title: Routine screening for Coxiella burnetii infection during pregnancy: a clustered randomised controlled trial during an outbreak, the Netherlands, 2010.
abstract: Between 2007 and 2010, the Netherlands experienced one of the largest outbreaks of Q fever. Since asymptomatic Coxiella burnetii infection has been associated with maternal and obstetric complications, evidence about the effectiveness of routine screening during pregnancy in outbreak areas is needed. We performed a clustered randomised controlled trial during the Dutch outbreak, in which 55 midwife centres were randomised to recruit pregnant women for an intervention or control strategy. In both groups a serum sample was taken between 20 and 32 weeks of gestation. In the intervention group (n=536), the samples were analysed immediately by indirect immunofluorescence assay for the presence of IgM and IgG (phase I/II) and treatment was given during pregnancy in case of an acute or chronic infection. In the control group (n=693), sera were frozen for analysis after delivery. In both groups 15% were seropositive. In the intervention group 2.2% of the women were seropositive and had an obstetric complication, compared with 1.4% in the control group (Odds ratio: 1.54 (95% confidence interval 0.60-3.96)). During a large Q fever outbreak, routine C. burnetii screening starting at 20 weeks of gestation was not associated with a relevant reduction in obstetric complications and should therefore not be recommended.
authors.affiliation: University of Groningen, University Center for Pharmacy, PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands. j.munster@umcg.nl
authors.forename: J M
authors.initials: JM
authors.lastname: Munster
authors.forename: A C
authors.initials: AC
authors.lastname: Leenders
authors.forename: C J
authors.initials: CJ
authors.lastname: Hamilton
authors.forename: J C
authors.initials: JC
authors.lastname: Meekelenkamp
authors.forename: P M
authors.initials: PM
authors.lastname: Schneeberger
authors.forename: W
authors.initials: W
authors.lastname: van der Hoek
authors.forename: A
authors.initials: A
authors.lastname: Rietveld
authors.forename: E
authors.initials: E
authors.lastname: de Vries
authors.forename: R P
authors.initials: RP
authors.lastname: Stolk
authors.forename: J G
authors.initials: JG
authors.lastname: Aarnoudse
authors.forename: E
authors.initials: E
authors.lastname: Hak
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D016997:Coxiella burnetii / Q000302:isolation & purification*; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008403:Mass Screening; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D011778:Q Fever / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology