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doi: 10.1371/journal.pone.0038843. Epub 2012 Jun 7.

Q fever and pneumonia in an area with a high livestock density: a large population-based study

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Q fever and pneumonia in an area with a high livestock density: a large population-based study

Lidwien A M Smit et al. PLoS One. 2012.

Abstract

Concerns about public health risks of intensive animal production in The Netherlands continue to rise, in particular related to outbreaks of infectious diseases. The aim was to investigate associations between the presence of farm animals around the home address and Q fever and pneumonia.Electronic medical record data for the year 2009 of all patients of 27 general practitioners (GPs) in a region with a high density of animal farms were used. Density of farm animals around the home address was calculated using a Geographic Information System. During the study period, a large Q fever outbreak occurred in this region. Associations between farm exposure variables and pneumonia or 'other infectious disease', the diagnosis code used by GPs for registration of Q fever, were analyzed in 22,406 children (0-17 y) and 70,142 adults (18-70 y), and adjusted for age and sex. In adults, clear exposure-response relationships between the number of goats within 5 km of the home address and pneumonia and 'other infectious disease' were observed. The association with 'other infectious disease' was particularly strong, with an OR [95%CI] of 12.03 [8.79-16.46] for the fourth quartile (>17,190 goats) compared with the first quartile (<2,251 goats). The presence of poultry within 1 km was associated with an increased incidence of pneumonia among adults (OR [95%CI] 1.25 [1.06-1.47]).A high density of goats in a densely populated region was associated with human Q fever. The use of GP records combined with individual exposure estimates using a Geographic Information System is a powerful approach to assess environmental health risks.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Study area: the eastern part of the province of Noord-Brabant and the northern part of the province of Limburg.
Dots represent residential addresses of 92,548 study subjects. Squares represent farms holding a licence to keep livestock. Triangles represent goat farms.
Figure 2
Figure 2. Smoothed plots with 95% confidence bands representing associations of the number of goats within 5 km around the home address with pneumonia (A; P = 0.001) and ‘other infectious disease’ (C; P<0.0001), and associations of distance to nearest goat farm with pneumonia (B; P = 0.0002) and ‘other infectious disease’ (D; P<0.0001) among 70,142 adults.
Associations were adjusted for age and sex.

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