Comparison of the performance of IFA, CFA, and ELISA assays for the serodiagnosis of acute Q fever by quality assessment

Tineke Herremans*, Boris M. Hogema, Marrigje Nabuurs, Marcel Peeters, Marjolijn Wegdam-Blans, Peter Schneeberger, Carla Nijhuis, Daan W. Notermans, Joep Galama, Anton Horrevorts, Inge H. M. van Loo, Bart Vlaminckx, Hans L. Zaaijer, Marion P. Koopmans, Hanneke Berkhout, Cristina Socolovschi, Didier Raoult, John Stenos, William Nicholson, Henk Bijlmer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The indirect immunofluorescence assay (IFA) is considered the reference method for diagnosing Q fever, but serology is also performed by complement fixation assay (CFA) or enzyme-linked immunosorbent assay (ELISA). However, comparability between these assays is not clear, and therefore a quality assessment was performed. A total of 25 serum samples from negative controls, Q fever patients, and a serial diluted high-positive sample were analyzed in 10 Dutch laboratories. Six laboratories performed CFA, 5 performed IFA, and 5 performed ELISAs. Three international reference laboratories from Australia, France, and the USA also participated in this study. Qualitative values between laboratories using the same methods were within close range, and all 3 methods correctly identified acute Q fever patients. The IFA, ELISA, and CFA are all suitable serodiagnostic assays to diagnose acute Q fever, but the IFA remains an important tool in the follow-up of patients and in identifying patients at risk for developing chronic Q fever.
Original languageEnglish
Pages (from-to)16-21
JournalDiagnostic Microbiology and Infectious Disease
Issue number1
Publication statusPublished - Jan 2013


  • Coxiella burnetii
  • Q fever
  • Serology
  • Quality assessment

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