Routine screening for Coxiella burnetii infection during pregnancy: a clustered randomised controlled trial during an outbreak, the Netherlands, 2010

J M Munster; A C Leenders; C J Hamilton; J C Meekelenkamp; P M Schneeberger; W van der Hoek; A Rietveld; E de Vries; R P Stolk; J G Aarnoudse; E Hak

doi:10.2807/ese.18.24.20504-en

Surveillance and outbreak reports Open Access

Like 0

Download

Routine screening for Coxiella burnetii infection during pregnancy: a clustered randomised controlled trial during an outbreak, the Netherlands, 2010
J M Munster^1,2,3 , A C Leenders⁴ , C J Hamilton⁵ , J C Meekelenkamp⁴ , P M Schneeberger⁴ , W van der Hoek⁶ , A Rietveld⁷ , E de Vries⁸ , R P Stolk³ , J G Aarnoudse² , E Hak^1,3
View Affiliations Hide Affiliations

Affiliations: ¹ University of Groningen, University Center for Pharmacy, PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands ² University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, the Netherlands ³ University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands ⁴ Jeroen Bosch Hospital, Department of Medical Microbiology and Infection Prevention, ‘s-Hertogenbosch, the Netherlands ⁵ Jeroen Bosch Hospital, Department of Obstetrics and Gynaecology, ‘s-Hertogenbosch, the Netherlands ⁶ National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and Surveillance Unit, Bilthoven, the Netherlands ⁷ Municipal Health Service ‘’Hart voor Brabant’’, ‘s-Hertogenbosch, the Netherlands ⁸ Jeroen Bosch Hospital, Department of Paediatrics, ‘s-Hertogenbosch, the Netherlands

Correspondence:
J Munster
j.munster umcg.nl
View Citation Hide Citation

Citation style for this article: Munster J M, Leenders A C, Hamilton C J, Meekelenkamp J C, Schneeberger P M, van der Hoek W, Rietveld A, de Vries E, Stolk R P, Aarnoudse J G, Hak E. Routine screening for Coxiella burnetii infection during pregnancy: a clustered randomised controlled trial during an outbreak, the Netherlands, 2010. Euro Surveill. 2013;18(24):pii=20504. https://doi.org/10.2807/ese.18.24.20504-en Received: 12 Dec 2012

Abstract

Between 2007 and 2010, the Netherlands experienced one of the largest outbreaks of Q fever. Since asymptomatic Coxiella burnetii infection has been associated with maternal and obstetric complications, evidence about the effectiveness of routine screening during pregnancy in outbreak areas is needed. We performed a clustered randomised controlled trial during the Dutch outbreak, in which 55 midwife centres were randomised to recruit pregnant women for an intervention or control strategy. In both groups a serum sample was taken between 20 and 32 weeks of gestation. In the intervention group (n=536), the samples were analysed immediately by indirect immunofluorescence assay for the presence of IgM and IgG (phase I/II) and treatment was given during pregnancy in case of an acute or chronic infection. In the control group (n=693), sera were frozen for analysis after delivery. In both groups 15% were seropositive. In the intervention group 2.2% of the women were seropositive and had an obstetric complication, compared with 1.4% in the control group (Odds ratio: 1.54 (95% confidence interval 0.60-3.96)). During a large Q fever outbreak, routine C. burnetii screening starting at 20 weeks of gestation was not associated with a relevant reduction in obstetric complications and should therefore not be recommended.