Q FEVER vaccinations should be subsidised by the Federal Government and more funding is needed to finalise development of a new vaccine for the debilitating condition, according to a leading researcher.

Dr Stephen Graves

After Victoria recently reported an increase in Q Fever cases, medical director at the Australian Rickettsial Reference Laboratory, Dr Stephen Graves said he believed the true incidence of Q Fever is underreported.

Victoria’s acting chief health officer David Lister said suitable weather conditions last year, or the movement of infected animals, may have contributed to the recent increase in reported Q Fever cases.

Dr Graves said in rural parts of Australia the seroprevalence rates – the percentage of the population with antibodies to Coxiella burnetii indicative of prior exposure to this bacterium and likely past Q fever – are much higher that the official notification rates for Q Fever.

“This is backed up by anecdotal reports of Q Fever being mis-diagnosed in patients because it is a difficult infection to differentiate from other, similar infections.

“Yes, I am of the view that the true number of Q Fever cases is higher than those officially notified, but I do not know by how much,” he said.

Dr Graves said in rural and regional Australia only some doctors offer the vaccine because it is difficult to use in a normal GP clinic.

“The current vaccine (Q-VAX) requires at least two trips to the doctor; the first to have the skin test and the blood test done and the second for the actual vaccine to be given.

“The patient must return exactly seven days after the skin test injection to have it read by the doctor,” he said.

“This can often be difficult for a patent working on the land and a long distance from the doctor.”

He said the current Q Fever vaccine is expensive, including the cost of two doctor visits, the vaccine and the pathology (blood) test.

“The total cost may be in the order of $300 per person.

“This is too much for some people and discourages them from having the vaccine, even though they may be at risk of Q Fever,” he said.

“For employees, the employer may be discouraged from paying out so much to vaccinate employees when they may only stay for a short while and then move on.”

“Because the Commonwealth government pays for virtually all other vaccines, from birth to old age, it is illogical that this vaccine is not free also,” Dr Graves said.

“I would suggest that a financial allocation be made to each rural and regional local government area for this purpose.

“They would then negotiate with a local medical practice to provide the vaccines, say, every 2nd or 3rd week to the local community.”

Dr Graves said the main problem is that the current Q-VAX is a very reactogenic vaccine and for this reason the pre-vaccination testing of the patient is essential, which adds costs and difficulties.

“A less reactogenic vaccine is needed.

“The Australian Rickettsial Reference Laboratory is developing such a vaccine that could be given to people without pre-testing. Unfortunately we need more money to proceed with its development.”

More vaccine research funding is needed

Dr Graves said the laboratory has been working on a new human Q Fever vaccine for the past five years and is seeking funding to carry out a further three years study of the new vaccine in guinea pigs.

“These are the best laboratory animals for this work as they develop acute Q Fever similar to humans when infected with Coxiella burnetii.”

Dr Graves said the laboratory expected to be doing this work at the Elizabeth Macarthur Agricultural Institute in Menangle in New South Wales, and an agreement between the NSW Department of Primary Industries and the laboratory is currently being drawn-up.

“We need to use their PC-3 facilities to grow the bacterium to make the vaccine and to infect experimentally vaccinated guinea pigs to test the vaccine’s efficacy.

“We need $500,000 as a minimum for this part of the work, so the NSW Health Department $200,000 will only go part way towards the costs,” Dr Graves said.

“Once we know for sure that the new vaccine works in guinea pigs and is safe in previously-exposed guinea pigs, then we will go into phase 1 human trials. Further funding will be required for this.”

Dr Graves said preliminary studies conducted in Newcastle suggest that the vaccine is effective and safe in guinea pigs, but more funding and better data is needed.

“This new human Q fever vaccine would not require patients to be pre-tested, so no blood or skin test will be required prior to vaccination, unlike the situation with Q-VAX.”

AgForce supports a Q Fever vaccine subsidy and more funding

AgForce policy director Ruth Thompson supported Commonwealth subsidisation of Q Fever vaccinations and the granting of further funding to to develop the new vaccine.

Anything that is going to drive healthier outcomes for people in the bush is a no-brainer.

“And it is not just people in the bush; it is people that engage with animals,” she said.

She said there is obviously some issues with the “clunkiness” of the existing vaccine, including the pathology tests required, the loss of productivity in doctor visits, the cost and availability.

“It is very costly for a lot of people.”

Ms Thompson said has been an increase in the number of Q Fever cases among hobby farmers.

“And you’ve got a lot of people entering industry that might not have in-depth knowledge in regards to Q Fever.

“So often there would be a lot of unreported cases and a lot of people who are handling livestock now who traditionally have not come from an agricultural background and might not understand what they are dealing with.”

Ms Thompson said she hoped international and Australian researchers attending the nation’s first Q Fever Symposium is being held in Byron Bay in July would address many of the issues.

“And probably highlight the need for funding just to finish these things off – we’re so close.

“When you think that $1.2 million dollars is probably all they need to implement human trials and have it all completed,” she said.

“$1.2 million dollars is probably not a lot of money when you consider the lost productivity of people getting sick from this disease.”