title: Q fever in the Netherlands: public perceptions and behavioral responses in three different epidemiological regions: a follow-up study.
abstract: BACKGROUND
  Over the past years, Q fever has become a major public health problem in the Netherlands, with a peak of 2,357 human cases in 2009. In the first instance, Q fever was mainly a local problem of one province with a high density of large dairy goat farms, but in 2009 an alarming increase of Q fever cases was observed in adjacent provinces. The aim of this study was to identify trends over time and regional differences in public perceptions and behaviors, as well as predictors of preventive behavior regarding Q fever.
  
  
  METHODS
  One cross-sectional survey (2009) and two follow-up surveys (2010, 2012) were performed. Adults, aged≥18 years, that participated in a representative internet panel were invited (survey 1, n=1347; survey 2, n=1249; survey 3, n=1030).
  
  
  RESULTS
  Overall, public perceptions and behaviors regarding Q fever were consistent with the trends over time in the numbers of new human Q fever cases in different epidemiological regions and the amount of media attention focused on Q fever in the Netherlands. However, there were remarkably low levels of perceived vulnerability and perceived anxiety, particularly in the region of highest incidence, where three-quarters of the total cases occurred in 2009. Predictors of preventive behavior were being female, older aged, having Q fever themselves or someone in their household, more knowledge, and higher levels of perceived severity, anxiety and (self-) efficacy.
  
  
  CONCLUSIONS
  During future outbreaks of (zoonotic) infectious diseases, it will be important to instil a realistic sense of vulnerability by providing the public with accurate information on the risk of becoming infected. This should be given in addition to information about the severity of the disease, the efficacy of measures, and instructions for minimising infection risk with appropriate, feasible preventative measures. Furthermore, public information should be adapted to regional circumstances.
authors.affiliation: Municipal Public Health Service Rotterdam-Rijnmond, P,O, Box 70032, 3000 Rotterdam, LP, The Netherlands. m.bults@rotterdam.nl.
authors.forename: Marloes
authors.initials: M
authors.lastname: Bults
authors.forename: Desirée
authors.initials: D
authors.lastname: Beaujean
authors.forename: Clementine
authors.initials: C
authors.lastname: Wijkmans
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.forename: Hélène
authors.initials: H
authors.lastname: Voeten
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001294:Attitude to Health; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011778:Q Fever / Q000453:epidemiology* / Q000523:psychology*; D012306:Risk; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D055815:Young Adult