{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:05:16Z","timestamp":1791266716772,"version":"4.1.0"},"reference-count":30,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2015,10,28]],"date-time":"2015-10-28T00:00:00Z","timestamp":1445990400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>A significant proportion of Q fever patients from the first Dutch Q fever outbreak in 2007 showed impairment in health status up to 1 year after infection. Interested in whether this decrease in health status persisted, we set out to determine the health status in the same cohort of patients, 4 years after primary infection and to compare health status scores at the individual patient level between 1 and 4 years follow-up. Health status was assessed with the Nijmegen Clinical Screening Instrument (NCSI). Patients were serologically tested to exclude patients with possible, probable or proven chronic Q fever. Results on the NCSI sub-domains at group level [2008 (<jats:italic>n<\/jats:italic>\u00a0=\u00a054) and 2011 (<jats:italic>n<\/jats:italic>\u00a0=\u00a046)] showed a persistent significant percentage of patients exhibiting clinically relevant (\u2018severe\u2019) scores for all NCSI sub-domains. After 4 years, undue fatigue was present in 46% and exactly half of all patients experienced a severely impaired general quality of life. Patients with NCSI scores available in both 2008 and 2011 (<jats:italic>n<\/jats:italic>\u00a0=\u00a037) showed no difference in all sub-domain scores, except for a small decrease in dyspnoea emotions in 2011. In this group, a significant proportion of patients either improved or worsened in one or more sub-domains of health status. We conclude that at the group level, health status of Q fever patients remained impaired 4 years after primary infection. At the individual patient level, health status may change.<\/jats:p>","DOI":"10.1017\/s0950268815002216","type":"journal-article","created":{"date-parts":[[2015,10,28]],"date-time":"2015-10-28T05:14:36Z","timestamp":1446009276000},"page":"1142-1147","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":10,"title":["Persistence of impaired health status of Q fever patients 4 years after the first Dutch outbreak"],"prefix":"10.1017","volume":"144","author":[{"given":"G. J. 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