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A Q fever outbreak in a psychiatric care institution in The Netherlands

  • R. P. M. KOENE (a1) (a2), B. SCHIMMER (a2) (a3), H. RENSEN (a4), M. BIESHEUVEL (a5), A. DE BRUIN (a6), A. LOHUIS (a1), A. HORREVORTS (a7), F. VERDUYN LUNEL (a8), C. E. DELSING (a9) and J. L. A. HAUTVAST (a1) (a2)
  • DOI:
  • Published online: 09 February 2010

In May 2008 the Nijmegen Municipal Health Service (MHS) was informed about an outbreak of atypical pneumonia in three in-patients of a long-term psychiatric institution. The patients had been hospitalized and had laboratory confirmation of acute Q fever infection. The MHS started active case finding among in-patients, employees of and visitors to the institution. In a small meadow on the institution premises a flock of sheep was present. One of the lambs in the flock had been abandoned by its mother and cuddled by the in-patients. Samples were taken of the flock. Forty-five clinical cases were identified in employees, in-patients and visitors; 28 were laboratory confirmed as Q fever. Laboratory screening of pregnant women and persons with valvular heart disease resulted in one confirmed Q fever case in a pregnant woman. Of 27 samples from animals, seven were positive and 15 suspect for Coxiella burnetii infection. This outbreak of Q fever in a unique psychiatric setting pointed to a small flock of sheep with newborn lambs as the most likely source of exposure. Care institutions that have vulnerable residents and keep flocks of sheep should be careful to take adequate hygienic measures during delivery of lambs and handling of birth products.

Corresponding author
*Author for correspondence: R. P. M. Koene, P.O. Box 1120, 6501BCNijmegen, The Netherlands. (Email:
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1.D Raoult , T Marrie . Q fever. Clinical Infectious Diseases 1995; 20: 489495.

4.R Fenollar , Chronic endocarditis following acute Q fever. Clinical Infectious Diseases 2000; 33: 312316.

6.G Dupuis , An important outbreak of human Q-fever in a Swiss Alpine valley. International Journal of Epidemiology 1987; 16: 282287.

9.O Lyytikïnen , An outbreak of sheep-associated Q fever in a rural community in Germany. European Journal of Epidemiology 1997; 14: 193199.

11.TF Hatchette , Goat-associated Q fever: a new disease in Newfoundland. Emerging Infectious Diseases 2001; 7: 413419.

13.A Stein . Pigeon pneumonia in provence: a bird-borne Q fever outbreak. Clinical Infectious Diseases 1999; 29: 617620.

14.RL Pinsky . An outbreak of cat-associated Q fever in the United States. Journal of Infectious Diseases 1991; 164: 202204.

16.MP Carriere , Investigation of a slaughterhouse-related outbreak of Q fever in the French Alps. European Journal of Clinical Microbiology & Infectious Diseases 2002; 21: 1721.

18.A Boschini , Consecutive epidemics of Q fever in a residential facility for drug abusers: impact on persons with human immunodeficiency virus infection. Clinical Infectious Diseases 1999; 28: 866872.

21.CHW Klaassen , Multigenotype Q Fever outbreak, the Netherlands [Letter]. Emerging Infectious Diseases 2009; 15: 613.

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