title: In search of hidden Q-fever outbreaks: linking syndromic hospital clusters to infected goat farms.
abstract: Large Q-fever outbreaks were reported in The Netherlands from May 2007 to 2009, with dairy-goat farms as the putative source. Since Q-fever outbreaks at such farms were first reported in 2005, we explored whether there was evidence of human outbreaks before May 2007. Space-time scan statistics were used to look for clusters of lower-respiratory infections (LRIs), hepatitis, and/or endocarditis in hospitalizations, 2005-2007. We assessed whether these were plausibly caused by Q fever, using patients' age, discharge diagnoses, indications for other causes, and overlap with reported Q fever in goats/humans. For seven detected LRI clusters and one hepatitis cluster, we considered Q fever a plausible cause. One of these clusters reflected the recognized May 2007 outbreak. Real-time syndromic surveillance would have detected four of the other clusters in 2007, one in 2006 and two in 2005, which might have resulted in detection of Q-fever outbreaks up to 2 years earlier.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands. kees.van.den.wijngaard@rivm.nl
authors.forename: C C
authors.initials: CC
authors.lastname: van den Wijngaard
authors.forename: F
authors.initials: F
authors.lastname: Dijkstra
authors.forename: W
authors.initials: W
authors.lastname: van Pelt
authors.forename: L
authors.initials: L
authors.lastname: van Asten
authors.forename: M
authors.initials: M
authors.lastname: Kretzschmar
authors.forename: B
authors.initials: B
authors.lastname: Schimmer
authors.forename: N J D
authors.initials: NJ
authors.lastname: Nagelkerke
authors.forename: P
authors.initials: P
authors.lastname: Vellema
authors.forename: G A
authors.initials: GA
authors.lastname: Donker
authors.forename: M P G
authors.initials: MP
authors.lastname: Koopmans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D015511:Goat Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D006041:Goats; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011778:Q Fever / Q000453:epidemiology / Q000635:transmission / Q000662:veterinary*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult; D015047:Zoonoses