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Chronic Q fever in patients with valvular heart disease
Marit de Lange
Chronic Q fever | 30-11-2016
Province North-Brabant
Chronic Q fever | 30-11-20162
Province North-Brabant
Chronic Q fever | 30-11-20163
The Netherlands 2007-2010
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4,000 notified acute Q fever patients
50,000 acute infections:symptomatic + asymptomatic
Chronic Q fever:323 patients
Chronic Q fever
Vascular infection > endocarditis
Vascular infection < endocarditis
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Aim of the study
How many experienced Q fever infections and chronic Q fever in patients with valvular heart disease
Evaluate whether the policy of not routinely screening should be adapted
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MethodsCross sectional study, started 15 February 2016
Small regional hospital
Eligible: 18 years or older, valvular heart disease, attended cardiologist
One blood sample
Underlying disease
One year, until 2,000 patients
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Laboratory methods
Immunofluorescence assay:
IgG phase II antibodies: indication passed acute infection● Titre of ≥ 1:64
IgG phase I antibodies: indication chronic infection● IgG phase I titre of ≥ 1:1024● IgG phase I titre 1:512 further examination by hospital
consultant
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Results
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792 invited people
727/792 (92%) participants
110/727 (15%) experienced infection
617/727 (85%) no passed infection
107/110 (97%) no
chronic Q fever infection
3/110 (3%) chronic Q fever infection
DiscussionThis study:Valvular heart disease: 15% acute, 3% chronic
Other screening studies in the Netherlands, same area:● General population: 34% acute, 1% chronic● Other risk groups for chronic Q fever:
– Aneurysm or vascular prosthesis: 17% acute, 31% chronic
– Cardiac valve surgery: 20% acute, 8% chronic
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Discussion
Strong points:● High participation rate● High incidence area
Limitations:● Long after outbreaks● Incomplete inclusion due to high workload● Survivor bias
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Conclusion
Low % chronic Q fever found in this study
Social and political discussion about screening
Results used for cost-effectiveness study:● Is screening needed?● If yes, in which patient group, where and when?
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AcknowledgementsCo-authors:● Wim van der Hoek (National Institute for Public Health and the
Environment)● Peter Schneeberger (Jeroen Bosch and Bernhoven Hospital)● Arko Scheepmaker (Bernhoven hospital)● Monique Leclercq (Bernhoven hospital)
Funding:Study funded by the Q-Support foundation.
Chronic Q fever | 30-11-201613