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Dutch Q Fever Outbreak: 40% had post infective chronic fatigue syndrome 1 to 2 years later

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Self-reported sick leave and long-term health symptoms of Q-fever patients
– Source: European Journal of Public Health, Feb 7, 2012

By G Morroy, et al.

[Note: Q fever is a disease caused by Coxiella burnetti bacteria. It begins with flu-like symptoms (but can be inapparent) and is known to produce a “post-Q chronic fatigue syndrome” lasting 5 to 10 years or more in 15% to 20% of cases. Q fever is worldwide, carried mostly by grazing stock and ticks but also pets and animals in the wild. Mostly contracted via inhalation of dried excretions in airborne dust, but also tick bites, infected milk, skin abrasions.]

Background: In The Netherlands, 1,168 Q-fever patients were notified in 2007 and 2008.

Patients and general practitioners (GPs) regularly reported persisting symptoms after acute Q-fever, especially fatigue and long periods of sick leave, to the public health authorities.

International studies on smaller Q-fever outbreaks demonstrate that symptoms may persist years after acute illness. Data for the Dutch outbreaks were unavailable. The aim of this study is to quantify sick leave after acute Q-fever and long-term symptoms.

Methods: Our study targeted 898 acute Q-fever patients, notified in 2007 and 2008 residing in the Province Noord-Brabant. Patients from the 2008 cohort were mailed a questionnaire at 12 months and those of the 2007 cohort at 12-26 months after onset of illness.

Patients reported underlying illness, Q-fever-related symptoms and sick leave.

Results: The response rate was 64%. Forty percent of the working patients reported long-term (greater than 1 month) sick leave. Pre-existent heart disease odds ratio (OR) 4.50; confidence interval (CI) 1.27-16.09), hospitalization in the acute phase (OR 3.99; 95% CI 2.15-7.43) and smoking (OR 1.69; 95% CI 1.01-2.84) were significant predictors for long-term absence. [Note: an odds ratio of 1.0 would indicate average risk, so the odds of long term sick leave in those with preexisting heart disease is 350% greater than the average.]

Of the patients who resumed work, 9% were – at the time of completing the questionnaire [one to two years after acute illness] – still unable to function at pre-infection levels due to fatigue or concentration problems.

Of the respondents:

• 40% reported persisting physical symptoms at the time of follow-up.

• Fatigue (20%) was most frequently reported.

• Daily activities were affected in 30% of cases.

Conclusions: Q-fever poses a serious persisting long-term burden on patients and society.

Source: European Journal of Public Health, Feb 7, 2012. PMID:22315459, by Morroy G, Bor HH, Polder J, Hautvast JL, van der Hoek W, Schneeberger PM, Wijkmans CJ. Department of Infectious Disease Control, Municipal Health Service, Hart voor Brabant, ‘s-Hertogenbosch, The Netherlands.

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