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The public health importance of vaccination against<jats:italic>C.\u00a0burnetii<\/jats:italic>shedding from sheep and goats was evaluated using systematic review and meta\u2010analysis to provide evidence for policy direction to prevent potential zoonotic spread. Publications reporting shedding of<jats:italic>C.\u00a0burnetii<\/jats:italic>in vaginal and uterine secretions, milk, placenta and faeces were included. A single observational (one goat) and seven experimental (four goat and three sheep) vaccine studies were included in the review. No relevant publications on other interventions were identified. Random effects meta\u2010analyses were performed for the risk of shedding in individuals in the control and vaccinated groups and for the mean difference in the level of bacterial shedding in sheep and goats stratified by age and previous exposure status. Limited data were available for further analytic evaluation. From the pooled analysis, an inactivated phase I vaccine significantly reduced the risk of shedding from uterine (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.10; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.05\u20130.20) secretions in previously sensitized goats. Individual studies reported significant risk reduction in milk (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.03; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.01\u20130.26), vaginal secretions (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.40; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.22\u20130.75) and faeces (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.79; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>0.63\u20130.97) from na\u00efve goats. The pooled mean levels of bacteria shed from placental [mean difference (<jats:styled-content style=\"fixed-case\">MD<\/jats:styled-content>\u00a0=\u00a0\u22125.24 Log<jats:sub>10<\/jats:sub>; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u22126.75 to \u22123.7)] and vaginal (<jats:styled-content style=\"fixed-case\">MD<\/jats:styled-content>\u00a0=\u00a0\u22121.78 Log<jats:sub>10<\/jats:sub>; 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u22122.19 to \u22121.38) routes were significantly decreased in vaccinated na\u00efve goats compared with controls. Shedding through all other routes from vaccinated goats was not significantly different than shedding from control goats. No effect of vaccination was found on the risk of shedding or the mean level of shedding in vaccinated sheep compared with control sheep. Our conclusions are based on a limited amount of data with variable risk of systematic error.<\/jats:p>","DOI":"10.1111\/zph.12086","type":"journal-article","created":{"date-parts":[[2013,11,19]],"date-time":"2013-11-19T14:17:48Z","timestamp":1384870668000},"page":"519-533","source":"Crossref","is-referenced-by-count":24,"title":["A Systematic Review and Meta\u2010Analysis of Phase I Inactivated Vaccines to Reduce Shedding of<i>Coxiella burnetii<\/i>From Sheep and Goats From Routes of Public Health Importance"],"prefix":"10.1111","volume":"61","author":[{"given":"T. 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