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Glen is a cattle farmer on a property just outside of Tamworth. He rarely visits the doctor but has booked an appointment to see you (his GP) as his wife has been urging him to be vaccinated against Q fever. After ascertaining that he has not been vaccinated or had Q fever in the past you explain the need for pre-vaccination testing. Glen asks if he can just get the vaccine anyway while he is here. He has never been sick before. It is difficult for him to leave the farm he is not able to come back next week.
A: You advise Glen that he may experience a serious reaction if you get the vaccine when you have already been exposed to the bacteria. It is quite possible that he may have been exposed to Q fever but not experienced any symptoms. He is at high risk of Q fever infection as a cattle farmer and may become very unwell if infected with Q fever. It is important that he is vaccinated as early as possible if he found to be nonimmune.
Glen remains unconvinced. He wants to know why he needs to have both the skin test and the blood test. He is unable to return for at least a fortnight as he will be busy branding cattle.
A: It is important to test for both humoral and cell mediated immunity. Detectable antibodies may decline at a quicker rate than cell mediated immunity. You explain to him that the skin test and the blood test are both needed because immunity can wane over time. The skin test and the blood test are looking at different types of immunity. One test may be positive and the other negative. Glen cannot be vaccinated if either test is positive. You advise him that if he was to become infected with Q fever he may be forced to take some time off work. Some people with Q fever require extended time periods (months) of work. This would have a significant impact on his life and that of his family. Glen should reschedule another appointment the earliest he can make the 2 appointments.
Reproduced by permission, NSW Health © 2019