Background: After the largest outbreaks of Q fever ever recorded in history occurred in the Netherlands, concern\r\narose that Coxiella may be transmitted via donated tissues of latent or chronically infected donors. The Dutch\r\nHealth Council recently advised to screen tissue donors, donating high risk tissues, for Coxiella infection.\r\nMethods: After validation of an enzyme immunoassay (EIA) test for IgG antibodies against phase 2 of C. burnetii for\r\nuse on post-mortem samples, serum samples of 1033 consecutive Dutch post-mortem tissue donors were tested\r\nfor IgG antibodies against phase 2 of C. burnetii. Confirmation of reactive results was done by immunofluorescence\r\nassay (IFA). All available tissues (corneas, heart valves, skin and bone marrow) from donors with IgG reactivity were\r\ntested for presence of Coxiella DNA by PCR. Risk factors for IgG reactivity were investigated.\r\nResults: After validation of the tests for use on post-mortem samples, 50/1033 donors (4.8%) screened positive for\r\nphase 2 anti-Coxiella IgG by EIA, and 31 were confirmed by IFA (3.0%). One donor showed a serological profile\r\ncompatible with chronic infection. All tested tissues (25 corneas, 6 heart valves, 4 skin and 3 bone marrow) from\r\ndonors with IgG reactivity tested negative for the presence of Coxiella DNA. Except for living in a postal code area\r\nwith a high number of Q fever notifications, no risk factors for IgG reactivity were found.\r\nConclusions: The strong correlation between notifications and seroprevalence confirms that the used assays are\r\nsufficiently specific for use on post-mortem samples, although one has to be aware of differences between batches.\r\nThus, this study provides a validated method for screening tissue donors for infection with Coxiella burnetii that can\r\nbe used in future outbreaks.
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