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Biosecurity BriefingLarge Q Fever Epidemic Ongoing in the NetherlandsBy Kunal Rambhia, August 18, 2008 On July 31, 2008, Eurosurveillance published a study about an ongoing Q fever outbreak in the Netherlands; as of July 24, 677 cases have been reported this year. In past years, relatively few cases of Q fever were reported in the Netherlands, with 5-16 cases per year between 1997 and 2006. This year’s outbreak is by far the largest ever recorded in the Netherlands.1 The sharp increase of cases from 2007 to 2008 can be partially explained by “an increased awareness of Q fever” among the scientific and healthcare communities. However, when all factors are considered—the increased case numbers, the “widespread pattern” of infections, and the observed increase in the number of patients experiencing symptoms, especially pneumonia—this situation is described as alarming.1 Q fever is caused by the bacterium Coxiella burnettii, which commonly infects cattle, sheep, goats, and other wild and domesticated animals. Humans become infected by inhaling aerosols that are contaminated with the bacteria. Common symptoms of Q fever include; fever, pneumonia and/or hepatitis, fatigue, night sweating, headache, and general malaise. Approximately 40 percent of infections result in symptoms, but there is a significant risk to pregnant women who are infected regardless of the presence of observable symptoms.1 Clinical diagnosis of Q fever is confirmed by PCR as well as by two other laboratory tests. While the cause of the current outbreak has not yet been identified, the size and geographic spread of the case reports points to multiple sources. Case reports in the Netherlands have been particularly high in regions with large numbers of dairy goats. The Dutch Ministry of Agriculture has responded to the epidemic by initiating a number of control measures including enhanced surveillance and reporting, a ban on the spread of manure when infection is confirmed, and restricted visitation to farms. In addition, an international expert meeting was held on July 22nd to address issues such as the need to screen pregnant women for Q fever, and a ban on blood donations from affected regions. The authors hope that “through this paper [they will] raise awareness of this problem and inspire colleagues from other European countries to report whether they have observed similar increase[s] in Q fever case numbers and share their experience.” References
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