Prevalence and risk factors for Q fever, spotted fever group rickettsioses, and typhus group rickettsioses in a pastoralist community of northern Tanzania, 2016–2017

Author:

Moorthy Ganga S.12ORCID,Rubach Matthew P.2345ORCID,Maze Michael J.6ORCID,Refuerzo Regina P.7,Shirima Gabriel M.8ORCID,Lukambagire AbdulHamid S.910,Bodenham Rebecca F.10ORCID,Cash‐Goldwasser Shama2ORCID,Thomas Kate M.11ORCID,Sakasaka Philoteus12,Mkenda Nestory13,Bowhay Thomas R.11ORCID,Perniciaro Jamie L.14ORCID,Nicholson William L.14,Kersh Gilbert J.14ORCID,Kazwala Rudovick R.15ORCID,Mmbaga Blandina T.4912ORCID,Buza Joram J.8ORCID,Maro Venance P.412ORCID,Haydon Daniel T.7ORCID,Crump John A.23411ORCID,Halliday Jo E. B.7ORCID

Affiliation:

1. Division of Pediatric Infectious Diseases Duke University Medical Center Durham North Carolina USA

2. Duke Global Health Institute Duke University Durham North Carolina USA

3. Division of Infectious Diseases and International Health Duke University Medical Center Durham North Carolina USA

4. Programme in Emerging Infectious Diseases Duke‐National University of Singapore Medical School Singapore Singapore

5. Kilimanjaro Christian Medical University College Tumaini University Moshi Tanzania

6. Department of Medicine University of Otago Christchurch New Zealand

7. School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK

8. School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology Arusha Tanzania

9. Kilimanjaro Clinical Research Institute Moshi Tanzania

10. EcoHealth Alliance New York New York USA

11. Centre for International Health University of Otago Dunedin New Zealand

12. Kilimanjaro Christian Medical Centre Moshi Tanzania

13. Endulen Hospital, Ngorongoro Conservation Area Endulen Tanzania

14. Rickettsial Zoonoses Branch US Centers for Disease Control and Prevention Atlanta Georgia USA

15. Department of Veterinary Medicine and Public Health Sokoine University of Agriculture Morogoro Tanzania

Abstract

AbstractBackgroundIn northern Tanzania, Q fever, spotted fever group (SFG) rickettsioses, and typhus group (TG) rickettsioses are common causes of febrile illness. We sought to describe the prevalence and risk factors for these zoonoses in a pastoralist community.MethodsFebrile patients ≥2 years old presenting to Endulen Hospital in the Ngorongoro Conservation Area were enrolled from August 2016 through October 2017. Acute and convalescent blood samples were collected, and a questionnaire was administered. Sera were tested by immunofluorescent antibody (IFA) IgG assays using Coxiella burnetii (Phase II), Rickettsia africae, and Rickettsia typhi antigens. Serologic evidence of exposure was defined by an IFA titre ≥1:64; probable cases by an acute IFA titre ≥1:128; and confirmed cases by a ≥4‐fold rise in titre between samples. Risk factors for exposure and acute case status were evaluated.ResultsOf 228 participants, 99 (43.4%) were male and the median (interquartile range) age was 27 (16–41) years. Among these, 117 (51.3%) had C. burnetii exposure, 74 (32.5%) had probable Q fever, 176 (77.2%) had SFG Rickettsia exposure, 134 (58.8%) had probable SFG rickettsioses, 11 (4.8%) had TG Rickettsia exposure, and 4 (1.8%) had probable TG rickettsioses. Of 146 participants with paired sera, 1 (0.5%) had confirmed Q fever, 8 (5.5%) had confirmed SFG rickettsioses, and none had confirmed TG rickettsioses. Livestock slaughter was associated with acute Q fever (adjusted odds ratio [OR] 2.54, 95% confidence interval [CI] 1.38–4.76) and sheep slaughter with SFG rickettsioses case (OR 4.63, 95% CI 1.08–23.50).DiscussionAcute Q fever and SFG rickettsioses were detected in participants with febrile illness. Exposures to C. burnetii and to SFG Rickettsia were highly prevalent, and interactions with livestock were associated with increased odds of illness with both pathogens. Further characterisation of the burden and risks for these diseases is warranted.

Funder

Biotechnology and Biological Sciences Research Council

Royal Society

Economic and Social Research Council

National Institutes of Health

Publisher

Wiley

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