A systematic knowledge synthesis on the spatial dimensions of Q fever epidemics

Myrna M.T. de Rooij*, Jeroen P.G. van Leuken, Arno Swart, Mirjam E.E. Kretzschmar, Mirjam Nielen, Aline A. de Koeijer, Ingmar Janse, Inge M. Wouters, Dick J.J. Heederik

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)


From 2007 through 2010, the Netherlands experienced the largest Q fever epidemic ever reported. This study integrates the outcomes of a multidisciplinary research programme on spatial airborne transmission of Coxiella burnetii and reflects these outcomes in relation to other scientific Q fever studies worldwide. We have identified lessons learned and remaining knowledge gaps. This synthesis was structured according to the four steps of quantitative microbial risk assessment (QMRA): (a) Rapid source identification was improved by newly developed techniques using mathematical disease modelling; (b) source characterization efforts improved knowledge but did not provide accurate C. burnetii emission patterns; (c) ambient air sampling, dispersion and spatial modelling promoted exposure assessment; and (d) risk characterization was enabled by applying refined dose–response analyses. The results may support proper and timely risk assessment and risk management during future outbreaks, provided that accurate and structured data are available and exchanged readily between responsible actors.

Original languageEnglish
Pages (from-to)14-25
JournalZoonoses and Public Health
Issue number1
Early online date6 Nov 2018
Publication statusPublished - Feb 2019


  • airborne exposure
  • Coxiella burnetii
  • epidemiology
  • Q fever
  • risk assessment
  • spatial analysis


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