Abstract
BackgroundDuring the Dutch Q fever epidemic more than 4,000 Q fever cases were notified. This provided logistical challenges for the organisation of serological follow-up, which is considered mandatory for early detection of chronic infection. The aim of this study was to investigate the proportion of acute Q fever patients that received serological follow-up, and to identify regional differences in follow-up rates and contributing factors, such as knowledge of medical practitioners.MethodsSerological datasets of Q fever patients diagnosed between 2007 and 2009 (N = 3,198) were obtained from three Laboratories of Medical Microbiology (LMM) in the province of Noord-Brabant. One LMM offered an active follow-up service by approaching patients; the other two only tested on physician's request. The medical microbiologist in charge of each LMM was interviewed. In December 2011, 240 general practices and 112 medical specialists received questionnaires on their knowledge and practices regarding the serological follow-up of Q fever patients.ResultsNinety-five percent (2,226/2,346) of the Q fever patients diagnosed at the LMM with a follow-up service received at least one serological follow-up within 15 months of diagnosis. For those diagnosed at a LMM without this service, this was 25% (218/852) (OR 54, 95% CI 43–67). Although 80% (162/203) of all medical practitioners with Q fever patients reported informing patients of the importance of serological follow-up, 33% (67/203) never requested it.ConclusionsRegional differences in follow-up are substantial and range from 25% to 95%. In areas with a low follow-up rate the proportion of missed chronic Q fever is potentially higher than in areas with a high follow-up rate. Medical practitioners lack knowledge regarding the need, timing and implementation of serological follow-up, which contributes to patients receiving incorrect or no follow-up. Therefore, this information should be incorporated in national guidelines and patient information forms.
Highlights
In the Netherlands, more than 4,000 patients were notified with acute Q fever during seasonal outbreaks between 2007 and 2010 [1,2]
Laboratories of Medical Microbiology We received serological datasets of 3,198 patients diagnosed by three LMMS between 2007 and 2009 with serology indicative of acute Q fever (Figure 1)
The difference in percentage of patients without serological follow-up within 15 months of diagnosis, differed greatly between LMMs with an active or passive follow-up approach (Table 1); 5% (120/2,346) versus 74% (634/852) respectively
Summary
In the Netherlands, more than 4,000 patients were notified with acute Q fever during seasonal outbreaks between 2007 and 2010 [1,2]. There are no estimates for the proportion of asymptomatic acute C. burnetii infections that develop into chronic infection. Serological follow-up of acute Q fever patients is advised in order to identify and ensure timely treatment of chronic Q fever [8,9,10]. Follow-up is especially important for patients with valvulopathy, vascular prosthesis/abnormalities, pregnant women, and immunocompromised patients, as they have a higher risk of developing chronic Q fever after acute infection [8,11]. During the Dutch Q fever epidemic more than 4,000 Q fever cases were notified This provided logistical challenges for the organisation of serological follow-up, which is considered mandatory for early detection of chronic infection. The aim of this study was to investigate the proportion of acute Q fever patients that received serological followup, and to identify regional differences in follow-up rates and contributing factors, such as knowledge of medical practitioners
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