Q fever is underestimated in the United States: a comparison of fatal Q fever cases from two national reporting systems

Abstract

Two national surveillance systems capturing reports of fatal Q fever were compared with obtained estimates of Q fever underreporting in the United States using capture-recapture methods. During 2000-2011, a total of 33 unique fatal Q fever cases were reported through case report forms submitted to the Centers for Disease Control and Prevention and through U.S. death certificate data. A single case matched between both data sets, yielding an estimated 129 fatal cases (95% confidence interval [CI] = 62-1,250) during 2000-2011. Fatal cases of Q fever were underreported through case report forms by an estimated factor of 14 and through death certificates by an estimated factor of 5.2.

Figure 1.

The P value from Pearson's χ² test versus the number of fatal Q fever cases in the United States, 2000–2011. The shaded area, 62–1,250, correspond to the number of fatal Q fever cases consistent with the null hypothesis of independence of reporting between the case report form system and the multiple cause of death system at α = 0.05.