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Landratsamt-Gesundheitsamt Freudenstadt Local Health Office Baden-Württemberg Germany

Public Health Infrastructure in an Outbreak of Q Fever (District of Freudenstadt 2008). Landratsamt-Gesundheitsamt Freudenstadt Local Health Office Baden-Württemberg Germany Dr. Christoph Meier.

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Landratsamt-Gesundheitsamt Freudenstadt Local Health Office Baden-Württemberg Germany

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  1. Public Health Infrastructure in an Outbreak of Q Fever (District of Freudenstadt 2008) Landratsamt-Gesundheitsamt Freudenstadt Local Health Office Baden-Württemberg Germany Dr. Christoph Meier Joint Seminar between EHESP & NPHSW : Comparing Health systems and practice – Brittany (France), Baden - Württemberg (Germany) & Wales (UK) & Italy; F-Rennes 11.3. – 12.3.2009 

  2. (Rural) District of Freudenstadt • Population served: 122.000 • Area: 871 qkm • Tourisme, Agriculture Forestry, Industrie

  3. Q Fever • Zoonosis • Coxiella burnetti • Reservoir • Sheep, goats, cattle, cats, dogs • placenta and birth products spreading bacteria • High environmental resistence • Transmission to humans • Mainly airborne spread, direct contact with animals • Incubation period 1-3 weeks, up to 5 weeks • Clinical features: asymptomatic to severe • Flu-like illness, pneumonia, pericarditis, hepatitis • In early pregnancy high risk of abortion or premature delivery • Chronic infection (valvular heart disease, pregnancy) • Notifiable disease: §7 Infektionsschutzgesetz (Federal Act on the Prevention and Control of Infectious Diseases in Man); Labs to report to Local Health Office results indicative of acute illness

  4. Q Fever Outbreak 2008 • Moving Sheep herd (600 sheep) tested positive • 39 confirmed cases of human Q Fever (symptoms and laboratory confirmation); • Population at risk along herding route: ~1000 people • Onset of Symptoms: May to September 2008 Link between herd trail, residence of patients and time of onset of symptoms

  5. Stefan Brockmann, State Health Office, Stuttgart

  6. 38 Local Health Offices/Health Protection as part of Local Authority • 4 Regional Governments • Small patches, cross border outbreaks more complicated • 38 on call arrangements • Differing Public Health Policies • Professional Audit by the State‘s and Regional Government (Food and Veterinary Offices are organized in a similar way)

  7. Local Health Office/Health Protection (Gesundheitsamt Freudenstadt) population served: 122.000 inhabitants • Medical Staff: 4 positions • Dental Staff: 0,5 positions • „Environmental Health Officers“: 3 positions • „Public Health Nurses“ and 3,10 positions • Administrative Staff 3,15 positions

  8. Local Health Office/Health Protection (Gesundheitsamt Freudenstadt) • Medical assessments, medical expert opinion • Medical pre-school tests • Dental Health: Prevention and Screening • Regional Health Reports • Usually not involved in health care development

  9. Local Health Office/HealthProtection(Gesundheitsamt Freudenstadt) • Communicable Disease Control: notification, outbreak control, prevention (including food borne diseases, TB) • Infectious Disease Control: Monitoring of Hospitals, Nursing Homes, Nurseries, Tattoo Studios ... • HIV + STI: anonymous counceling and testing • Vaccination: Information, campaigns, surveillance • Environmental Health • Contributing to Emergency Planning • Water safety: Monitoring of Public and Privat Water Supplies, Recreational Water • Mains water supply staff rung up seeking advice: members of the public linked local cases of pneumonie to drinking water

  10. Local Public Office- Health Protection - • Wide field of Health Protection Issues • Integrated approach to outbreak management („open mind“) • More flexibility about staffing in times of increased pressure and strain (outbreak)

  11. Outbreak of Q Fever in the District of Freudenstadt 2008 • Initial outbreak investigation according to § 16 Infektions-schutzgesetz (Federal Act on the Prevention and Control of Infectious Diseases in Man): • 5 cases of pneumonia in a single neighbourhood admitted to hospital: further testing by hospital showed Q Fever in one case • Case finding in the community: initial cases tested and questionned during home visits by Local Health Office for rapid confirmation of outbreak and generating hypothesis of possible sources outbreak confirmed: 2. patient tested positive by State Health Office Reference Laboratory

  12. State Health Office of Baden-Württemberg, Stuttgart (Landesgesundheitsamt) • Communicable Disease Surveillance Branch • Reference Laboratory for Q Fever • GPs and Hospitals were offered free and quick testing, asked to fill in questionnaire • Expert Advice and Support on Public Health Management for Local Health Office No hierarchical system with direct chain of command down to Local Health Offices

  13. Local Health Office/Health Protection as part of Local Authority • Organisationally under the same roof with the Food and Veterinary Office and Agricultural Department (the latter not being directly involved) • Close, good working relationship with Vets • One press office only • Theoretical conflicts of interest on a Local Authority level (public health, animal health, agricultur, tourism)

  14. District Council of FreudenstadtLocal Health Office/Health Protection (Gesundheitsamt) Food and Veterinary Office (Veterinäramt) Local Health Office/Health Protection (Gesundheitsamt) Food and Veterinary Office (Veterinäramt)

  15. Expert advice on sheep health • Compulsary insurance covering domestic animal infectious diseases in Baden-Württemberg (Tierseuchenkasse) • Expert advice by Sheep Health Branch (Schafsherdengesundheitsdienst): • sees and tests herds regularly/routinely • knows outbreak herd‘s health history • advice on animal testing

  16. Working together with primary and secondary care • Fragmentation of the health care system:no centralized system - neither nationally nor locally (e.g. NHS, LHB ...) • Primary Care for the usually compulsary General Health Insurance (90% of Population): GPs , specialists • Health Care Providers are e.g. • privately owned (e.g. laboratories, hospitals), • state run (e.g. University Hospitals), • district run (District Hospitals), • church or charity run (hospitals), • self employed (GPs and primary care specialists), • charity run (ambulance services, blood bank) In an outbreak good working relationships with independent partners are important

  17. 05.03.2009:2. Outbreak of human Q-Fever in the region confirmed currently: 8 cases confirmed

  18. Further Information: Landratsamt Freudenstadt Dr. Christoph Meier Gesundheitsamt - Local Health OfficeReichsstr.11D-72250 Freudenstadt Tel: 0049 (0) 7441 920 - 4101 (Reception) - 4199 (Fax) gafds@landkreis-freudenstadt.de Internet: www.landkreis-freudenstadt.de

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