Q Fever in Migrant Workers, Scotland

Zee A, Rothova A. Demonstration of Bar-tonella grahamii DNA in ocular fl uids of a patient with neuroretinitis. Rochalimaea elizabethae sp. nov. isolated from a patient with endocarditis. To the Editor: Q fever is a zoo-nosis caused by infection with Coxi-ella burnetii and is most commonly associated with occupational exposure to animal-slaughtering facilities. C. burnetii is an obligate intracellular bacterium and causes highly variable disease, ranging from asymptomatic infection to fatal chronic infective en-docarditis. In June 2006, the United Kingdom experienced its largest outbreak of Q fever with 138 cases associated with a slaughterhouse near Stir-ling in Scotland. The slaughterhouse had been processing post-parturition ewes in the lairage (place for keeping livestock temporarily) at the end of May. These animals were thought to be among the most likely to shed the organism (1). Further investigation showed that a ewe had aborted in the lairage toward the end of May. Although the sheep lairage was the most likely source of the infection, no mi-crobiologic evidence confi rmed this, as C. burnetii was not isolated from environmental samples. The outbreak was neither remarkable for its putative mode of transmission nor for the industry involved, but both the number and nationalities of migrant workers infected was noteworthy. Since 2004, 12 member states have joined the European Union and this has led to an infl ux of immigrants to the United Kingdom. The increase in migrant numbers has partly been a result of the government's managed migration policy, expanding migration to fi ll vacancies in skilled and low-wage occupations. Employers have diffi culty recruiting UK workers because of the jobs' physical demands, long hours that limit social activities, and low pay. They therefore recruit international workers with a good work ethic and reliability; central and Eastern European workers are compared favorably with UK nationals (2). Migrants from Eastern and central Eu-rope are now more likely to be found in low-wage occupations in agriculture , construction, hospitality, and au pair employment. Of the 138 cases of Q fever, 48 were immigrants from the following countries: Slovakia (41), Poland (3), Czech Republic (2), and Lithuania (2). Unsurprisingly, epide-miologic case interviews were beset with linguistic and logistic problems. The diagnosis of Q fever relies predominantly on its serologic legacy since asymptomatic seroconversion occurs in up to 60% of patients (3). Analysis of our cohort found that non-UK patients were signifi cantly less likely than their UK counterparts …