnetii-stimulated but not in Escherichia coli lipopolysaccharide -stimulated PBMCs. Coxiella burnetii induced MMP-1 and MMP-9 production in PBMCs of healthy individuals (both p<0.001), individuals with past Q fever (p<0.05, p<0.01, respectively) and of patients with chronic Q fever (both p<0.001). SNPs in MMP7 (rs11568810) (p<0.05) and MMP9 (rs17576) (p<0.05) were more common in patients with chronic Q fever. Circulating MMP-7 serum levels were higher in patients with chronic Q fever (median 33.5 ng/mL, interquartile range 22.3-45.7 ng/mL) than controls (20.6 ng/mL, 15.9-33.8 ng/mL). CONCLUSION: Coxiella burnetii-induced MMP production may contribute to the development of chronic Q fever.

Development of a real time PCR for the detection of Taylorella equigenitalis directly from genital swabs and discrimination from Taylorella asinigenitalis.

A discriminatory real time PCR for the detection of Taylorella equigenitalis, the causative agent of contagious equine metritis (CEM), and the related species T. asinigenitalis was developed for the direct examination of genital swabs. The 112bp amplicons produced from the two species were discriminated from each other using TaqMan probes labelled with different fluorophores. The TaqMan PCR was shown to be specific for the 16S ribosomal DNA of the two species of taylorella and did not cross-hybridise with the 16S ribosomal DNA of other bacteria tested. Direct amplification from genital swabs was shown to be equally sensitive to that of culture methods. Prevalence in a sample set from The Netherlands was shown to be equivalent to that demonstrated by culture. A companion real time PCR that amplified a fragment of the 16S rDNA gene of equine commensal bacteria was developed to ensure bacterial DNA was extracted from swab material supplied for testing. The use of a rapid and reliable real time PCR for the organism causing CEM should aid the control of this disease.

GermOnline, a cross-species community knowledgebase on germ cell differentiation.

GermOnline provides information and microarray expression data for genes involved in mitosis and meiosis, gamete formation and germ line development across species. The database has been developed, and is being curated and updated, by life scientists in cooperation with bioinformaticists. Information is contributed through an online form using free text, images and the controlled vocabulary developed by the GeneOntology Consortium. Authors provide up to three references in support of their contribution. The database is governed by an international board of scientists to ensure a standardized data format and the highest quality of GermOnline's information content. Release 2.0 provides exclusive access to microarray expression data from Saccharomyces cerevisiae and Rattus norvegicus, as well as curated information on approximately 700 genes from various organisms. The locus report pages include links to external databases that contain relevant annotation, microarray expression and proteome data. Conversely, the Saccharomyces Genome Database (SGD), S.cerevisiae GeneDB and Swiss-Prot link to the budding yeast section of GermOnline from their respective locus pages. GermOnline, a fully operational prototype subject-oriented knowledgebase designed for community annotation and array data visualization, is accessible at http://www.germonline.org. The target audience includes researchers who work on mitotic cell division, meiosis, gametogenesis, germ line development, human reproductive health and comparative genomics.

[Neonatal diarrhoea in pigs: alpha- and beta2-toxin produced by Clostridium perfringens]. / Neonatale diarree bij biggen: alpha- en beta2-toxine producerende Clostridium perfringens.

Since 2001 the Pig Health Unit of Utrecht University has been consulted by various pig farms regarding neonatal diarrhoea. When preventive measures against E. coli-induced diarrhoea had no or limited results, the diarrhoeic piglets were investigated further. The microbiological and pathological findings were indicative of infection with Clostridium perfringens. Toxin typing by polymerase chain reaction led to the detection of genes encoding a-toxin (cpa) and beta2-toxin (cpb2). Surprisingly, alpha- and beta2-toxin-producing C. perfringens was isolated from all tested herds with piglets with neonatal diarrhoea. From our observations, it is likely that many herds in the Netherlands are infected with beta2-toxin-producing C. perfringens strains. As present vaccines lack beta2-toxoid and thus do not provide piglets with protection against beta2-induced diarrhoea.

Analysis of Q fever in Dutch dairy goat herds and assessment of control measures by means of a transmission model.

Between 2006 and 2009 the largest human Q fever epidemic ever described occurred in the Netherlands. The source of infection was traced back to dairy goat herds with abortion problems due to Q fever. The first aim of control measures taken in these herds was the reduction of human exposure. To analyze Q fever dynamics in goat herds and to study the effect of control measures, a within-herd model of Coxiella burnetii transmission in dairy goat herds was developed. With this individual-based stochastic model we evaluated six control strategies and three herd management styles and studied which strategy leads to a lower Q fever prevalence and/or to disease extinction in a goat herd. Parameter values were based on literature and on experimental work. The model could not be validated with independent data. The results of the epidemiological model were: (1) Vaccination is effective in quickly reducing the prevalence in a dairy goat herd. (2) When taking into account the average time to extinction of the infection and the infection pressure in a goat herd, the most effective control strategy is preventive yearly vaccination, followed by the reactive strategies to vaccinate after an abortion storm or after testing BTM (bulk tank milk) positive. (3) As C. burnetii in dried dust may affect public health, an alternative ranking method is based on the cumulative amount of C. burnetii emitted into the environment (from disease introduction until extinction). Using this criterion, the same control strategies are effective as when based on time to extinction and infection pressure (see 2). (4) As the bulk of pathogen excretion occurs during partus and abortion, culling of pregnant animals during an abortion storm leads to a fast reduction of the amount of C. burnetii emitted into the environment. However, emission is not entirely prevented and Q fever will not be eradicated in the herd by this measure. (5) A search & destroy (i.e. test and cull) method by PCR of individual milk samples with a detection probability of 50% of detecting and culling infected goats - that excrete C. burnetii intermittently - will not result in eradication of Q fever in the herd. This control strategy was the least effective of the six evaluated strategies. Subject to model limitations, our results indicate that only vaccination is capable of preventing and controlling Q fever outbreaks in dairy goat farms. Thus, preventive vaccination should be considered as an ongoing control measure.

Boosting nitrification with the BABE technology.

Over the past years there has been a growing interest for compact, simple, low cost and robust technologies to upgrade wastewater treatment plants for nitrogen removal. The BABE (Bio Augmentation Batch Enhanced) technology is such a new concept. This patented system for biological treatment of sludge liquor - the effluent produced from digested sludge - uses a new principle, boosting the nitrifying bacteria in a side stream in such a way that the activated sludge in the main process is augmented. This augmentation increases the nitrification capacity of the wastewater treatment plant (wwtp). Experiments on a practical scale have demonstrated the effective and stable operation of the BABE technology. Model studies supported by the results of the full-scale tests showed that the technology can be applied in several situations, i.e. 1) introducing nitrification at high loaded wwtps; 2) enhancing nitrification at wwtps with incomplete nitrification; 3) enlarging denitrification at wwtps with complete nitrification. Most likely this year a full-scale application will be realized in the Netherlands at a wwtp with insufficient nitrification throughout the year.

Coxiella burnetii infections in sheep or goats: an opinionated review.

Q fever is an almost ubiquitous zoonosis caused by Coxiella burnetii, which is able to infect several animal species, as well as humans. Cattle, sheep and goats are the primary animal reservoirs. In small ruminants, infections are mostly without clinical symptoms, however, abortions and stillbirths can occur, mainly during late pregnancy. Shedding of C. burnetii occurs in feces, milk and, mostly, in placental membranes and birth fluids. During parturition of infected small ruminants, bacteria from birth products become aerosolized. Transmission to humans mainly happens through inhalation of contaminated aerosols. In the last decade, there have been several, sometimes large, human Q fever outbreaks related to sheep and goats. In this review, we describe C. burnetii infections in sheep and goats, including both advantages and disadvantages of available laboratory techniques, as pathology, different serological tests, PCR and culture to detect C. burnetii. Moreover, worldwide prevalences of C. burnetii in small ruminants are described, as well as possibilities for treatment and prevention. Prevention of shedding and subsequent environmental contamination by vaccination of sheep and goats with a phase I vaccine are possible. In addition, compulsory surveillance of C. burnetii in small ruminant farms raises awareness and hygiene measures in farms help to decrease exposure of people to the organism. Finally, this review challenges how to contain an infection of C. burnetii in small ruminants, bearing in mind possible consequences for the human population and probable interference of veterinary strategies, human risk perception and political considerations.