title: Population Screening for Chronic Q-Fever Seven Years after a Major Outbreak.
abstract: BACKGROUND
  From 2007 through 2010, the Netherlands experienced a large Q-fever epidemic, with 4,107 notifications. The most serious complication of Q-fever is chronic Q-fever.
  
  
  METHODS
  In 2014, we contacted all 2,161 adult inhabitants of the first village in the Netherlands affected by the Q-fever epidemic and offered to test for antibodies against Coxiella burnetii using immunofluorescence assay (IFA) to screen for chronic infections and assess whether large-scale population screening elsewhere is warranted.
  
  
  RESULTS
  Of the 1,517 participants, 33.8% were IFA-positive. Six IFA-positive participants had an IgG phase I titer ≥1:512. Two of these six participants were previously diagnosed with chronic Q-fever. Chronic infection was diagnosed in one of the other four participants after clinical examination.
  
  
  CONCLUSIONS
  Seven years after the initial outbreak, seroprevalence remains high, but the yield of screening the general population for chronic Q-fever is low. A policy of screening known high-risk groups for chronic Q-fever in outbreak areas directly following an outbreak might be more efficient than population screening. A cost-effectiveness analysis should also be performed before initiating a population screening program for chronic Q-fever.
authors.affiliation: Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands; Department of Primary and Community Care, Academic Collaborative Centre AMPHI, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Gabriëlla
authors.initials: G
authors.lastname: Morroy
authors.affiliation: Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: van der Hoek
authors.affiliation: Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: Albers
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Radboud Expertise Center for Q-fever, Radboud university medical center, Nijmegen, the Netherlands.
authors.forename: Chantal P
authors.initials: CP
authors.lastname: Bleeker-Rovers
authors.affiliation: Department of Medical Microbiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schneeberger
mesh_terms: D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood*; D002908:Chronic Disease; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D016997:Coxiella burnetii; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands; D011778:Q Fever / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G