Dr Koen de Schrijver, Health Inspector, Antwerp, Belgium.
Epidemiologisch bulletin van de Gezondheidinspectie van de Vlaamse Gemeenschap, 1995, (2) January.
In March 1994, health authorities in Antwerp, Belgium, were informed that a member of a team of 15 customs officers had developed psittacosis. The customs officer concerned had been admitted to hospital with pneumonia 10 days after exposure to parakeets that had been imported illegally by an Indian sailor.
The 15 customs officers who had possibly been exposed to the birds were surveyed using a telephone questionnaire. A probable case of psittacosis was defined by a history of clinical atypical pneumonia. A confirmed case was defined by the isolation of Chlamydia psittaci or seroconversion. C. psittaci was identified at the zoological centre laboratory by the Stamp colouration reaction and antibody levels were measured by complement fixation.
The first patient was a 54 year old customs officer admitted to hospital with atypical pneumonia, who developed antibodies against C. psittaci. Six other officers, who had been in contact with the birds while they were held in the customs office, developed atypical pneumonia. Two cases of psittacosis were confirmed serologically. The attack rate was 47% (7 of 15). The risk of contracting psittacosis was 2.8 times higher in officers exposed for more than 2 hours to parakeets than for those briefly exposed (Fisher’s exact test p = 0.03).
Necropsy of one of the parakeets revealed pericardial lesions typical of C. psittaci infection. It is thought that the customs officers handled the birds without adequate protection, increasing their risk of acquiring the infection. Preventive measures to avoid future outbreaks have been implemented: customs officers have received health education; procedures have been developed for handling, transporting and captivity of confiscated birds; protective clothing has been supplied for customs officers at risk of potentially infectious contact; and medical surveillance of officers was strengthened in collaboration with occupational health services.
This outbreak is a reminder of the infectivity of C. psittaci. The results of the survey emphasise the need for notification and close collaboration between clinicians, epidemiologists, and zoologists.