Department of Medical Microbiology,Maastricht University Medical Center,The Netherlands.
Department of Infectious Diseases,Public Health Service,Hart voor Brabant, 's-Hertogenbosch,The Netherlands.
Epidemiol Infect. 2019 Jan;147:e191. doi: 10.1017/S0950268819000736.
From 2007 to 2010, the largest reported Q-fever epidemic occurred in the Netherlands with 4026 notified laboratory-confirmed cases. During the course of the epidemic, health-seeking behaviour changed and awareness among health professionals increased. Changes in laboratory workflows were implemented. The aim of this study was to analyse how these changes instigated adjustments of notification criteria and how these adjustments affected the monitoring and interpretation of the epidemic. We used the articles on laboratory procedures related to the epidemic and a description of the changes that were made to the notification criteria. We compared the output of a regional laboratory with notifications to the regional Public Health Service and the national register of infectious diseases. We compared the international notification criteria for acute Q-fever. Screening with ELISA IgM phase II and PCR was added to the diagnostic workflow. In the course of the epidemic, serology often revealed a positive IgG/IgM result although cases were not infected recently. With increasing background seroprevalence, the presence of IgM antibodies can only be suggestive for acute Q-fever and has to be confirmed either by seroconversion of IgG or a positive PCR result. Differences in sero-epidemiology make it unlikely that full harmonisation of notification criteria between countries is feasible.
从 2007 年到 2010 年，荷兰发生了有记录以来最大的 Q 热疫情，共有 4026 例实验室确诊病例报告。在疫情期间，人们的求医行为发生了变化，卫生专业人员的意识也有所提高。实验室工作流程发生了变化。本研究旨在分析这些变化如何引发通知标准的调整，以及这些调整如何影响疫情的监测和解释。我们使用了与疫情相关的实验室程序的文章和对通知标准所做的更改的描述。我们比较了一个地区实验室的输出结果与该地区公共卫生局和国家传染病登记处的通知。我们比较了急性 Q 热的国际通知标准。酶联免疫吸附试验 IgM 二期和 PCR 的筛查被添加到诊断工作流程中。在疫情期间，尽管病例最近没有感染，但血清学检测经常显示出 IgG/IgM 阳性结果。随着背景血清阳性率的增加，IgM 抗体的存在只能提示急性 Q 热，必须通过 IgG 的血清转化或 PCR 阳性结果来确认。血清流行病学的差异使得国家之间完全协调通知标准不太可能实现。
