Volume 81, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


We performed serum testing for IgG antibodies against (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 was 3.1% (95% confidence interval [CI] = 2.1–4.3%) among 4,437 adults ≥ 20 years of age. 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, < 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%) ( < 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.


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  1. Derrick EH, 1937. “Q” fever, new fever entity: clinical features, diagnosis, and laboratory investigation. Med J Aust 2: 281–299. [Google Scholar]
  2. McQuiston JH, Holman RC, McCall CL, Childs JE, Swerdlow DL, Thompson HA, 2006. National surveillance and the epidemiology of human Q fever in the United States, 1978–2004. Am J Trop Med Hyg 75: 36–40. [Google Scholar]
  3. Benenson AS, Tigertt WD, 1956. Studies on Q fever in man. Trans Assoc Am Physicians 69: 98–104. [Google Scholar]
  4. Williams JC, 1991. Infectivity, virulence, and pathogenicity of Coxiella burnetii for various hosts. Williams JC, Thompson HA, eds. Q Fever: The Biology of Coxiella burnetii. Boca Raton, FL: CRC Press, 21–71.
  5. Fournier PE, Marrie TJ, Raoult D, 1998. Diagnosis of Q fever. J Clin Microbiol 36: 1823–1834. [Google Scholar]
  6. McQuiston JH, Childs JE, 2002. Q fever in humans and animals in the United States. Vector Borne Zoonotic Dis 2: 179–191. [Google Scholar]
  7. Maurin M, Raoult D, 1999. Q fever. Clin Microbiol Rev 12: 518–553. [Google Scholar]
  8. Madariaga MG, Rezai K, Trenholme GM, Weinstein RA, 2003. Q fever: a biological weapon in your backyard. Lancet Infect Dis 3: 709–721. [Google Scholar]
  9. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (NHANES) 1999–2004. Available at: http://www.cdc.gov/nchs/about/major/nhanes/datalink.htm. Accessed November 1, 2006.
  10. Ezzati T, Khare M, 1993. Non-response Adjustment in a National Hhealth Survey 1992 Proceedings of the Survey Research Methods Section of the American Statistical Association, 339–344. [Google Scholar]
  11. Shah BV, Barnwell BG, Bieler GS, La Vange LM, 1996. SUDAAN Software for the Statistical Analysis of Correlated Data, User’s Manual Release 7.0. Research Triangle Park, NC: Research Triangle Institute.
  12. Mohadjer L, Montaquila J, Waksberg J, 1996. National Health and Nutrition Examination Survey III: Weighting and Examination Methodology. Prepared for the National Center for Health Statistics, Hyattsville, MD. Westat, Inc.
  13. Korn LK, Graubard BI, 1998. Confidence intervals for proportions with small expected number of positive counts estimated from survey data. Surv Methodol 24: 193–201. [Google Scholar]
  14. U.S. Census Bureau, 2004. Current Population Survey. Available at: http://www.census.gov/cps. Accessed January 24, 2007.
  15. Philip RN, Casper EA, Ormsbee R, Peacock MG, Burgdorfer W, 1976. Microimmunofluorescence test for the serological study of Rocky Mountain spotted fever and typhus. J Clin Microbiol 3: 51–61. [Google Scholar]
  16. Péter O, Dupuis G, Burgdorfer W, Peacock MG, 1985. Evaluation of complement fixation and indirect immunofluorescence tests in the early diagnosis of primary Q fever. Eur J Clin Microbiol 4: 394–396. [Google Scholar]
  17. Whitney EA, Massung RF, Candee AJ, Ailes EC, Myers LM, Patterson NE, Berkelman RL, 2009. Seroepidemiologic and occupational risk survey for Coxiella burnetii antibodies among U.S. veterinarians. Clin Infect Dis 48: 550–557. [Google Scholar]
  18. Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E, Stein A, Nesri M, HArle JR, Weiller PJ, 2000. Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 79: 109–123. [Google Scholar]
  19. Raoult D, Marrie T, Mege J, 2005. Natural history and pathophysiology of Q fever. Lancet Infect Dis 5: 219–226. [Google Scholar]
  20. Gleeson TD, Decker CF, Johnson MD, Hartzell JD, Mascola JR, 2007. Q fever in U.S. military returning from Iraq. Am J Med 120: 11–12. [Google Scholar]
  21. Anderson AD, Smoak B, Shuping E, Ockenhouse C, Petruccelli B, 2005. Q fever and the U.S. military. Emerg Infect Dis 11: 1320–1322. [Google Scholar]
  22. Leung-Shea C, Danaher PJ, 2006. Q fever in members of the United States armed forces returning from Iraq. Clin Infect Dis 43: 77–82. [Google Scholar]

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  • Received : 31 Mar 2009
  • Accepted : 24 Jun 2009

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