To the Editor: Q fever is a zoo-nosis caused by infection with Coxi-ella burnetii and is most commonly associated with occupational expo-sure to animal-slaughtering facilities. C. burnetii is an obligate intracellular bacterium and causes highly variable disease, ranging from asymptomatic infection to fatal chronic infective en-docarditis. In June 2006, the United Kingdom experienced its largest out-break of Q fever with 138 cases asso-ciated with a slaughterhouse near Stir-ling in Scotland. The slaughterhouse had been processing post-parturition ewes in the lairage (place for keep-ing livestock temporarily) at the end of May. These animals were thought to be among the most likely to shed the organism (1). Further investiga-tion showed that a ewe had aborted in the lairage toward the end of May. Al-though the sheep lairage was the most likely source of the infection, no mi-crobiologic evidence confi rmed this, as C. burnetii was not isolated from environmental samples.The outbreak was neither remark-able for its putative mode of transmis-sion nor for the industry involved, but both the number and nationalities of migrant workers infected was note-worthy. Since 2004, 12 member states have joined the European Union and this has led to an in. ux of immigrants to the United Kingdom. The increase in migrant numbers has partly been a result of the government's managed migration policy, expanding migration to fi ll vacancies in skilled and low-wage occupations. Employers have diffi culty recruiting UK workers be-cause of the jobs' physical demands, long hours that limit social activities, and low pay. They therefore recruit in-ternational workers with a good work ethic and reliability; central and East-ern European workers are compared favorably with UK nationals (2). Mi-grants from Eastern and central Eu-rope are now more likely to be found in low-wage occupations in agricul-ture, construction, hospitality, and au pair employment. Of the 138 cases of Q fever, 48 were immigrants from the following countries: Slovakia (41), Poland (3), Czech Republic (2), and Lithuania (2). Unsurprisingly, epide-miologic case interviews were beset with linguistic and logistic problems
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