Nieuws - 24 november 2010

Professor: RIVM too late in finding Q Fever source

Broer Scholtens

Not only the ministries but the scientific community should bear the blame. 'Those infected ought to have been questioned sooner to trace possible links between sources and cases of infection.'

A connection could have been made much earlier between cases of Q Fever in humans and infected goats in the vicinity. Measures ought to have been taken sooner, such as culling the sheep and stopping manure spread.
This is the conclusion of the Q Fever evaluation committee in a devastating report submitted this week to health minister Schippers and agriculture state secretary Bleker. 'Timely awareness would have prevented many infections in humans' is the opinion of committee chairman Prof. dr. ir. Gert van Dijk, cooperatives professor at Wageningen University and the Nyenrode Business University.
Ten people died
In the last few years, many thousands of people have been infected by the Q Fever bacteria transmitted from goats to humans. The situation has been particularly bad in the northern part of the province of North Brabant, an area with hundreds of goat farms. It has been established that ten people had died from Q Fever. The disease appears to have made a comeback since 2009 even after drastic measures such as clearing of tens of goat farms and vaccinating several hundred thousand goats.
The Van Dijk committee was commissioned in January this year to look for the cause of the infection outbreak in the Netherlands, caused by a bacteria considered as 'harmless' for goats and humans before 2007. Then, there were less than fifteen cases of infections yearly. In 2009, there were 2354 cases reported at health authorities.
It took too long before policy makers in the ministries acknowledged that there was sufficient 'scientific evidence' to show that dairy goat farms were the sources of the Q Fever outbreak, concludes the evaluation committee. The ball had been tossed several times to and fro between the agriculture and the health ministries, without any decisions being made.
How did this happen?
Van Dijk: 'The Q Fever outbreak in the Netherlands was the biggest of all. Outbreaks also took place in other countries, but they were smaller. In Germany, for example. The authorities there began looking for the source sooner and quickly discovered that ruminants were involved, being sheep in their case. Already in 2006, the risk of infection was looked into, as well as the distance between the infected and possible sources.'
Didn't we know that here?
'Although this has not been said before, we doubt if the National Institute for Public Health and the Environment (RIVM) was aware of the German incidences described in published sources. In Soest in Germany, close to Dortmund, almost three hundred people were infected with the bacteria in 2003.'
Should the goat sector be singled out much sooner as the source of the bacteria?
'The RIVM came up with a source list for the Netherlands only in 2008. That was too late. Health services in the ministries could have contacted one another at an earlier stage. One ministry was not aware of how another worked. It had also long been the opinion that Q Fever infection was not so serious; after all, it goes unnoticed by sixty percent of those infected. There was also no ministerial consensus concerning the measures to be taken.'
Was the scientific community too cautious?
'Scientists couldn't come up with conclusive proof. They could have tried to bring up enough evidence to go on, though. I was surprised that no similar source investigation was carried out immediately. As a result, the question remained in the sector as to whether there was sufficient hard evidence to point to the goats as being the source of Q Fever. Those infected ought to have been questioned earlier to trace possible links between sources and cases of infection.'