title: Implementation of a Q fever vaccination program for high-risk patients in the Netherlands.
abstract: BACKGROUND
  Between 2007 and 2011 the Netherlands was faced with an unprecedented Q fever outbreak with more than 4000 people affected. Dairy goats were considered the main source of infection. In addition to taking veterinary measures, the Dutch government offered an unlicensed vaccine against the causative bacterium Coxiella burnetii to patient groups at high-risk of Q fever complications. This article describes the complexity of the vaccination program for Q fever in 2010-2011.
  
  
  METHODS
  High-risk patients were selected and referred mainly by their general practitioner to a publicly funded centralized screening and vaccination program. In addition, cardiovascular specialists and the public were informed. Patients were screened for previous infection with C. burnetii by serology and skin-tests. Patients who tested positive were excluded from vaccination.
  
  
  RESULTS
  Of the 2741 referred high-risk patients (1669 male, 1957 from the high-risk area), 955 were excluded because vaccination was considered unnecessary or the distance to the vaccination clinic too far. 388 (22% of those screened) were excluded because of a positive skin-test or serology. 1368 patients (77% of those screened) were vaccinated between January and June 2011. Two-thirds of the vaccinees reported an adverse event. 89 patients (6.6%) reported serious adverse events. In just one patient, with an injection site reaction, a possible causal relationship was considered.
  
  
  CONCLUSIONS
  This Q fever vaccination program posed challenges to the Dutch Health Care system. Creating clarity on the roles and responsibilities of those involved precluded timely vaccination. Targeting the high-risk population through GPs was challenging but appeared to be efficient. The vaccination was considered to be safe and compliance of the screened patients was high.
authors.affiliation: Centre for Infectious Disease and Control, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. leslie.isken@rivm.nl
authors.forename: Leslie D
authors.initials: LD
authors.lastname: Isken
authors.forename: Marleen
authors.initials: M
authors.lastname: Kraaij-Dirkzwager
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Vermeer-de Bondt
authors.forename: Hans C
authors.initials: HC
authors.lastname: Rümke
authors.forename: Clementine
authors.initials: C
authors.lastname: Wijkmans
authors.forename: Wim
authors.initials: W
authors.lastname: Opstelten
authors.forename: Aura
authors.initials: A
authors.lastname: Timen
mesh_terms: D000818:Animals; D001428:Bacterial Vaccines / Q000008:administration & dosage* / Q000276:immunology; D016997:Coxiella burnetii / Q000276:immunology*; D004196:Disease Outbreaks; D019353:Endemic Diseases; D005260:Female; D015511:Goat Diseases / Q000453:epidemiology* / Q000382:microbiology; D006041:Goats; D006801:Humans; D008297:Male; D032541:Mass Vaccination / Q000379:methods / Q000458:organization & administration*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011778:Q Fever / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control* / Q000662:veterinary; D012307:Risk Factors; D015047:Zoonoses / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control
chemical_list: D001428:Bacterial Vaccines