Q fever: the Dutch policy

Between 2007 and 2010, the Netherlands experienced an unprecedented outbreak of Q fever of more than 4000 human cases. Q fever infections of dairy goats, leading to abortion waves, were considered to be the cause of this outbreak. Measures to combat the outbreak had to be taken based on limited scientific knowledge and were aimed at the interruption of the infection cycle. Next to a notification obligation, hygienic and manure measures were made obligatory. A voluntary vaccination programme started in 2008 in the risk region and was made compulsory and extended to the whole country in the years thereafter. Unexpectedly, the implemented measures did not lead to the desired result and the number of patients increased instead of decreased in the second year of the epidemic. The measures were not effective, and the scientific knowledge was still limited and did not provide the necessary answers in 2008. To curb the epidemic, the control had to change from a risk-based approach to the precautionary principle which finally, during the lambing season of 2009/2010, led to the culling of more than 50,000 pregnant goats from infected herds. After taking this drastic measure, on top of the hygiene measures and compulsory vaccination of all dairy goats in the country, the number of patients decreased to the pre-outbreak level and in 2012 the epidemic could be declared ended.