Coxiella burnetii in sewage water at sewage water treatment plants in a Q fever epidemic area

During 2007-2010, over 4000 persons in The Netherlands contracted Q-fever, a zoonosis caused by the bacterium Coxiella burnetii. Goats and sheep are the main reservoir of C. burnetti and infected animals shed the bacterium with their urine, faeces and birth products. Human infections may occur through direct contact with infected animals, or through inhalation of contaminated dust particles or aerosols. Discharge of waste water from Q fever contaminated goat farms may result in the presence of C. burnetii in sewage water and aerosols at sewage water treatment plants (SWTPs) which may pose a health risk for workers or neighbouring residents. The objectives of this study were to determine the presence of C burnetii at SWTPs and to optimize available detection methods. In March-July 2011, sewage influent and aeration tank samples from four SWTPs receiving discharge from Q fever positive goat farms were examined by using a multiplex real-time PCR detecting C. bumetii DNA by targeting 151111 and com1 genes. Influent (44%; n=16/36) and active sludge (36%; n=13/36) samples were positive with low C. bumetii DNA content. Percentage positive samples per SWTP were 28-61%. Positive samples were most frequent in March 2011 and least frequent in May 2011. The presence of C bumetii DNA in sewage water samples suggests that SWTPs receiving waste water from Q fever contaminated goat farms may contribute to the spread of C bumetii to the environment. The low levels of C bumetii DNA in sewage water during the decline of the Q fever outbreak in The Netherlands in 2011 indicate a low health risk for SWTP workers and residents. (C) 2013 Elsevier GmbH. All rights reserved.