Netherlands - Q fever outbreak - 20+ deaths

[Gert van der Hoek]

Re: Netherlands - Q fever outbreak - 18 deaths

Source: http://www.examiner.com/infectious-d...reak-continues

The Netherlands: Q Fever outbreak continues
* February 12th, 2011 7:50 pm ET

The outbreak that started in 2007 continues into its fifth year in the Netherlands. As of Feb. 2, there were 8 more confirmed cases so far in 2011.

Since 2007, there have been greater than 4,000 cases and several deaths, including 11 deaths in 2010...

"Outbreak continues " , some thoughts:

- The "Q-fever" bacteria (Coxiella Burnettii) is a very persistent bacteria, once in the environment it can survive for years. You can find it almost everywhere, including in cities, schools, postoffices etc., according to research in the USA.

- The shedding of the CB bacteria in the Netherlands has (almost) stopped because of vaccination of all dairy goats and sheep.

-In 2011 untill now 10 new cases were reported; in 2010 and 2009 at this time of year it was some 135.

- We don't know what the baselevel of Q-fever infection is. Q-fever is a neglected disease, all over the world. After 4000+ cases and 20+ deaths Dutch doctors know now they have to check for Q-fever in some cases. So if you look for it, you will find it.

- Serosurveillance showed the % of Dutch with Q-fever antibodies went down from ca 50% 30-40 years ago to ca 2% or 3% today. People seem to have become more vulnerable?

- It could very well be the outbreak has stopped and the cases we see now are "base level".

- You can't draw any conclusions on the basis of a number of 10 cases.

- Most infections are during May and June; last year - 2010 - 506 cases were reported; in 2009 it was more than 2350 cases. Some graphs here.

- You can't say in february: "the outbreak continues" ; we will know more in June.

[Gert van der Hoek]

Re: Netherlands - Q fever outbreak - 18 deaths

Epidemiol Infect. 2011 Feb 16:1-9.

Low seroprevalence of Q fever in The Netherlands prior to a series of large outbreaks.

Schimmer B, Notermans DW, Harms MG, Reimerink JH, Bakker J, Schneeberger P, Mollema L, Teunis P, VAN Pelt W, VAN Duynhoven Y.

Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.

Abstract

SUMMARY - The Netherlands has experienced large community outbreaks of Q fever since 2007. Sera and questionnaires containing epidemiological data from 5654 individuals were obtained in a nationwide seroprevalence survey used to evaluate the National Immunization Programme in 2006-2007.

We tested these sera for IgG phase-2 antibodies against Coxiella burnetii with an ELISA to estimate the seroprevalence and to identify determinants for seropositivity before the Q fever outbreaks occurred. Overall seroprevalence was 1?5% [95% confidence interval (CI) 1?3-1?7].

Corrected for confirmation with immunofluorescence results in a subset, the estimated seroprevalence was 2?4%. Seropositivity ranged from 0?48% (95% CI 0?00-0?96) in the 0-4 years age group to 2?30% (95% CI 1?46-3?15) in the 60-79 years age group.

Keeping ruminants, increasing age and being born in Turkey were independent risk factors for seropositivity.

The low seroprevalence before the start of the outbreaks supports the hypothesis that The Netherlands has been confronted with a newly emerging Q fever problem since spring 2007.

pubmed

[Gert van der Hoek]

Re: Netherlands - Q fever outbreak - 20+ deaths

Q-Fever update

On may 12 the number of Q-Fever patients reported in 2011 in the Netherlands was 41, including 1 fatality. The patient who died had chronic Q-fever, was infected in a previous year and underlying medical problems according to the RIVM (= Dutch CDC).

This number of patients seems to be close to the "base level" .

Last year on may 12 307 patients were reported, compared to 367 patients in 2009 during the same period.

RIVM - Link to graph

[Shiloh]

Re: Netherlands - Q fever outbreak - 20+ deaths

Source: http://www.dutchnews.nl/news/archive...ached_at_l.php

Q-fever death toll reached at least 24
Wednesday 29 February 2012

The number of people killed by Q-fever, a flu-like illness which mainly infects sheep and goats, was at least 24, the head of the public health institute RIVM told television current affairs show Nieuwsuur on Tuesday.

The previous official death toll stood at 19.

The outbreak of Q-fever began in 2007...

[Gert van der Hoek]

Re: Netherlands - Q fever outbreak - 20+ deaths

Q-fever victims to sue government for compensation

Thursday 05 July 2012

Some 400 people who became infected with the sheep and goat disease Q-fever during the recent epidemic are planning to sue the government for damages, lawyer Luc Rohof told television show Nieuwsuur.

Nieuwsuur also accuses ministers of misinforming parliament about the epidemic, which killed at least 25 people.

Brabant health chief Jos van de Sande told the programme: 'The cabinet is trying to keep its street clean but the problems keep on piling up.'

The cabinet has set aside ?10m to support people who became ill, but is not willing to set up a compensation fund, despite serious criticism of its position from the national ombudsman about the way it handled the epidemic.

Chronic conditions

Hundreds of people are said to still have chronic health problems since the outbreak which ended two years ago. Q-fever was a serious problem on Dutch goat farms between 2007 and 2010. Over 40,000 goats were killed in an effort to eradicate the disease.

The national ombudsman Alex Brenninkmeijer said last month the government had failed to take the outbreak seriously and was too slow to react. He also said ministers should apologise to victims and pay them reasonable compensation.

In February, it emerged a number of victims are also in the process of suing the goat farms where they became infected.

Dutch News

[Gert van der Hoek]

Re: Netherlands - Q fever outbreak - 20+ deaths

Screening for Coxiella burnetii seroprevalence in chronic Q fever high-risk groups reveals the magnitude of the Dutch Q fever outbreak


SUMMARY
The Netherlands experienced an unprecedented outbreak of Q fever between 2007 and 2010. The Jeroen Bosch Hospital (JBH) in 's-Hertogenbosch is located in the centre of the epidemic area.

Based on Q fever screening programmes, seroprevalence of IgG phase II antibodies to Coxiella burnetii in the JBH catchment area was 10?7% [785 tested, 84 seropositive, 95% confidence interval (CI) 8?5?12?9]. Seroprevalence appeared not to be influenced by age, gender or area of residence. Extrapolating these data, an estimated 40 600 persons (95% CI 32 200?48 900) in the JBH catchment area have been infected by C. burnetii and are, therefore, potentially at risk for chronic Q fever.

This figure by far exceeds the nationwide number of notified symptomatic acute Q fever patients and illustrates the magnitude of the Dutch Q fever outbreak. Clinicians in epidemic Q fever areas should be alert for chronic Q fever, even if no acute Q fever is reported.

(Accepted May 22 2012) - Epidemiology and Infection