The aim of the study presented here was to describe the different epidemiological methods used to investigate an outbreak
of Q fever that occurred in the spring of 1996 among inhabitants of Briançon, a small town in the French Alps. Three approaches
were used: (i) a comparison between a 2-month exhaustive serological survey among blood donors and a retrospective serological
survey performed on frozen plasma collected by the transfusion centre in the spring of 1995; (ii) a serological survey performed
in the general population by cluster sampling, using dried blood on blotting paper; and (iii) a case-control study. A total
of 29 cases of acute Q fever were diagnosed by physicians during hospitalisations of the patients or ambulatory care. The
case-control study suggested that the outbreak resulted from airborne transmission of contaminated sheep waste, which had
been left uncovered in the slaughterhouse area. Such transmission may have been facilitated by the nearby heliport. The comparison
between the cumulative incidence of Q fever among blood donors during the spring seasons of 1995 and 1996 confirmed the outbreak
(0.38% vs. 2.58%, respectively;
P<0.0001). Health authorities promptly decided to close the slaughterhouse. The use of complementary epidemiological methods
allows investigators to focus on major issues related to an outbreak: timely detection of cases, identification of the source,
estimations of incidence, and public health intervention. Rapid recognition and management of outbreaks in the general population
of a rural region need to be improved, particularly at a time when airborne agents could be used as biological weapons.
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