Open Access Research article

Q fever in the Netherlands: public perceptions and behavioral responses in three different epidemiological regions: a follow-up study

Marloes Bults12*, Desirée Beaujean3, Clementine Wijkmans4, Jan Hendrik Richardus12 and Hélène Voeten12

Author Affiliations

1 Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, 3000 Rotterdam, LP, The Netherlands

2 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 Rotterdam, CA, The Netherlands

3 National Institute of Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720 Bilthoven, BA, The Netherlands

4 Municipal Public Health Service “Hart voor Brabant”, P.O. Box 3166, 5203 DD ‘s-Hertogenbosch, The Netherlands

For all author emails, please log on.

BMC Public Health 2014, 14:263  doi:10.1186/1471-2458-14-263

Published: 20 March 2014



Over the past years, Q fever has become a major public health problem in the Netherlands, with a peak of 2,357 human cases in 2009. In the first instance, Q fever was mainly a local problem of one province with a high density of large dairy goat farms, but in 2009 an alarming increase of Q fever cases was observed in adjacent provinces. The aim of this study was to identify trends over time and regional differences in public perceptions and behaviors, as well as predictors of preventive behavior regarding Q fever.


One cross-sectional survey (2009) and two follow-up surveys (2010, 2012) were performed. Adults, aged ≥18 years, that participated in a representative internet panel were invited (survey 1, n = 1347; survey 2, n = 1249; survey 3, n = 1030).


Overall, public perceptions and behaviors regarding Q fever were consistent with the trends over time in the numbers of new human Q fever cases in different epidemiological regions and the amount of media attention focused on Q fever in the Netherlands. However, there were remarkably low levels of perceived vulnerability and perceived anxiety, particularly in the region of highest incidence, where three-quarters of the total cases occurred in 2009. Predictors of preventive behavior were being female, older aged, having Q fever themselves or someone in their household, more knowledge, and higher levels of perceived severity, anxiety and (self-) efficacy.


During future outbreaks of (zoonotic) infectious diseases, it will be important to instil a realistic sense of vulnerability by providing the public with accurate information on the risk of becoming infected. This should be given in addition to information about the severity of the disease, the efficacy of measures, and instructions for minimising infection risk with appropriate, feasible preventative measures. Furthermore, public information should be adapted to regional circumstances.

Zoonotic infections; Q fever; Risk perception; Behavioral responses; General public; risk communication