Attitudes and barriers to Q fever vaccination in the Australian veterinary workforce Emily Sellens a , Navneet Dhand a , Katrina Bosward a , Jacqueline Norris a , Jane Heller b , Lynne Hayes b , Heather Gidding c,d , Nicholas Wood c,e a Faculty of Veterinary Science, the University of Sydney NSW 2006. b School of Animal and Veterinary Sciences, Charles Sturt University, Locked Bag 588, Wagga Wagga NSW 2678. c National Centre for Immunisation Research and Surveillance, Locked Bag 4001, Westmead NSW 2145. d School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, NSW 2052. e Discipline of Paediatrics and Child Health, Sydney Medical School, the University of Sydney NSW 2006. Background Q fever is a serious zoonotic disease in people with sequelae including hepatopathies, atypical pneumonia, chronic Q fever fatigue and endocarditis. The causative agent, Coxiella burnetii, is a small, intracellular, gram-negative bacterium shed from host species in bodily fluids, most significantly at parturition, with inhalation the most common route of infection. A wide variety of domestic and wild animal species act as reservoirs for Q fever, however domestic livestock (cattle, sheep and goats) have traditionally been considered the major source of infection for humans. Generally Q fever is considered primarily a disease of production animal workers and rural communities, however many notified cases in Australia have no known association with livestock risk factors 1, 2 . Additionally, seroprevalence for C. burnetii was found to be similar between people in rural and metropolitan areas of Queensland 3 which may be attributed to exposure from a range of domestic and wildlife species. Tozer and colleagues (2013) reported detection rates among horses in Queensland of 11.9% while prevalence in cats, dogs, flying foxes, kangaroos and koalas ranged from 5.1-7.8% 4 . Such studies propose that Q fever may be under-diagnosed in populations considered at low risk, and suggest a need to view the potential for C. burnetii transmission through a wider lens, in order to avoid the current myopic view that results in an overly narrow focus on production animals. All veterinary workers in Australia should be considered at risk of contracting Q fever regardless of their species focus. Both the current (2013) Australian Immunisation Handbook 5 and the Australian Veterinary Association Biosecurity Guidelines 6 recommend Q fever vaccination (Q-Vax®, CSL Biotherapies, Parkville, Vic) for all veterinarians, veterinary students and veterinary nurses. Currently vaccination is routinely administered to veterinary students at some but not all domestic veterinary schools. Outside of this tertiary environment, Q fever vaccination may be recommended or provided by employers or actively sought by veterinary workers. Despite the availability of vaccination, a recent study found Q fever to be the second most common zoonosis reported among Australian veterinarians 7 , highlighting a potential shortfall in the uptake of Q fever vaccination among this cohort. This raises questions regarding uptake by other veterinary workers, such as nurses, who remain relatively under-studied. It is essential to understand who in this workforce is vaccinated and why, so that recommendations can be made to improve vaccination uptake where necessary.