Published Date: 2008-07-25 16:00:27
Subject: PRO/AH/EDR> Q fever - Netherlands: (NBR)
Archive Number: 20080725.2267
Q FEVER - NETHERLANDS: (NOORD-BRABANT)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 25 Jul 2008
Source: Expatica, Radio Netherlands report [edited]
The 25 Jul 2008 edition of de Volkskrant reports on an outbreak of Q
fever in the southern province of North Brabant. Q fever, an
infectious disease, which is transmitted to humans [usually] via
contact with sheep and goats, is caused by the _Coxiella burnetii_
bacterium. It can cause fever and even pneumonia.
Usually, only between 5 and 20 cases are reported a year, but in 2007
a major outbreak occurred in a village near the town of Oss, where
around 170 fell ill.
This year , the number has risen to 497 from all across the province.
The health authorities say they have no explanation for the sudden
increase in the number of infections, adding that they doubt whether
the outbreak has been brought under control.
Date: Fri 25 Jul 2008
Source: Netherlands Info Services (NIS) News Bulletin [edited]
The outbreak of Q fever in the Netherlands is unique in the world.
This is the conclusion of scientists following an international
conference held by the National Institute for Healthcare ad the
Environment (RIVM) in partnership with the Health Council.
"Experts from Canada, France, Germany, Denmark, Sweden, and the
Netherlands participated in the meeting. Via the exchange of
experiences it came to light that the situation in the Netherlands is
unique in the world," according to the RIVM. "There have also been
outbreaks of Q fever in other countries, but not in such an extended
and densely populated area as at present in the province of
Q fever occurred sporadically in the Netherlands before 2007. But in
2007, the number of cases climbed to 497, of which 369 were in
Noord-Brabant, many around the town of Oss.
[ProMED-mail previously posted regarding the earlier part of this
outbreak in 2007 (Q fever - Netherlands (Noord-Brabant, Gelderland)
20070809.2592). As discussed below, the organism, often acquired by
close exposure to animals, is infectious with a very low inoculum and
may be aerosolized over a distance. It is not clear what contact the
infected people had with animals or how close they were to farms.
_Coxiella burnetii_, the causative agent, was discovered in 1937.
This organism is an agent that can be resistant to heat and
desiccation, and is highly infectious by the aerosol route. A single
inhaled organism may produce clinical illness. Indeed, in [non-human]
primates, the dose to kill 50 percent of the primates was found to be
1.7 organisms (1).
Cattle, sheep, and goats are the primary reservoirs of _C. burnetii_.
Infection has been noted in a wide variety of other animals,
including other species of livestock and in domesticated pets. _C.
burnetii_ does not usually cause clinical disease in these animals,
although abortion in goats and sheep has been linked to _C. burnetii_
infection. Organisms are excreted in milk, urine, and feces of
infected animals. Most importantly, during birthing the organisms are
shed in high numbers within the amniotic fluids and the placenta.
Contact with contaminated wool is known to be a mode of transmission
The organisms can be resistant to heat, drying, and many common
disinfectants. These features enable the bacteria to survive for long
periods in the environment. This very stable form of _C. burnetii_ is
associated with compact small cell variants of the organism that are
produced during standard replication along with the less resistant
large cell form, metabolically dormant, and spore-like (3).
Infection of humans usually occurs by inhalation of these organisms
from air that contains airborne barnyard dust contaminated by dried
placental material, birth fluids, and excreta of infected herd
animals. Humans are often very susceptible to the disease, and very
few organisms may be required to cause infection.
Ingestion of contaminated milk, followed by regurgitation and
inspiration of the contaminated food, is a less common mode of
transmission. Other modes of transmission to humans, including tick
bites and human-to-human transmission, are rare.
1. Lille RD, Perrin TL, Armstrong C: An institutional outbreak of
pneumonitis. III. Histopathology in man and rhesus monkeys in the
pneumonitis due to the virus of "Q fever." Pub Hlth Rep 1941; 56:
2. Maurin M, Raoult D: Q fever. Clin Microbiol Rev 1999; 12: 518-53.
3. Norlander L: Q fever epidemiology and pathogenesis. Microbes
Infect 2000; 2: 417-24.
4. CDC online: Q fever
The location of the southern province of Noord-Brabant (North
Brabant) can be found on map at
Oss, in the northern part of the province, can be located on the map at
Gelderland, an adjacent province was also involved in the initial
2007 outbreak - Mod.LL
An image of _C. burnetii_ bacteria is at: