title: Severely impaired health status of non-notified Q fever patients leads to an underestimation of the true burden of disease.
abstract: Q fever patients are often reported to experience a long-term impaired health status, including fatigue, which can persist for many years. During the large Q fever epidemic in The Netherlands, many patients with a laboratory-confirmed Coxiella burnetii infection were not notified as acute Q fever because they did not fulfil the clinical criteria of the acute Q fever case definition (fever, pneumonia and/or hepatitis). Our study assessed and compared the long-term health status of notified and non-notified Q fever patients at 4 years after onset of illness, using the Nijmegen Clinical Screening Instrument (NCSI). The study included 448 notified and 193 non-notified Q fever patients. The most severely affected subdomain in both patient groups was 'Fatigue' (50·5% of the notified and 54·6% of the non-notified patients had severe fatigue). Long-term health status did not differ significantly between the notified and non-notified patient groups, and patients scored worse on all subdomains compared to a healthy reference group. Our findings suggest that the magnitude of the 2007-2009 Q fever outbreak in The Netherlands was underestimated when only notified patients according to the European Union case definition are considered.
authors.affiliation: Academic Collaborative Centre AMPHI,Department of Primary and Community Care,Radboud university medical center,Nijmegen,The Netherlands.
authors.forename: J A F
authors.initials: JA
authors.lastname: van Loenhout
authors.affiliation: Department of Medical Microbiology and Infection Control,Jeroen Bosch Hospital, 's-Hertogenbosch,The Netherlands.
authors.forename: C C H
authors.initials: CC
authors.lastname: Wielders
authors.affiliation: Academic Collaborative Centre AMPHI,Department of Primary and Community Care,Radboud university medical center,Nijmegen,The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Morroy
authors.affiliation: Academic Collaborative Centre AMPHI,Department of Primary and Community Care,Radboud university medical center,Nijmegen,The Netherlands.
authors.forename: M J M
authors.initials: MJ
authors.lastname: Cox
authors.affiliation: Centre for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),Bilthoven,The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: van der Hoek
authors.affiliation: Academic Collaborative Centre AMPHI,Department of Primary and Community Care,Radboud university medical center,Nijmegen,The Netherlands.
authors.forename: J L A
authors.initials: JL
authors.lastname: Hautvast
authors.affiliation: Academic Collaborative Centre AMPHI,Department of Primary and Community Care,Radboud university medical center,Nijmegen,The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Paget
authors.affiliation: Academic Collaborative Centre AMPHI,Department of Primary and Community Care,Radboud university medical center,Nijmegen,The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van der Velden
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D018563:Disease Notification / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D005221:Fatigue / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011778:Q Fever / Q000150:complications / Q000453:epidemiology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Coxiella burnetii; Q fever; fatigue; health status; quality of life