TY - JOUR
T1 - Q fever
T2 - Evidence of a massive yet undetected cross-border outbreak, with ongoing risk of extra mortality, in a Dutch-German border region
AU - Hackert, Volker H.
AU - Hoebe, Christian J. P. A.
AU - Dukers-Muijrers, Nicole
AU - Krafft, Thomas
AU - Kauhl, Boris
AU - Henning, Klaus
AU - Karges, Wolfram
AU - Sprague, Lisa
AU - Neubauer, Heinrich
AU - Al Dahouk, Sascha
N1 - Funding Information:
We thank public health nurses Rick Boesten, Elleke Leclercq and Hans Frantzen, and consultant in communicable disease control Henriëtte ter Waarbeek of Public Health Service (PHS) South Limburg, Netherlands, for their contribution to data logistics; Geneviève van Liere, MSc, of PHS South Limburg for her contribution to data analysis. We also wish to thank Isabel Knittel (ArcGIS and serology), Jane Kowall (molecular diagnostics) and Enno Luge (serology) from the German Federal Institute for Risk Assessment, Berlin, Germany, for their technical assistance. We thank Nadin Lemser, who performed molecular diagnostics, and Roswitha Wehr, who performed serology and culturing, from the Friedrich‐Loeffler‐Institut, Jena, Germany. Moreover, we thank the Blood Donation Center and the Central Clinical Laboratory at RWTH Aachen University Hospital for their support. We also wish to express our gratitude to Prof. Dr. Silke Fischer from the National Reference Laboratory for Q Fever at the Baden‐Württemberg State Health Authority (Landesgesundheitsamt Baden‐Württemberg) in Stuttgart, Germany, for her advice on diagnostics. We further wish to thank Dr. Jacqueline Buijs from Zuyderland Medical Centre, Heerlen and Sittard, Netherlands, for updating us on regional chronic Q fever epidemiology. This work was supported by the Netherlands Organisation for Health Research and Development [50‐50405‐98‐133] and the German Federal Ministry of Education and Research [BMBF‐01 KI 1001A].
Funding Information:
We thank public health nurses Rick Boesten, Elleke Leclercq and Hans Frantzen, and consultant in communicable disease control Henri?tte ter Waarbeek of Public Health Service (PHS) South Limburg, Netherlands, for their contribution to data logistics; Genevi?ve van Liere, MSc, of PHS South Limburg for her contribution to data analysis. We also wish to thank Isabel Knittel (ArcGIS and serology), Jane Kowall (molecular diagnostics) and Enno Luge (serology) from the German Federal Institute for Risk Assessment, Berlin, Germany, for their technical assistance. We thank Nadin Lemser, who performed molecular diagnostics, and Roswitha Wehr, who performed serology and culturing, from the Friedrich-Loeffler-Institut, Jena, Germany. Moreover, we thank the Blood Donation Center and the Central Clinical Laboratory at RWTH Aachen University Hospital for their support. We also wish to express our gratitude to Prof. Dr. Silke Fischer from the National Reference Laboratory for Q Fever at the Baden-W?rttemberg State Health Authority (Landesgesundheitsamt Baden-W?rttemberg) in Stuttgart, Germany, for her advice on diagnostics. We further wish to thank Dr. Jacqueline Buijs from Zuyderland Medical Centre, Heerlen and Sittard, Netherlands, for updating us on regional chronic Q fever epidemiology. This work was supported by the Netherlands Organisation for Health Research and Development [50-50405-98-133] and the German Federal Ministry of Education and Research [BMBF-01 KI 1001A].
Publisher Copyright:
© 2020 The Authors. Transboundary and Emerging Diseases published by Blackwell Verlag GmbH
PY - 2020/2/6
Y1 - 2020/2/6
N2 - Background Following outbreaks in other parts of the Netherlands, the Dutch border region of South Limburg experienced a large-scale outbreak of human Q fever related to a single dairy goat farm in 2009, with surprisingly few cases reported from neighbouring German counties. Late chronic Q fever, with recent spikes of newly detected cases, is an ongoing public health concern in the Netherlands. We aimed to assess the scope and scale of any undetected cross-border transmission to neighbouring German counties, where individuals unknowingly exposed may carry extra risk of overlooked diagnosis.Methods (A) Seroprevalence rates in the Dutch area were estimated fitting an exponential gradient to the geographical distribution of notified acute human Q fever cases, using seroprevalence in a sample of farm township inhabitants as baseline. (B) Seroprevalence rates in 122 neighbouring German postcode areas were estimated from a sample of blood donors living in these areas and attending the regional blood donation centre in January/February 2010 (n = 3,460). (C) Using multivariate linear regression, including goat and sheep densities, veterinary Q fever notifications and blood donor sampling densities as covariates, we assessed whether seroprevalence rates across the entire border region were associated with distance from the farm.Results (A) Seroprevalence in the outbreak farm's township was 16.1%. Overall seroprevalence in the Dutch area was 3.6%. (B) Overall seroprevalence in the German area was 0.9%. Estimated mean seroprevalence rates (per 100,000 population) declined with increasing distance from the outbreak farm (0-19 km = 2,302, 20-39 km = 1,122, 40-59 km = 432 and >= 60 km = 0). Decline was linear in multivariate regression using log-transformed seroprevalence rates (0-19 km = 2.9 [95% confidence interval (CI) = 2.6 to 3.2], 20 to 39 km = 1.9 [95% CI = 1.0 to 2.8], 40-59 km = 0.6 [95% CI = -0.2 to 1.3] and >= 60 km = 0.0 [95% CI = -0.3 to 0.3]).Conclusions Our findings were suggestive of widespread cross-border transmission, with thousands of undetected infections, arguing for intensified cross-border collaboration and surveillance and screening of individuals susceptible to chronic Q fever in the affected area.
AB - Background Following outbreaks in other parts of the Netherlands, the Dutch border region of South Limburg experienced a large-scale outbreak of human Q fever related to a single dairy goat farm in 2009, with surprisingly few cases reported from neighbouring German counties. Late chronic Q fever, with recent spikes of newly detected cases, is an ongoing public health concern in the Netherlands. We aimed to assess the scope and scale of any undetected cross-border transmission to neighbouring German counties, where individuals unknowingly exposed may carry extra risk of overlooked diagnosis.Methods (A) Seroprevalence rates in the Dutch area were estimated fitting an exponential gradient to the geographical distribution of notified acute human Q fever cases, using seroprevalence in a sample of farm township inhabitants as baseline. (B) Seroprevalence rates in 122 neighbouring German postcode areas were estimated from a sample of blood donors living in these areas and attending the regional blood donation centre in January/February 2010 (n = 3,460). (C) Using multivariate linear regression, including goat and sheep densities, veterinary Q fever notifications and blood donor sampling densities as covariates, we assessed whether seroprevalence rates across the entire border region were associated with distance from the farm.Results (A) Seroprevalence in the outbreak farm's township was 16.1%. Overall seroprevalence in the Dutch area was 3.6%. (B) Overall seroprevalence in the German area was 0.9%. Estimated mean seroprevalence rates (per 100,000 population) declined with increasing distance from the outbreak farm (0-19 km = 2,302, 20-39 km = 1,122, 40-59 km = 432 and >= 60 km = 0). Decline was linear in multivariate regression using log-transformed seroprevalence rates (0-19 km = 2.9 [95% confidence interval (CI) = 2.6 to 3.2], 20 to 39 km = 1.9 [95% CI = 1.0 to 2.8], 40-59 km = 0.6 [95% CI = -0.2 to 1.3] and >= 60 km = 0.0 [95% CI = -0.3 to 0.3]).Conclusions Our findings were suggestive of widespread cross-border transmission, with thousands of undetected infections, arguing for intensified cross-border collaboration and surveillance and screening of individuals susceptible to chronic Q fever in the affected area.
KW - communicable disease control
KW - Coxiella burnetii infection
KW - international health regulations
KW - one health
KW - outbreaks
KW - Q fever
KW - COXIELLA-BURNETII INFECTION
U2 - 10.1111/tbed.13505
DO - 10.1111/tbed.13505
M3 - Article
C2 - 32027783
SN - 1865-1674
VL - 67
SP - 1660
EP - 1670
JO - Transboundary and Emerging Diseases
JF - Transboundary and Emerging Diseases
IS - 4
ER -