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Seroprevalence of Q Fever in the United States, 2003–2004

We performed serum testing for IgG antibodies against Coxiella burnetii (phase I and phase II) and analyzed questionnaire data from 4,437 adults 20 years of age who participated in the National Health and Nutrition Examination Survey 2003–2004 survey cycle. National Q fever seroprevalence was determined by enzyme-linked immunosorbent assay and confirmed by using immunofluorescent antibody testing. Overall seroprevalence for Coxiella burnetii was 3.1% (95% confidence interval [CI] = 2.1–4.3%) among 4,437 adults 20 years of age. Coxiella burnetii age-adjusted antibody prevalence was higher for men than for women (3.8%, 95% CI = 2.7–5.2% versus 2.5%, 95% CI = 1.5–3.7%, respectively, P < 0.05). Mexican Americans had a significantly higher antibody prevalence (7.4%, 95% CI = 6.6–8.3%) than either non-Hispanic whites (2.8%, 95% CI = 1.7–4.3%) or non-Hispanic blacks (1.3%, 95% CI = 0.6–2.5%) (P < 0.001). Multivariate analysis showed that the risk for Q fever antibody positivity increased with age and was higher among persons who were foreign-born, male, and living in poverty. These findings indicate that the national seroprevalence of Q fever in the United States is higher than expected on the basis of case numbers reported to the Centers for Disease Control and Prevention from state health departments. Potential differences in risk for exposure by race/ethnicity warrant further study.

Received March 31, 2009. Accepted for publication June 24, 2009.

Financial support: This study was supported by the Rickettsial Zoonoses Branch, CDC.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC.

^* Address correspondence to Alicia D. Anderson, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-44, Atlanta, GA 30333. E-mail: aha5{at}cdc.gov

Authors’ addresses: Alicia D. Anderson, William L. Nicholson, Rachel A. Priestley, Amanda J. Candee, Nicole E. Patterson, and Robert F. Massung, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, E-mails: wan6{at}cdc.gov, rnp9{at}cdc.gov, acandeeis{at}gmail.com, dsv4{at}cdc.gov, and rfm2{at}cdc.gov. Deanna Kruszon-Moran and Geraldine McQuillan, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, E-mails: ddk0{at}cdc.gov and gmm2{at}cdc.gov. Amanda D. Loftis, Department of Biological Sciences, University of Idaho, Pocatello, ID 83209, E-mail: adloftis{at}gmail.com.