Date Published: March 31, 2017
Publisher: Public Library of Science
Author(s): Gudrun S. Freidl, Ineke T. Spruijt, Floor Borlée, Lidwien A. M. Smit, Arianne B. van Gageldonk-Lafeber, Dick J. J. Heederik, Joris Yzermans, Christel E. van Dijk, Catharina B. M. Maassen, Wim van der Hoek, Christophe Leroyer.
Previous research conducted in 2009 found a significant positive association between pneumonia in humans and living close to goat and poultry farms. However, as this result might have been affected by a large goat-related Q fever epidemic, the aim of the current study was to re-evaluate this association, now that the Q-fever epidemic had ended. In 2014/15, 2,494 adults (aged 20–72 years) living in a livestock-dense area in the Netherlands participated in a medical examination and completed a questionnaire on respiratory health, lifestyle and other items. We retrieved additional information for 2,426/2,494 (97%) participants from electronic medical records (EMR) from general practitioners. The outcome was self-reported, physician-diagnosed pneumonia or pneumonia recorded in the EMR in the previous three years. Livestock license data was used to determine exposure to livestock. We quantified associations between livestock exposures and pneumonia using odds ratios adjusted for participant characteristics and comorbidities (aOR). The three-year cumulative frequency of pneumonia was 186/2,426 (7.7%). Residents within 2,000m of a farm with at least 50 goats had an increased risk of pneumonia, which increased the closer they lived to the farm (2,000m aOR 1.9, 95% CI 1.4–2.6; 500m aOR 4.4, 95% CI 2.0–9.8). We found no significant associations between exposure to other farm animals and pneumonia. However, when conducting sensitivity analyses using pneumonia outcome based on EMR only, we found a weak but statistically significant association with presence of a poultry farm within 1,000m (aOR: 1.7, 95% CI 1.1–2.7). Living close to goat and poultry farms still constitute risk factors for pneumonia. Individuals with pneumonia were not more often seropositive for Coxiella burnetii, indicating that results are not explained by Q fever. We strongly recommend identification of pneumonia causes by the use of molecular diagnostics and investigating the role of non-infectious agents such as particulate matter or endotoxins.
In the Netherlands, the number of intensive livestock farms doubled within the first decade of the 21st century . Although the total number of farms has decreased over the past decades, the number of farm animals has increased . This trend has raised concern about potential negative health effects on residents living close to intensive livestock farms. The debate between civil groups opposed to intensive livestock farming, the farming sector and policy makers was further fueled by the recent Q fever epidemic that occurred between 2007 and 2009 in the southern part of the Netherlands . Caused by the zoonotic bacterium Coxiella burnetii, this epidemic resulted in more than 4000 notified human cases, mostly presenting as pneumonia . Aborting dairy goats and dairy sheep were found to be the main cause of infection in humans, who were infected through inhalation of contaminated dust or aerosols distributed via the airborne route. Human cases started to decrease in 2010 in the Netherlands, coinciding with the introduction of veterinary interventions comprising of culling of pregnant goats and sheep on Q fever positive farms and vaccination of dairy goats and dairy sheep [3, 5]. Since the start of this vaccination campaign in early 2009, farms with at least 50 sheep or goats are obliged to vaccinate, which is strictly reinforced .
In this study in non-farming adults from the general population, we found that the presence of goat farms near the home was strongly positively associated with pneumonia, with increasing odds the closer the residence was located to the farm. Remarkably, the present study investigated the occurrence of pneumonia between 2012 and 2015, whereas similar results were found in a study conducted during a Q fever outbreak in 2009 . A positive test for antibodies against Coxiella burnetii was not associated with pneumonia. The magnitude of the association between the presence of a poultry farm within 1000m and pneumonia was comparable to previous findings when using EMR-recorded pneumonia as an outcome. No associations between other animal farms/ types and pneumonia was found.