Netherlands - Q fever outbreak - 20+ deaths

[Gert van der Hoek]

Same region as last year. It seems more patients this year.

On Dutch Radio a patient told he was just walking in the country with friends, when he got infected. GP did not recognize it. The man himself looked on internet to find out he had Q-fever. Tests confirmed it.
He did not come near goats or sheep, however he walked near farms. The bacterium probably was airborn, spread by inhaled dust.

Problem is: Q-fever is not a disease which has to be reported.



machinetranslated

Explosive increase Q-fever reported

DEN BOSCH - The number of reported cases of people with Q-fever rises in Brabant explosive. Until yesterday received the Public Health Service Hart for 58 Brabant reported. The patients come from all over Brabant [province], with a concentration east of Den Bosch.

Q fever comes particularly from goats, sheep and cattle to humans. The bacterium can cause serious long-term flu-like damage. The Public Health Service warns against panic, stressing that not everybody gets complaints.

Until last year nationwide were about twenty people per year Q-fever. In Herpen broke last year from an epidemic. 76 people were sick. What caused the rise this year, the Public Health Service can not say. It could be due to more infected animals or by following the outbreak last year of sick people more quickly examined at Q-fever.

The Public Health Service considers it important for public health that the government takes measures, including establishing a notification requirement for companies where Q-fever prevails.

http://www.deondernemer.nl/artikel/542899/Explosieve_stijging_meldingen_Q-koorts_

Q fever is a zoonotic disease caused by Coxiella burnetii, a species of bacteria that is distributed globally. In 1999, Q fever became a notifiable disease in the United States but reporting is not required in many other countries. Because the disease is underreported, scientists cannot reliably assess how many cases of Q fever have actually occurred worldwide. Many human infections are inapparent.

Only about one-half of all people infected with C. burnetii show signs of clinical illness. More information on Q-fever here:

http://www.cdc.gov/ncidod/dvrd/qfever/

.

[Shiloh]

Re: Netherlands: new outbreak of Q fever

Q fever occurs in Iowa as well according to this article

Source: http://www.zwire.com/site/news.cfm?n...d=130069&rfi=6

Q Fever makes an appearance

REGIONAL -- Local health officials are cautioning local residents about the presence of Q Fever in the community, as several patients have been identified and treated through Myrtue Medical Center.
"Recently, several cases of Q Fever have been identified in our area, and we would like to provide some information about the disease and sources of additional information," said Myrtue Medical Center Community Health Director Vickie Gillespie.
Q Fever is caused by bacteria, which can not only be found in the environment but in livestock and wildlife populations. Cattle, sheep and goats are the primary reservoirs of the bacteria.
Cases of Q Fever occur in both the animal and human populations every year in Iowa. Humans can become infected when they breathe in dust contaminated by the bacteria. This typically occurs in barnyards or other areas where dried placental material, birth fluids and animal feces are found.
Approximately 60 percent of people exposed to the bacteria will never get sick. Most patients who do become ill will have mild, flu-like symptoms within two-three weeks of exposure.
Less than one percent can have more serious complications, which most commonly occur in people with heart valve conditions, a weakened immune system or pregnant women.
Symptoms include high fevers, severe headache, general malaise, confusion, sore throat, chills, sweats, cough, nausea, vomiting, diarrhea, abdominal pain and chest pain.
The fever can last from one-two weeks, and pneumonia can occur up to 50 percent of the time in patients with Q Fever.
Patients will be treated with antibiotics.

[Gert van der Hoek]

Re: Netherlands: 2nd outbreak of Q fever

2nd recent outbreak of Q fever, this time from sheep owned by a psychogeriatric clinic, the sheep were in a field at the clinic.

machinetranslated

Date: May 13, 2008


Four persons of the MHC, location Nijmegen Baan, who with similar symptoms last week were included in the hospital, Q-fever. The Food Authority (VWA) examines whether the sheep in the area of setting the cause of the outbreak. Q fever is not life-threatening disease and to treat with antibiotics.

A final ruling on the outbreak of the infection can not yet be done. The Public Health Service is currently investigating whether there are more people infected.

Tomorrow examine the VWA together with the National Institute of Health and Environment (RIVM) the animals on which the people have been in contact. The results of this study are approximately two weeks. The owner of the animals, the animals placed in seclusion.


June 2, 2008

Update Q-fever psychogeriatric clinic:

until yesterday when the Public Health Service were 19 cases of Q fever known as well as 20 patients in whom the Q-fever had not yet been confirmed.

Today in this group was a new infection is confirmed, bringing the final number of infections now at 20. The number of patients in whom examining whether they actually Q-fever, is currently 21. All these cases can be traced to the psychogeriatric fields.

http://www.ggdnijmegen.nl/client/1/?websiteid=1&tpl=_nieuwsoverzicht.tpl

[Gert van der Hoek]

Re: Netherlands: 2nd recent outbreak of Q fever

Regional Health Service is expecting more human cases, from more sources:

http://www.trouw.nl/laatstenieuws/ln_binnenland/article1002805.ece/GGD_ziet_meer_haarden_voor_Q-koorts_in_Gelderland

[Gert van der Hoek]

Re: Netherlands: 2nd recent outbreak of Q fever

machinetranslated

Q-fever now is a notifiable disease. Farmers on infected farms should refrain from activities wich could spread dust.

Tue June 10, 2008,

Extra measures against spread Q-fever

THE HAGUE - The rise of Q-fever hits encounter Agriculture Minister Gerda Verburg additional measures. So is there a notification requirement for farmers with infected stables. Visit to stables of infected farms has been provisionally taboo, said the minister Tuesday.

Q fever is a flu disease transmissible from animals to humans could be transferred. In severe cases, people can reach pneumonia.

In the area between Den Bosch and Nijmegen, the number of infections with Q-fever in recent weeks has risen to 113.

The additional measures shall enter into force Thursday.

http://www.telegraaf.nl/binnenland/4200432/_Maatregelen_tegen_opmars_Q-koorts__.html

[Gert van der Hoek]

Re: Netherlands: possibly first Q fever death

machinetranslated

Fri Jun 27, 2008,

Possibly the first Q fever death

Sittard - In Limburg deceased is a man who was infected with Q fever. The elderly man had problems with the functioning of the heart valves, which sometimes by Q-fever can become inflamed, writes newspaper De Limburger.

It is not yet sure whether the man actually is deceased because of the fever.

Q fever is a contagious disease caused by a bacterium, particularly by goats and sheep to humans is discussed. The disease is only dangerous for people with lower resistance such as the elderly.

Until last year, the disease in the Netherlands for barely average twenty cases per year. Last year, in the regions Oss and Nijmegen 170 cases reported ; this year more than 180 already. In Limburg this year three cases of Q fever reported.

According to a infectiedeskundige of the Public Health Service South Limburg is no question of an outbreak of Q fever and people need not fear that they are infected with the disease.

Mostly from the disease in humans as a mild flu. Sometimes infection can lead to headaches, high fever, muscle pain, nausea, pneumonia or chest pain. In rare cases, Q fever can lead to inflammation of the heart valves. The Limburg deceased man also had problems with his heart valves.

The Limburg deceased husband lived in an area with goat farms, but did not work in the sector. The Public Health Service is still looking into the cause of the infection. About the deceased and possibly an investigation into the exact cause of death, the Public Health Service for privacy reasons nothing to say.

The Ministers of Agriculture and Gerda Verburg Ab Klink of Health announced earlier this month measures against spread of the Q-fever. Infected farms for example, may no longer spreading manure, because the bacterium can convey. People can not infect each other.

http://www.telegraaf.nl/binnenland/4332803/_Mogelijk_eerste_dode_Q-koorts__.html

[Gert van der Hoek]

Re: Netherlands: possibly the first Q fever death

machinetranslated

02 jul 2008,

Q-fever spreading in Brabant

AMSTERDAM - The Q-fever spreading in Brabantbegins to look like and epidemic. In recent months were about fifty people in Central and North Brabant by the disease. A number of victims had liver- infection or pneumonia .

This has the Public Health Service for Hart Brabant reported today. Fifty other cases are still being examined.

Until last year there were ten cases nationwide average of Q-fever reported. This year is already counting on 332 cases in Brabant GGD region.

Most cases occur in the municipalities Bernheze, Landerd, Oss and Uden. The disease is transmitted directly or indirectly, mainly by goats, reported the Press.

Also in the southeast of the province have in recent weeks twenty people contracted Q-fever.

The Public Health Service Hart suspects that the number of reported decreases. Farmers must now notify their animals when the Q-fever has been established.

http://www.telegraaf.nl/binnenland/1411163/__Van_Oranje..._naar_geitenkoorts__.html

[Gert van der Hoek]

Re: Netherlands: possibly the first Q fever death

machinetranslation

Q-fever is a threat to pregnant rural women

Bram van der Heijden and Rene Steenhorst

AMSTERDAM - GP?s give pregnant women in rural areas is the urgent advice to investigations of contamination with Q-fever.

Two physicians from the North Brabant town Herpen called the situation worrying. Women since they consider a real risk to be infected with the disease by sheep and goats can be transferred to humans. Early births and miscarriages among the major threats.

According GP Besselink play the problems arise mainly in Brabant and parts of Gelderland. "It is what we are concerned for all women in these areas at increased risk of contact with the Q-fever bacterie, who came from the manure by air can be circulated.

Women farmers are significantly greater chance of contamination. "Doctor Besselink doing its recommendations in the published yesterday artsentijdschrift Medical Contact, along with fellow doctor Olde Loohuis and Prof. Dr. WJHM van den Bosch, professor of Family Medicine at the Radboud University Nijmegen.

The region where the two GPs practise, in recent years increasingly confronted with patients with initially unclear flu-like ilnesses.

Further investigation revealed however that it went to Q-fever. The disease led to at least eleven patients pneumonia, which she ended up in hospital. According to the health authorities could be spoken of a local epidemic. France has some time ago the Q-koortsscreening for pregnant women. Farmers are obliged cases of Q fever among their animals to report.

According Besselink and Olde Loohuis has lasted too long before the Ministry of Agriculture introduced the reporting. "Apparently the department was afraid farmers on extra costs," says general practitioners.

http://www.telegraaf.nl/binnenland/1429616/__Q-koorts_gevaar_voor_zwangeren__.html

[Gert van der Hoek]

Re: Netherlands: possibly the first Q fever death

machinetranslation

Fewer reports of Q-fever in region

Saturday, July 19, 2008 |

HELMOND - The number of new reports of Q-fever in south-Brabant in the last two weeks has diminished.

Last week the disease was detected in five people. Last week was the GGD Brabant-south ten to fifteen reports. In early July, there was even talk of thirty new cases per week.

Especially people from Helmond-North appeared to have been infected with Q fever. In this disease occur flu symptoms such as fever, chills and headache.

In total, in south-Brabant eighty persons infected. According to the Public Health Service is about three-quarters of the people back completely refurbished.

Q fever is a contagious disease which is transmitted mainly by goats and sheep.

http://www.ed.nl/regio/helmondstad/3440946/Minder-meldingen-van-Qkoorts-in-regio.ece

[Gert van der Hoek]

Re: Netherlands: possibly the first Q fever death

machinetranslation

Q-fever: already more than 800 cases in Brabant

by Joris Roes. Tuesday, July 22, 2008

Last updated: Wednesday, July 23, 2008


DEN BOSCH - If there is not fast more concrete measures be taken to combat Q fever, according to the Public Health Service receives Brabant next year to deal with a major outbreak of the disease.

This year in the province for over 800 people became ill. Certainly 67 of them were hospitalised.

Yesterday was a national conference in Utrecht on Q-fever. Representatives of the National Institute of Health and Environment, home and veterinarians, the Public Health Service and foreign experts talked to the Health Council about the disease that suddenly as advances in Brabant.

New concrete measures were under Jos van de Sande of the Public Health Service and doctor Alfonso Olde Loohuis from Herpen not agreed. The reporting requirements for affected companies remain in force.

Q fever can lead to severe flu like symptoms. It is transmitted to humans by goats, sheep and cattle. In Herpen last year was the largest outbreak of Q fever which the Netherlands ever found. Now there again this year many people are sick in Melbourne, according to the Olde Loohuis the utmost importance to the source of the disease.

According Olde Loohuis and Van de Sande, it is likely that the goats in Brabant the source.

During the conference it was agreed that the Health Council that will investigate. Until that time applies only to companies where hailing a Q-fever is discovered, plus a temporary stop of spreading of manure. Van de Sande would have preferred a lengthy uitrijverbod of manure. "Then you at least research or goats actually the source. In that case you can oblige farmers manure and burning them harmless."

The Health Council looking According to Van de Sande prefer 'scientific evidence'. "We must be careful that we do not just talk and have the same problem next year."

http://www.brabantsdagblad.nl/voorpagina/3455263/Qkoorts-al-ruim-800-zieken-in-Brabant.ece

[tropical]

Re: Netherlands: possibly the first Q fever death

"Q-fever: already more than 800 cases in Brabant"

Looking at the number of 800 illnessed people a year, seems to view it from an developing countryside area instead from the whelty one.

The ways of transmission are notorious.
Are so dificult to establish an field manure decontamination in the whole area, or is cheaper to have more illnessed.

[Gert van der Hoek]

Re: Netherlands: more than 800 cases of Q fever this year

machinetranslated

Outcome Conference Q fever -

July 23, 2008

On July 22 the Health Council and the RIVM held a conference on Q-fever in the Netherlands. At the meeting that showed very valuable, took part experts from Canada, France, Germany, Denmark, Sweden and the Netherlands. By exchanging experiences came to light that the situation in the Netherlands is unique in the world.

Also in other countries have been occasional outbreaks of Q-fever, but not in such a densely populated area such as expanded and now in the Netherlands. Measures to outbreaks in other countries, are therefore not applicable in the Netherlands.

Pregnancy and blood

On the agenda of the conference were mainly issues surrounding the usefulness of screening of pregnant women at Q-fever and possible transmission through blood transfusion. The conclusion was that non-compliance with the conditions responsible for screening all pregnant women in the affected region. There is not enough known about the risk of pregnancy by a Q-koortsinfectie, especially among pregnant women who go through Q-fever without their complaints.

Also, the laboratory tests available to Q-fever to determine not yet reliable enough for screening large groups.

Moreover, it is not sure what the effectiveness and potential drawbacks of long-term treatment of Q-fever with antibiotics during pregnancy. The RIVM is doing further research to better understanding of the risks of Q-fever during pregnancy.

Based on international data blood seems a negligible risk to the transfer of Q-fever. The Foundation Sanquin Boedvoorziening will make proposals for further investigation. Meanwhile, there is no reason for the policy for blood donors to adapt.

Further actions

There are still new cases of Q fever reported. That is why the Centre Infectieziektebestrijding of the RIVM consult with veterinary experts on how to transfer from animals to humans exactly occurs and whether further measures are possible or necessary to prevent this from happening.

It also will be more precise guidelines on diagnosis and treatment of Q-fever for general practitioners and gynecologists.

http://www.rivm.nl/cib/actueel/nieuws/Uitkomst_conferentie_Q-koorts.jsp

[tropical]

Re: Netherlands: more than 800 cases of Q fever this year

Thanks Dutchy.

Bad thing if it's unique indeed.
Hopefuly it would maybe not rise in wider spreads, nor in the blood chain.

[Gert van der Hoek]

Re: Netherlands: more than 800 cases of Q fever this year

Press release in English.

Note: an earlier report mentioned "more than 800 cases" , citing a regional health authority; this report says: " So far this year, 497 people have been diagnosed with Q fever"

May be the difference is: laboratory confirmed. Not all cases are tested in a lab?

Q fever outbreak ?unique?

Thursday 24 July 2008

The current outbreak of the flu-like Q fever in Noord-Brabant is unique, experts from the health and the environment institute RIVM said on Wednesday, news agency ANP reports.

RIVM officials held round-table talks with experts from Canada, France, Germany, Denmark and Sweden about the disease, which is spread in goat, sheep and cattle urine and faeces.

The Dutch outbreak is concentrated in a small area, which is rare, experts said. So far this year, 497 people have been diagnosed with Q fever, most of whom are in Brabant. Until 2007, there were only a handful of cases a year in the country as a whole.

The RIVM is now to meet vets to see if new steps can be taken to prevent the spread of the disease, ANP said.

Q fever has flu-like symptoms and can be treated with antibiotics.

http://www.dutchnews.nl/news/archives/2008/07/q_fever_outbreak_unique.php

[Gert van der Hoek]

Re: Netherlands: more than 800 cases of Q fever this year

Experts are baffled, by the size of the outbreak, the high number of infections and geographic spreading and the long duration. More questions than answers.

Last year after the first large outbreak of Q-fever, a seroprevalence study was done in a village called "Herpen": a quarter of the adults had anti-bodies.
Official numbers of Q-fever infection is 497; Roel Coutinho, the head of the Centre Infectious Diseases says the number is at least 10 times higher, this means thousands of people are infected.

machinetranslation

Q-fever, it's stupid, but we do not know '

INTERVIEW, From our reporter Broer Scholtens

published on July 25,

Amsterdam - 'It sounds clumsy, but we do not know. We just have questions about why these Q-fever bacterium so stubbornly is roaming around in a large area in North Brabant. "

Roel Coutinho, the head of the Centre Infectious Diseases is full of surprise. The outbreak of Q fever in the Brabant is unique, foreign experts confirmed Tuesday during a briefing. "The size, great range and long-term, it's unprecedented."

The disease is caused by a bacterium, Coxiella brunetti. Especially sheep and goats are infected with it. The bacteria reach humans via dust that is inhaled. The disease is everywhere in the world. Until 2007 was the low number of reports here: five to twenty infections per year.

Last year there was a large outbreak among the population of Herpen, a village near Oss. Around 170 people reported symptoms. This year it's even worse. Since January 1, there are already 497 reports, the vast majority from the province of Brabant.

Coutinho: "These are people who by GPs have been notified by the regional Public Health Service. They have symptoms as fever. Of more serious symptoms such as pneumonia. "

Most people find nothing of an infection. In the spring of 2007 has examined the blood of residents of Herpen. From found antibodies can be deduced that one quarter of adults a bacterial infection has been through.

Coutinho: "This means that the number of infections by at least ten should be multiplied. It is therefore currently thousands of infected people. People can not infect each other. Dissemination goes through intensive contact with animals. "

Does it make sense to test pregnant women for Q fever?

'No. Little is known about pregnancy complications as a result of an infection. Moreover, the laboratory test is not watertight. If you treat an infection, even though women who do not show symptoms, then the question is what are the effects of prolonged antibiotic use. "

Is the epidemic under control?

" I doubt it. In the coming days we will analyse the figures well. The bacterium is in the livestock, and occasionally raises it head. Eradication can not be done.

"The numbers are now very high. That is crazy. The bacterial excretion is especially in the springtime when the most lambs are born.

"Infected animals are not sick. The bacterium may well cause miscarriages and early birth. Then bacteria in large numbers come out through urine, faeces, placenta, milk and amniotic fluid. They then be disseminated through the manure. "

"The risk is small, but along that road, people can become infected, is the idea. There must be other routes for infection, because there now few lambs are born. "

http://www.volkskrant.nl/binnenland/article1048045.ece/Q-koorts,_het_is_knullig,_maar_we_weten_het_niet