{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T17:46:48Z","timestamp":1779904008176,"version":"3.53.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T00:00:00Z","timestamp":1648598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMW","doi-asserted-by":"publisher","award":["50\u201352200-98\u2013807"],"award-info":[{"award-number":["50\u201352200-98\u2013807"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A causative role of Coxiella burnetii (the causative agent of Q fever) in the pathogenesis of B-cell non-Hodgkin lymphoma (NHL) has been suggested, although supporting studies show conflicting evidence. We assessed whether this association is present by performing a detailed analysis on the risk of mature B-cell NHL after Q fever during and after the largest Q fever outbreak reported worldwide in the entire Dutch population over a 16-year period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed an ecological analysis. The incidence of mature B-cell NHL in the entire Dutch population from 2002 until 2017 was studied and modelled with reported acute Q fever cases as the determinant. The adjusted relative risk of NHL after acute Q fever as the primary outcome measure was calculated using a Poisson regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between January 2002 and December 2017, 266\u200a050\u200a745 person-years were observed, with 61\u200a424 diagnosed with mature B-cell NHL. In total, 4310 persons were diagnosed with acute Q fever, with the highest incidence in 2009. The adjusted relative risk of NHL after acute Q fever was 1.02 (95% CI 0.97\u20131.06, P\u2009=\u20090.49) and 0.98 (95% CI 0.89\u20131.07, P\u2009=\u20090.60), 0.99 (95% CI 0.87\u20131.12, P\u2009=\u20090.85) and 0.98 (95% 0.88\u20131.08, P\u2009=\u20090.67) for subgroups of diffuse large B-cell lymphoma, follicular lymphoma or B-cell chronic lymphocytic leukaemia, respectively. Modelling with lag times (1\u20134\u2009years) did not change interpretation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We found no evidence for an association between C. burnetii and NHL after studying the risk of mature B-cell NHL after a large Q fever outbreak in Netherlands.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ije\/dyac053","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T20:10:14Z","timestamp":1647029414000},"page":"1481-1488","source":"Crossref","is-referenced-by-count":6,"title":["No increased risk of mature B-cell non-Hodgkin lymphoma after Q fever detected: results from a 16-year ecological analysis of the Dutch population incorporating the 2007\u20132010 Q fever outbreak"],"prefix":"10.1093","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9419-216X","authenticated-orcid":false,"given":"Jesper M","family":"Weehuizen","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht and Utrecht University , Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja E","family":"van Roeden","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht and Utrecht University , Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander J","family":"Hogewoning","sequence":"additional","affiliation":[{"name":"Netherlands Comprehensive Cancer Organisation , Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"van der Hoek","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment , Bilthoven, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc J M","family":"Bonten","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University Medical Centre Utrecht and Utrecht University , Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy I M","family":"Hoepelman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht and Utrecht University , Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal P","family":"Bleeker-Rovers","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, Radboud University Medical Centre and Radboud Expertise Centre for Q fever , Nijmegen, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C","family":"Wever","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital , \u2019s-Hertogenbosch, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Jelrik","family":"Oosterheert","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht and Utrecht University , Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,30]]},"reference":[{"key":"2022101309182505200_dyac053-B1","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/S0140-6736(12)60605-9","article-title":"Non-Hodgkin lymphoma","volume":"380","author":"Shankland","year":"2012","journal-title":"Lancet"},{"key":"2022101309182505200_dyac053-B2","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.0303-6987.2003.00167.x","article-title":"Borrelia 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