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Epidemiology of Coxiella burnetii infection in Africa: a OneHealth systematic review.
Abstract
BACKGROUND: Q fever is a common cause of febrile illness and community-acquired pneumonia
in resource-limited settings. Coxiella burnetii, the causative pathogen, is transmitted
among varied host species, but the epidemiology of the organism in Africa is poorly
understood. We conducted a systematic review of C. burnetii epidemiology in Africa
from a "One Health" perspective to synthesize the published data and identify knowledge
gaps. METHODS/PRINCIPAL FINDINGS: We searched nine databases to identify articles
relevant to four key aspects of C. burnetii epidemiology in human and animal populations
in Africa: infection prevalence; disease incidence; transmission risk factors; and
infection control efforts. We identified 929 unique articles, 100 of which remained
after full-text review. Of these, 41 articles describing 51 studies qualified for
data extraction. Animal seroprevalence studies revealed infection by C. burnetii (≤13%)
among cattle except for studies in Western and Middle Africa (18-55%). Small ruminant
seroprevalence ranged from 11-33%. Human seroprevalence was <8% with the exception
of studies among children and in Egypt (10-32%). Close contact with camels and rural
residence were associated with increased seropositivity among humans. C. burnetii
infection has been associated with livestock abortion. In human cohort studies, Q
fever accounted for 2-9% of febrile illness hospitalizations and 1-3% of infective
endocarditis cases. We found no studies of disease incidence estimates or disease
control efforts. CONCLUSIONS/SIGNIFICANCE: C. burnetii infection is detected in humans
and in a wide range of animal species across Africa, but seroprevalence varies widely
by species and location. Risk factors underlying this variability are poorly understood
as is the role of C. burnetii in livestock abortion. Q fever consistently accounts
for a notable proportion of undifferentiated human febrile illness and infective endocarditis
in cohort studies, but incidence estimates are lacking. C. burnetii presents a real
yet underappreciated threat to human and animal health throughout Africa.
Type
Journal articleSubject
AfricaAnimals
Community-Acquired Infections
Humans
Incidence
Pneumonia, Bacterial
Q Fever
Risk Factors
Seroepidemiologic Studies
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https://hdl.handle.net/10161/13773Published Version (Please cite this version)
10.1371/journal.pntd.0002787Publication Info
Vanderburg, Sky; Rubach, Matthew P; Halliday, Jo EB; Cleaveland, Sarah; Reddy, Elizabeth
A; & Crump, John A (2014). Epidemiology of Coxiella burnetii infection in Africa: a OneHealth systematic review.
PLoS Negl Trop Dis, 8(4). pp. e2787. 10.1371/journal.pntd.0002787. Retrieved from https://hdl.handle.net/10161/13773.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Andrew Crump
Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University’s
collaborative research program based at Kilimanjaro Christian Medical Centre and Director
of Tanzania Operations for the Duke Global Health Institute. I oversee the design
and implementation of research studies on infectious diseases, particularly febrile
illness, invasive bacterial disease, HIV-associated opportunistic infections, clinical
trials of antiretroviral therapy and prevention of mother-to-child tr
Matthew P. Rubach
Associate Professor of Medicine
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