A Q Fever Outbreak in the Netherlands: Consequences for Tissue Banking

Abstract

Background: Emerging infectious diseases can compromise the safety of tissues for transplantations. A recent outbreak of Q fever, a zoonosis caused by the bacterium Coxiella burnetii, in the Netherlands compelled the Dutch tissue banks to assess the risk of Q fever transmission through tissue transplantation in order to maintain optimal safety. Methods: This article describes the systematic approach that was followed in the Netherlands. This approach included a review of the literature, a qualitative risk assessment, expert opinion gathering and investigations for specific strategies that can help to maintain the balance between tissue safety and availability. Results: This resulted in a specific donor selection policy and in development of further research to fill in gaps in knowledge about Q fever in tissue transplantation. Conclusion: The strategy described in this article may be useful for tissue bankers facing similar outbreaks of emerging infections or may be useful for development of future guidelines or assessment strategies for tissue banking.

Seroprevalence of Coxiella burnetii antibodies and chronic Q fever among post-mortal and living donors of tissues and cells from 2010 to 2015 in the Netherlands

“…After the acute phase, bacteria are usually not detectable in the blood, but they can persist in monocytes, bone marrow, spleen, prostate and liver [ 14 ]. An assessment showed that a potential risk of transmitting C. burnetii lies with transplantation of some tissues such as heart valves, musculoskeletal tissues and skin, although processing techniques may reduce the risk significantly [ 15 ].…”

<b><i>Coxiella burnetii</i></b> - Pathogenic Agent of Q (Query) Fever

“…In the chronic course, DNA can be detected periodically years after acute infection, and antibody titers remain high. Diagram based on Van Wijk et al, 2011 [134] (L. Guertler). …”

“…as PCR, is not routinely performed and, considering the current epidemiological situation, not necessary. In blood donors in the Netherlands, 1,004 donors in the area with the highest C. burnetii incidence were tested using PCR, and 3 (0.3%) were identified as being genome-positive [134]. The strategy shows that NAT can be introduced if required.…”

“…During acute infection, C. burnetii is also present in granulocytes, however, cannot be removed totally by leucocyte depletion. During the Q fever outbreak in the Netherlands, a specific donor selection strategy was developed to reduce efficiently the risk of Coxiella transmission: Exclusion of all donors who have a professional risk of exposure, all donors who live within a radius of 5 km from the center of the outbreak, and all donors who show flulike symptoms or had such symptoms within the past 2 weeks; and additional testing of all donations with a phase I IgM ELISA, even though a high false-positive rate was expected using this test [134]. Testing blood donors for phase I IgG has a 100% sensitivity only if the titer is above 1,024 [144].…”

Tissue Banking and Transfusion Medicine – a Suitable Cooperation Model

“…In a recent paper the extent of infection and the safety of local blood donations were tested for presence of Coxiella burnetii antibodies and DNA [2]. The impact of the Q fever outbreak for tissue donations was discussed by van Wijk et al [3] in their contribution.…”