The Netherlands National Institute for Public Health and the Environment has reported an outbreak of Q fever in The Netherlands.  As of Nov. 25, 2,293 human cases have been confirmed in 2009, including 6 deaths. Most of these cases have been in Noord (North) Brabant, Gelderland, Limburg, and Utrecht Provinces in the southern part of the country, although cases have been reported throughout the country. (See http://www.rivm.nl/cib/binaries/Qkoorts_per_gemeente_tcm92-60500.pdf [PDF]) These cases represent an ongoing outbreak of Q fever in the Netherlands since 2007; 190 cases were reported in 2007 and 1,000 cases in 2008.

Recommendations for U.S. Travelers

Q fever is a disease that is usually passed from infected farm animals to humans. The risk of Q fever infection is low; however, if you are traveling to The Netherlands, follow these recommendations to help stay healthy:

• Avoid farms in the affected areas.
  • If you cannot avoid visiting farms, avoid going near areas where animals are kept, such as barns and pens, and avoid direct contact with animals. Breathing in soil and dust contaminated by animals can make you sick.
• Eat only milk and dairy products that have been pasteurized.  Do not drink raw milk or eat raw milk products.
• Wash your hands often with soap and water, especially if you have been near animals. If soap and water are not available, use an alcohol-based hand gel with at least 60% alcohol. 

Pay attention to your health after your trip.  People can become sick with Q fever 2–5 weeks after being exposed to the disease.  If you feel sick, go to the doctor and tell him or her that you have traveled to The Netherlands.

More Information

Q fever is a disease caused by Coxiella burnetii, a species of bacteria found all around the world. Q fever is a zoonotic disease, which means that it is passed from animals to humans. Cattle, sheep, and goats are the primary carriers of C. burnetii; however, other animals can also carry the bacteria. Infected animals excrete C. burnetti through milk, urine, and droppings (feces), and during the birthing process. C. burnetti is resistant to heat, drying, and many common disinfectants, allowing it to survive for a long time in the environment.

People can become infected with Q fever by breathing in the C. burnetii bacteria, usually through contaminated barnyard dust and soil. People can also get infected by drinking or eating unpasteurized (raw) milk and dairy products. Q fever has a wide variety of clinical manifestations in humans including flu-like illness, pneumonia, and hepatitis. Q fever can be treated with antibiotics, and most people will recover fully.

For additional information about Q fever and the outbreak in The Netherlands, see the following links:

• Q Fever (CDC Division of Viral and Rickettsial Diseases)
• Q Fever and Animals (CDC Healthy Pets, Healthy People)
• Rickettsial Infections (CDC Health Information for International Travel 2010)
• Sustained Intensive Transmission of Q Fever in the South of the Netherlands, 2009 (Eurosurveillance, Volume 14, Issue 19, 14 May 2009)

For additional health information about travel to The Netherlands, visit The Netherlands destination page on CDC’s Travelers’ Health website.