title: Large regional differences in serological follow-up of Q fever patients in the Netherlands.
abstract: BACKGROUND
  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 follow-up, and to identify regional differences in follow-up rates and contributing factors, such as knowledge of medical practitioners.
  
  
  METHODS
  Serological 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.
  
  
  RESULTS
  Ninety-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.
  
  
  CONCLUSIONS
  Regional 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.
authors.affiliation: Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, The Netherlands. g.morroy@ggdhvb.nl
authors.forename: Gabriëlla
authors.initials: G
authors.lastname: Morroy
authors.forename: Cornelia C H
authors.initials: CC
authors.lastname: Wielders
authors.forename: Mandy J B
authors.initials: MJ
authors.lastname: Kruisbergen
authors.forename: Wim
authors.initials: W
authors.lastname: van der Hoek
authors.forename: Jan H
authors.initials: JH
authors.lastname: Marcelis
authors.forename: Marjolijn C A
authors.initials: MC
authors.lastname: Wegdam-Blans
authors.forename: Clementine J
authors.initials: CJ
authors.lastname: Wijkmans
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schneeberger
mesh_terms: D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008829:Microbiology; D009426:Netherlands / Q000453:epidemiology; D010820:Physicians / Q000706:statistics & numerical data; D011778:Q Fever / Q000097:blood* / Q000453:epidemiology* / Q000382:microbiology; D012698:Serologic Tests / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires