PDF(Pubmed)
Abstract：
Q fever is an important zoonotic disease with a worldwide distribution. Outbreaks of Q fever are unpredictable and can affect many people, resulting in a significant burden on public health. The epidemiology of the disease is complex and substantial efforts are required to understand and control Q fever outbreaks. The purpose of this study was to systematically review previous investigations of outbreaks and summarise important epidemiological features. This will improve knowledge of the factors driving the occurrence of Q fever outbreaks and assist decision makers in implementing mitigation strategies. A search of four electronic databases identified 94 eligible articles published in English between 1990 and 2022 that related to 81 unique human Q fever outbreaks. Outbreaks were reported across 27 countries and mostly in industrialised nations. Documented Q fever outbreaks varied in size (2 to 4107 cases) and duration (4 to 1722 days). Most outbreaks (43/81) occurred in communities outside of traditional at-risk occupational settings and were frequently associated with living in proximity to livestock holdings (21/43). Indirect transmission via environmental contamination, windborne spread or fomites was the most common route of infection, particularly for large community outbreaks. Exposure to ruminants and/or their products were confirmed as the principal risk factors for infection, with sheep (28/81) as the most common source followed by goats (12/81) and cattle (7/81). Cooperation and data sharing between human and animal health authorities is valuable for outbreak investigation and control using public health and veterinary measures, but this multisectoral approach was seldom applied (14/81). Increased awareness of Q fever among health professionals and the public may facilitate the early detection of emerging outbreaks that are due to non-occupational, environmental exposures in the community.
摘要：
Q热是一种重要的人畜共患疾病，在世界范围内分布。Q热的爆发是不可预测的，可以影响许多人，对公众健康造成重大负担。该疾病的流行病学是复杂的，需要大量的努力来了解和控制Q发烧爆发。这项研究的目的是系统地回顾以前的疫情调查，并总结重要的流行病学特征。这将提高对导致Q热爆发的因素的认识，并协助决策者实施缓解策略。对四个电子数据库的搜索确定了1990年至2022年间以英语发表的94篇合格文章，这些文章与81次独特的人类Q热暴发有关。据报道，27个国家爆发了疫情，大部分发生在工业化国家。记录的Q热暴发在规模（2至4107例）和持续时间（4至1722天）上有所不同。大多数暴发（43/81）发生在传统危险职业环境之外的社区，并且经常与居住在牲畜附近有关（21/43）。通过环境污染间接传播，风源传播或粪便是最常见的感染途径，特别是对于大型社区爆发。暴露于反刍动物和/或其产品被确认为感染的主要危险因素，以绵羊（28/81）为最常见的来源，其次是山羊（12/81）和牛（7/81）。人类和动物卫生当局之间的合作和数据共享对于使用公共卫生和兽医措施进行疫情调查和控制非常有价值。但是这种多部门方法很少应用(14/81)。提高卫生专业人员和公众对Q热的认识，可能有助于及早发现非职业性新爆发的疫情，社区中的环境暴露。
