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Screening of post-mortem tissue donors for Coxiella burnetii infection after large outbreaks of Q fever in The Netherlands

Marja J van Wijk1*, D Willemijn Maas1, Nicole HM Renders2, Mirjam HA Hermans2, Hans L Zaaijer34 and Boris M Hogema3

Author Affiliations

1 BISLIFE Foundation, PO Box 309, 2333BD Leiden, The Netherlands

2 Regional Laboratory Medical Microbiology and Infection Prevention, Jeroen Bosch Hospital, PO Box 90153, 5200ME ‘s Hertogenbosch, The Netherlands

3 Department of Blood-borne Infections and Viral Diagnostic Services, Sanquin blood supply foundation, PO Box 9892, 1006AN Amsterdam, The Netherlands

4 Department of Clinical Virology (CINIMA), Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands

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BMC Infectious Diseases 2014, 14:6  doi:10.1186/1471-2334-14-6

Published: 6 January 2014



After the largest outbreaks of Q fever ever recorded in history occurred in the Netherlands, concern arose that Coxiella may be transmitted via donated tissues of latent or chronically infected donors. The Dutch Health Council recently advised to screen tissue donors, donating high risk tissues, for Coxiella infection.


After validation of an enzyme immunoassay (EIA) test for IgG antibodies against phase 2 of C. burnetii for use on post-mortem samples, serum samples of 1033 consecutive Dutch post-mortem tissue donors were tested for IgG antibodies against phase 2 of C. burnetii. Confirmation of reactive results was done by immunofluorescence assay (IFA). All available tissues (corneas, heart valves, skin and bone marrow) from donors with IgG reactivity were tested for presence of Coxiella DNA by PCR. Risk factors for IgG reactivity were investigated.


After validation of the tests for use on post-mortem samples, 50/1033 donors (4.8%) screened positive for phase 2 anti-Coxiella IgG by EIA, and 31 were confirmed by IFA (3.0%). One donor showed a serological profile compatible with chronic infection. All tested tissues (25 corneas, 6 heart valves, 4 skin and 3 bone marrow) from donors with IgG reactivity tested negative for the presence of Coxiella DNA. Except for living in a postal code area with a high number of Q fever notifications, no risk factors for IgG reactivity were found.


The strong correlation between notifications and seroprevalence confirms that the used assays are sufficiently specific for use on post-mortem samples, although one has to be aware of differences between batches. Thus, this study provides a validated method for screening tissue donors for infection with Coxiella burnetii that can be used in future outbreaks.

Coxiella burnetii; Q fever; Tissue transplantation; Serological screening; Zoonotic infections; Outbreaks