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Severely impaired health status of non-notified Q fever patients leads to an underestimation of the true burden of disease

  • J. A. F. VAN LOENHOUT (a1), C. C. H. WIELDERS (a2) (a3), G. MORROY (a1) (a4), M. J. M. COX (a1), W. VAN DER HOEK (a3), J. L. A. HAUTVAST (a1), W. J. PAGET (a1) (a5) and J. VAN DER VELDEN (a1)...

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.

Corresponding author
* Author for correspondence: Mr J. A. F. van Loenhout, Radboud university medical center, Department of Primary and Community Care, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. (Email:
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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