Event highlights
On 15 July 2025, the WHO Country Office in Bulgaria supported the Bulgarian Ministry of Health’s National Centre of Infectious and Parasitic Diseases (NCIPD) in their efforts to identify and prevent Q fever through the facilitation of a webinar.
Q fever is transmitted by Coxiella burnetii bacteria from animals (i.e. goats, sheep and cattle) to humans. The webinar – attended by nearly 100 individuals from the health-care and zoonotic sectors in Bulgaria involved in the transmission, surveillance, prevention and control of diseases spread between animals and humans – was co-facilitated by the WHO Collaborating Centre for Laboratory Preparedness and Response for High Threat Pathogens and Biorisk, Netherlands’ (Kingdom of the) National Institute for Public Health and the Environment (RIVM) and Royal GD, a Netherlands-based organization in animal health.
Technical specialists from RIVM provided an overview of the laboratory diagnosis of Q fever within the One Health context – namely, the interconnections between human, animal and environmental dimensions. The webinar held a special focus on the risk to refugees exposed to livestock during migration and resettlement, with poor living conditions and limited access to health care and a general practitioner – a commonly reported barrier among refugee populations – potentially further delaying identification and treatment. In Bulgaria, the increase in migrants from Ukraine due to the ongoing conflict, as well as from Afghanistan, north Africa and the Syrian Arab Republic, increases the risk of Q fever and highlights the need for the timely identification of disease outbreaks as a first line of defence in population safety and health.
The RIVM shared their experiences with the prevention and control of the largest recorded Q fever outbreak in the world, from 2007–2011 with 4000 cases reported (although estimates are much higher), linked to transmission from dairy (i.e. goat and sheep) farms to humans through the inhalation of contaminated air. The RIVM presented their structure of 5 key centres working on infectious disease control through prevention, preparedness and response. The presentation highlighted that the bacterium causing Q fever, Coxiella burnetti, is a biosafety level 3 pathogen, which requires that sufficient preventive measures are in place to prevent microorganisms from being released into the environment, which cause incidents, accidents and contamination. A focus on biosafety and polymerase chain reaction (PCR) laboratory measures is essential in diagnosing bacterium transmission from animals to humans. The presentation also included a discussion around serum as the best material to test acute Q fever – through both PCR and serology, depending on the timing – identifying the advantages of each testing method, as well as the risk for false positives and the need for good negative controls.
The webinar presented the Netherlands’ experience with farm-based sampling, including compulsory vaccination, the culling of pregnant animals with positive Coxiella burnetti, as well as the collection of samples taken on farms by both PCR and sample testing laboratories, including the annual testing of bulk milk sampling. These surveillance methods supported reductions in animal and human cases over time.
The collaboration between WHO and the Bulgarian Ministry of Health to evaluate and improve diagnostic testing, techniques and algorithms enables an interdisciplinary approach for improvement based on real-life experiences. In Bulgaria, Q fever outbreaks have been sporadic, identified in the Yambol region (2020) and the Gabrovo region (2023), detected both in farm and human cases.
The knowledge sharing from RIVM and Royal GD during the webinar will provide Bulgaria with valuable support and expertise to safeguard public health at large, strengthening the diagnosis and outbreak response strategies and surveillance and diagnostic protocols for Q fever management.
The webinar is part of WHO/Europe’s wider Better Labs for Better Health initiative and is held under the support of the Asia-Europe Foundation (ASEF) and in coordination with the Embassy of Japan in Bulgaria.
Event notice
The WHO Country Office in Bulgaria will host a webinar on Q fever, a zoonotic disease caused by the Coxiella burnetii bacteria, which naturally infects animals such as goats, sheep and cows through urine, feces, birthing products and milk. Human infection can occur when breathing in contaminated dust from these animals. While this is of the highest concern for farmers, veterinarians and laboratory or staff working with animal samples, it is additionally a concern among refugee populations due to limited access to health-care services and thus delayed diagnosis, possible reduced immunity due to coinfections or other vulnerabilities, language and cultural barriers as well as exposure to livestock. Equally important is the risk among pregnant women and people with reduced cardiovascular functioning.
The webinar will take place on 15 July 2025, hosted and facilitated by the WHO Country Office in Bulgaria and Bulgarian Ministry of Health, with support from the Netherlands (Kingdom of) National Institute for Public Health and the Environment (RIVM). The webinar is part of WHO/Europe’s wider “Better Labs for Better Health initiative”.
The webinar is held under the support of the Asia-Europe Foundation (ASEF) and in coordination with the Embassy of Japan in Bulgaria.