Q fever health crisis: time to fight rural discrimination 

Published: February 2019 | By: Beverley Hadgraft

The federal government refuses to subsidise Q fever vaccinations that will give lifetime protection. As the drought worsens rural communities face an increased risk of Q fever. NSW Farmers is lobbying for change.

Coxiella burnetii – the bacterium responsible for Q fever.  

JENNI Jackson is a pharmacist. She dispenses “squillions” of dollars worth of free medications on the Pharmaceutical Benefits Scheme (PBS). “I don’t have a problem with that,” she says. She does have a problem, however, with the government’s refusal to subsidise a cheap effective vaccine that would provide a lifetime’s protection from Q fever.

Despite the risk of the airborne zoonotic disease (transmitted from animals) worsening due to dust and drought, the federal health minister Greg Hunt continues to insist Q fever is an occupational disease, which means vaccines should be paid for by employers. “It’s almost a form of rural discrimination,” says Jenni.

NSW Farmers lobbies hard for subsidised Q fever vaccinations 

Her interest in Q fever was sparked in dramatic fashion in 1992 when her husband James Jackson, now president of NSW Farmers, collapsed in the shower after contracting the disease. By evening he was in Armidale Hospital’s intensive care unit battling septicaemia and pneumonia and being given massive doses of strong antibiotics. The couple run sheep and cattle and James had just finished shearing. Also a vet, he was a prime candidate for the disease. Like many, he had never taken advantage of the vaccine, available since 1989.

RELATED: A day in the life of a rural vet

Jenni and James Jackson. Source: Supplied.

This is because, although effective, it requires at least two time-consuming visits to a doctor including a pre-vaccination skin test that some rural medical centres don’t offer due to the fact their doctors can’t administer the tricky intra-dermal needle necessary. Thankfully, that situation has been improved after NSW Farmers lobbied for GP training. Patients also have to pay for the vaccine itself – the total cost often reaching between $350 and $500, says Jenni.

She is publicity officer of NSW Farmers’ branch in Guyra, which is a hotspot for Q fever in NSW with 22% of the population testing positive. When she discovered it can leave 15% of sufferers with an incurable chronic fatigue, unable to work for months or even years, she decided to take matters into her own hands.

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She spoke to local GP Dr Thampapillai Jeyakumar at Guyra Medical Centre to see if she could do something jointly with NSW Farmers and the medical centre to at least get her local community protected. “He was so onside. He told me he was diagnosing an average of nearly one person a week,” Jenni says. 

After a media campaign, the Guyra branch organised two vaccination clinics and paid for 50 pre-vaccine skin tests. “I had so many people thanking me, saying this was something they’d been meaning to do,” says Jenni. Her only disappointment was that she couldn’t offer the vaccine to at-risk children – needed more than ever to help out on farms – because the vaccine hasn’t been authorised for use on children under the age of 15.

Unfortunately for farm kids, the vaccine is not authorised for use on those under the age of 15. Source: Getty Images.

She hopes to repeat the exercise, and at least two other NSW Farmers branches have already followed her example. Mudgee branch chair Dave Clarke has worked with a local GP to subsidise the cost of testing and vaccination so members were only $90 out of pocket. “It was really popular and I hope we’ll offer it regularly now,” says Dave. “We all know at least a couple of people who’ve had Q fever.”

Meanwhile, the Hartley branch has matched a community grant of $500 from the local Family First Credit Union with $500 from its coffers. Branch chair Rachel Nicoll says they aim to offer vaccination programs in the new year with the University of Notre Dame assisting with testing and vaccinating. “We’re also hoping they’ll do a study into our incidence rates as data is difficult to get and hasn’t been updated for a while,” Rachel says.

NSW Farmers secure funding for Q fever research

The Q fever organism is so virulent and so capable of withstanding heat and cold it has been classified as a category B biological weapon and potential terrorist threat.

No wonder then it’s long been a hot topic for Alexandra Bunton (pictured left), NSW Farmers’ senior policy advisor – cropping and horticulture. She’s delighted to see so many branches being proactive.

As well as lobbying the state to put up money for a Q fever awareness campaign, training for GPs and $200,000 towards research into a new vaccine currently being conducted by Dr Stephen Graves, NSW Farmers has also signed onto a project proposal to the National Health and Medical Research Council to conduct clinical trials on vaccinating 10-14-year-olds.

  "At the moment the only way to protect kids is with protective equipment or by not letting them take part in calving or lambing which isn’t feasible,” says Alexandra. 
Thanks to NSW Farmers, both of the state’s main political parties have accepted that Q fever is an issue that needs to be addressed, says Alexandra. While farm workers are most at risk, the disease has also been found in a two-year-old child who went to a travelling petting farm on the Gold Coast and art gallery staff who caught the disease from packing straw. 

However, other states need to get on board and Alexandra is keen to see governments fund vaccination clinics until the new vaccine is commercialised.  And, of course, she wants to see all vaccines on the PBS. “It needs to be a long-term strategy from state and federal governments,” she says. “And it’s not at the moment.” Read more of NSW Farmers Policy Wins.

Q fever: the facts
By: Dr Stephen Graves, medical director at the Australian Rickettsial Reference Laboratory- which is conducting research into a new vaccine for Q fever. 
The disease
Q fever is caused by the bacterium Coxiella burnetii. The organism is shed in large numbers when infected animals such as sheep, cattle and goats, give birth. However, many animals can carry and transfer Q fever to humans including cats, dogs, birds, native animals and ticks. The bacteria can survive in the soil for years and are blown around on dusty days.

The diagnosis
Australia has one of the highest reported rates of Q fever in the world – mostly in NSW and Queensland. It is estimated about 5% of Australians have been exposed. Although it’s a notifiable disease, it often isn’t reported because the symptoms – cough, lethargy, aches and pains – can be similar to conditions such as flu. If a GP doesn’t specifically test for Q fever, the diagnosis is missed.   

The complications
Most people recover from Q fever, especially with antibiotics. However about 3% develop a chronic version, which has a 30% mortality rate. It can affect the liver, heart and brain in adults and the bones in children, leading to osteomyelitis. About 15% develop post-Q fever fatigue syndrome, leaving them exhausted, depressed and unable to work.

The cost
Estimated medical costs stand at about $3,800 for each case of Q fever diagnosed and $20,500 for patients with chronic Q fever. Between 2002 and 2012, there were 177 workers compensation claims for Q fever in NSW with costs totalling more than $3.5 million.

The vaccine

Australia has the only Q fever vaccine in the world but it is difficult and time-consuming to administer. If a patient has already been exposed to the bacteria, it can cause a severe adverse reaction. It has not been tested on under-15s, but it has been given to at-risk children as young as two without ill effects.

Goats are known to be a carrier of Q fever. Photo by: Samara Harris.

How to organise your own Q fever vaccination clinic
Jenni Jackson explains how to organise one yourself

  1. Approach a local GP or medical centre and ask if they will be involved and agree dates – for a blood test and skin test, and then seven days later, if tests show no previous exposure to Q fever, for the vaccination. Coordinating through a medical practice is important as the doctor will have the necessary equipment and will be able to claim appointments through Medicare.
  2. Identify any local sponsors that might contribute to the cost and ask your local NSW Farmers branch to add a contribution.
  3. Advertise in the media and put notices up in shop windows to let everyone know what’s happening – why they should have the vaccine, what’s involved and when and where clinics are being held.
  4. Include the contact number of the local clinic so interested parties can book appointments and also a NSW Farmers contact for those requiring more information.​
Those most at risk of contracting Q fever

● Abattoir workers
● Agricultural, farm and dairy workers
● Stockyard workers
● Livestock transporters
● Shearers, wool classers, pelt and hide processors
● People exposed to cattle, camels, sheep,
goats and kangaroos or their products
● Veterinary and laboratory staff
● Dog and cat breeders
● Agricultural college staff and students
● Wildlife workers and volunteers
● Council/road workers who collect
dead animals from the roadside

Source: SafeWork NSW
The future for Q fever  A new vaccine has been developed by Dr Stephen Graves (pictured) which is much simpler to administer. However, $500,000 is required just to finish the animal testing and so far only $200,000 funding has been received from the NSW government. With adequate funding, the vaccine could be available in four-to-five years. Confident of its success, Dr Graves intends being the first human to have it. 

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