Dutch Government Faulted in Massive Disease Outbreak

Under control. After explosive growth in 2008 and 2009, reported cases of Q-fever (shown per week) dropped sharply in 2010.

Frederika Dijkstra (RIVM/CIb/EPI)

AMSTERDAM—The Dutch government failed to mount a robust response in the face of the world's worst outbreak of Q fever, a disease transmitted from farm animals to humans, according to an expert panel that presented its report on Monday. More than 4000 people have fallen ill since the outbreak began in 2007, and 14 have died.

Q fever, caused by the bacterium Coxiella burnetii, is primarily an infection of cattle, goats, and sheep. It occasionally sickens humans, usually after they breathe in air contaminated with the bacteria, which are present by the billions in amniotic fluid and placenta from infected females and in aborted fetuses. While most people have few or no symptoms, others develop fever, pneumonia, severe headaches, coughing, painful muscles and joints, or fatigue.

During the first years of the outbreak—which earned the Netherlands a travel warning from the U.S. Centers for Disease Control and Prevention—the government appeared to have a wait-and-see attitude, says the panel, chaired by agricultural economist Gert van Dijk of Nyenrode Business University. It took too long, for instance, to establish that goat farms were the main source of the outbreak and to adopt measures to contain the risk. Alarmed regional public health officials in North Brabant, the hardest-hit province, had trouble getting their voices heard by the national government in The Hague, says the report, which is in Dutch.

As a result, 2008, in which more than 900 people fell ill, was a "lost" year; only in 2009, when the crisis had escalated further, was a robust control program launched, including compulsory vaccination of goats and sheep and culling of 62,500 pregnant animals on infected farms.

One cause of the delays, says the report, was that the issue was handled by two departments that didn't always communicate well. The agriculture ministry was worried that aggressive control measures, if not backed by solid science, would lead to lawsuits from farmers; the health ministry didn't push back hard enough, nor did it have the formal powers to ensure that public health prevailed. In future outbreaks of zoonoses, diseases that are transmitted from animals to humans, the health ministry should have the lead, says the panel.

Numbers released earlier this month by the National Institute for Public Health and the Environment show that the control strategy eventually paid off: So far, only 382 people have fallen ill with Q-fever in 2010, compared with more than 2300 in 2009.