Editing Q fever

{{Short description|Coxiella burnetii infection}}
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{{Infobox medical condition (new)
| name            = Q&nbsp;fever
| synonyms        = Query fever, coxiellosis<ref name=CDC2020 /><ref name=NORD />
| image           = Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever endocarditis.jpg
| caption         = [[Immunohistochemical]] detection of ''C.&nbsp;burnetii'' in resected cardiac valve of a 60-year-old man with Q&nbsp;fever endocarditis, Cayenne, French Guiana: [[Monoclonal antibodies]] against ''C.&nbsp;burnetii'' and hematoxylin were used for staining; original magnification is ×50.
| pronounce       =
| field           =
| symptoms        =
| complications   =
| onset           =
| duration        =
| types           = acute, chronic<ref name=CDC2020 />
| causes          =
| risks           = Contact with livestock<ref name=NORD>{{Cite book | author =((National Organization for Rare Disorders))|chapter-url=https://books.google.com/books?id=99YPDvFWBB0C&pg=PA293|title=NORD Guide to Rare Disorders|chapter=Q Fever|page=293|date=2003|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-3063-1|language=en}}</ref>
| diagnosis       =
| differential    = [[pneumonia]], [[influenza]], [[brucellosis]], [[leptospirosis]], [[meningitis]], [[viral hepatitis]], [[dengue fever]], [[malaria]], other rickettsial infections<ref name=NORD />
| prevention      =
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}}
'''Q&nbsp;fever''' or '''query fever''' is a disease caused by infection with ''[[Coxiella burnetii]]'',<ref name="CDC2020">{{Cite web|date=2019-09-16|title=Epidemiology and Statistics {{!}} Q Fever {{!}} CDC|url=https://www.cdc.gov/qfever/stats/index.html|url-status=live|archive-url=https://web.archive.org/web/20200529130025/https://www.cdc.gov/qfever/stats/index.html|archive-date=2020-05-29|access-date=2020-05-27|website=www.cdc.gov|language=en-us}}</ref><ref name="pmid16547017">{{cite journal | vauthors = Beare PA, Samuel JE, Howe D, Virtaneva K, Porcella SF, Heinzen RA | title = Genetic diversity of the Q fever agent, Coxiella burnetii, assessed by microarray-based whole-genome comparisons | journal = Journal of Bacteriology | volume = 188 | issue = 7 | pages = 2309–2324 | date = April 2006 | pmid = 16547017 | pmc = 1428397 | doi = 10.1128/JB.188.7.2309-2324.2006 }}</ref><ref>{{Cite web|title=Q fever {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|url=https://rarediseases.info.nih.gov/diseases/7515/q-fever|url-status=live|archive-url=https://web.archive.org/web/20180418032604/https://rarediseases.info.nih.gov/diseases/7515/q-fever|archive-date=2018-04-18|access-date=2018-04-17|website=Genetic and Rare Diseases Information Center|language=en-US}}</ref> a [[bacterium]] that affects humans and other animals. This organism is uncommon, but may be found in [[cattle]], [[sheep]], [[goat]]s, and other [[domestic mammal]]s, including [[cat]]s and [[dog]]s. The infection results from [[inhalation]] of a spore-like small-cell variant, and from contact with the [[milk]], [[urine]], [[feces]], [[vaginal mucus]], or [[semen]] of infected animals. Rarely, the disease is [[tick]]-borne.<ref name="Centers for Disease Control and Prevention-2017">{{Cite web|date=2017-12-27|title=Q Fever {{!}} CDC|url=https://www.cdc.gov/qfever/|url-status=live|archive-url=https://web.archive.org/web/20180418032422/https://www.cdc.gov/qfever/|archive-date=2018-04-18|access-date=2018-04-17|website=Centers for Disease Control and Prevention|language=en-us}}</ref> The [[incubation period]] can range from {{nowrap|9 to 40 days}}. Humans are vulnerable to Q&nbsp;fever, and infection can result from even a few organisms.<ref name="Centers for Disease Control and Prevention-2017" /> The bacterium is an [[Intracellular parasites#Obligate|obligate intracellular pathogenic parasite]].

== Signs and symptoms ==
The incubation period is usually two to three weeks.<ref name="Brunette-2011-p270" /> The most common manifestation is [[flu-like symptoms]]: abrupt onset of [[fever]], [[malaise]], [[diaphoresis|profuse perspiration]], severe [[headache]], [[myalgia|muscle pain]], [[Arthralgia|joint pain]], [[Anorexia (symptom)|loss of appetite]], upper respiratory problems, dry cough, [[Pleurisy|pleuritic pain]], chills, [[mental confusion|confusion]], and gastrointestinal [[symptoms]], such as [[nausea]], vomiting, and [[diarrhea]]. About half of infected individuals exhibit no symptoms.<ref name="Brunette-2011-p270">{{cite book|chapter=Q Fever| veditors = Brunette GW, McQuiston J, etal |title=CDC Health Information for International Travel: The Yellow Book|publisher=Oxford University Press|year=2011|isbn=978-0-19-976901-8|page=[https://archive.org/details/cdchealthinforma0000unse/page/270 270]|chapter-url=https://books.google.com/books?id=5vCQpr1WTS8C&pg=PA270| vauthors = Anderson A |url-access=registration|url=https://archive.org/details/cdchealthinforma0000unse/page/270}}</ref>

During its course, the disease can progress to an [[atypical pneumonia]], which can result in a life-threatening [[acute respiratory distress syndrome]], usually occurring during the first four to five days of infection.<ref name="The Lecturio Medical Concept Library">{{cite web|title=Coxiella/Q Fever|url=https://www.lecturio.com/concepts/coxiella-q-fever/|url-status=live|archive-url=https://web.archive.org/web/20210515174110/https://www.lecturio.com/concepts/coxiella-q-fever/|archive-date=2021-05-15|access-date=7 July 2021|website=The Lecturio Medical Concept Library}}</ref>

Less often, Q&nbsp;fever causes (granulomatous) [[hepatitis]], which may be asymptomatic or become symptomatic with malaise, fever, [[Hepatomegaly|liver enlargement]], and pain in the right upper quadrant of the [[abdomen]]. This hepatitis often results in the [[elevated transaminases|elevation of transaminase values]], although [[jaundice]] is uncommon. Q fever can also rarely result in [[retinal vasculitis]].<ref>{{cite journal | vauthors = Kuhne F, Morlat P, Riss I, Dominguez M, Hostyn P, Carniel N, Paix MA, Aubertin J, Raoult D, Le Rebeller MJ | display-authors = 6 | title = [Is A29, B12 vasculitis caused by the Q fever agent? (Coxiella burnetii)] | language = fr | journal = Journal Français d'Ophtalmologie | volume = 15 | issue = 5 | pages = 315–321 | date = 1992 | pmid = 1430809 | trans-title = Is A29, B12 vasculitis caused by the Q fever agent? (Coxiella burnetii) | oclc = 116712679 }}</ref>

The chronic form of Q&nbsp;fever is virtually identical to [[endocarditis]] (i.e. [[inflammation]] of the inner lining of the heart),<ref name="pmid16757641">{{cite journal | vauthors = Karakousis PC, Trucksis M, Dumler JS | title = Chronic Q fever in the United States | journal = Journal of Clinical Microbiology | volume = 44 | issue = 6 | pages = 2283–2287 | date = June 2006 | pmid = 16757641 | pmc = 1489455 | doi = 10.1128/JCM.02365-05 }}</ref> which can occur months or decades following the infection. It is usually fatal if untreated. However, with appropriate treatment, the mortality falls to around 10%.{{citation needed|date=May 2021}}

A minority of Q fever survivors develop [[Q fever fatigue syndrome]] after acute infection, one of the more well-studied [[post-acute infection syndrome]]s. Q fever fatigue syndrome is characterised by [[post-exertional malaise]] and debilitating fatigue. People with Q fever fatigue syndrome frequently meet the diagnostic criteria for [[myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS). Symptoms often persist years after the initial infection.<ref name="pmid35585196">{{cite journal |vauthors=Choutka J, Jansari V, Hornig M, Iwasaki A |date=May 2022 |title=Unexplained post-acute infection syndromes |url= |journal=Nature Medicine |volume=28 |issue=5 |pages=911–923 |doi=10.1038/s41591-022-01810-6 |pmid=35585196|s2cid=248889597 |doi-access=free }}</ref>

== Diagnosis ==
[[File:Q fever management algorithm.gif|thumbnail|Q&nbsp;fever management algorithm from the [[Centers for Disease Control and Prevention]]]]
Diagnosis is usually based on [[serology]]<ref name="pmid10515901">{{cite journal | vauthors = Maurin M, Raoult D | title = Q fever | journal = Clinical Microbiology Reviews | volume = 12 | issue = 4 | pages = 518–553 | date = October 1999 | pmid = 10515901 | pmc = 88923 | doi = 10.1128/CMR.12.4.518 }}</ref><ref name="pmid12491231">{{cite journal | vauthors = Scola BL | title = Current laboratory diagnosis of Q fever | journal = Seminars in Pediatric Infectious Diseases | volume = 13 | issue = 4 | pages = 257–262 | date = October 2002 | pmid = 12491231 | doi = 10.1053/spid.2002.127199 }}</ref> (looking for an [[antibody]] response) rather than looking for the organism itself. Serology allows the detection of chronic infection by the appearance of high levels of the antibody against the virulent form of the bacterium. Molecular detection of bacterial DNA is increasingly used. Contrary to most [[Obligate intracellular parasite|obligate intracellular]] parasites, ''[[Coxiella burnetii]]'' can be grown in an [[axenic]] culture, but its culture is technically difficult and not routinely available in most microbiology laboratories.<ref>{{cite journal | vauthors = Omsland A, Cockrell DC, Howe D, Fischer ER, Virtaneva K, Sturdevant DE, Porcella SF, Heinzen RA | display-authors = 6 | title = Host cell-free growth of the Q fever bacterium Coxiella burnetii | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 106 | issue = 11 | pages = 4430–4434 | date = March 2009 | pmid = 19246385 | pmc = 2657411 | doi = 10.1073/pnas.0812074106 | doi-access = free | bibcode = 2009PNAS..106.4430O }}</ref>

Q&nbsp;fever can cause endocarditis (infection of the heart valves) which may require [[Echocardiography#Transesophageal echocardiogram|transoesophageal echocardiography]] to diagnose.  Q&nbsp;fever hepatitis manifests as an elevation of [[alanine transaminase]] and [[aspartate transaminase]], but a definitive diagnosis is only possible on [[liver biopsy]], which shows the characteristic [[fibrin ring granuloma]]s.<ref>{{cite journal|vauthors=van de Veerdonk FL, Schneeberger PM|date= May 2006 |title=Patient with fever and diarrhea|journal=[[Clinical Infectious Diseases]]|volume=42|issue=7|pages=1051–2|doi=10.1086/501027|doi-access=free}}</ref>

== Prevention ==
Research done in the 1960s{{ndash}}1970s by French Canadian-American [[microbiologist]] and [[Virology|virologist]] [[Paul Fiset]] was instrumental in the development of the first successful Q fever [[vaccine]].<ref>{{cite news| vauthors = Saxon W |date=March 8, 2001|title=Dr. Paul Fiset, 78, Microbiologist And Developer of Q Fever Vaccine|page=C-17|newspaper=[[The New York Times]]|url=https://www.nytimes.com/2001/03/08/us/dr-paul-fiset-78-microbiologist-and-developer-of-q-fever-vaccine.html|url-status=live|access-date=2022-01-28|archive-url=https://web.archive.org/web/20150527155503/https://www.nytimes.com/2001/03/08/us/dr-paul-fiset-78-microbiologist-and-developer-of-q-fever-vaccine.html|archive-date=2015-05-27}}</ref>

Protection is offered by Q-Vax, a whole-cell, inactivated vaccine developed by an Australian vaccine manufacturing company, [[CSL Limited]].<ref>{{cite web|date=17 January 2014|title=Q&nbsp;fever Vaccine|url=http://www.csl.com.au/docs/39/836/Q-Vax_PI_V4_TGA-Approved-17%20January%202014.pdf|url-status=dead|archive-url=https://web.archive.org/web/20170309080855/http://www.csl.com.au/docs/39/836/Q-Vax_PI_V4_TGA-Approved-17%20January%202014.pdf|archive-date=9 March 2017|access-date=11 July 2015|website=[[CSL Limited]]}}</ref> The intradermal vaccination is composed of killed ''C.&nbsp;burnetii'' organisms. Skin and blood tests should be done before vaccination to identify pre-existing immunity because vaccinating people who already have immunity can result in a severe local reaction. After a single dose of vaccine, protective immunity lasts for many years. Revaccination is not generally required. Annual screening is typically recommended.<ref>{{cite web |url=http://cdp.ucsf.edu/fileUpload/UCSF_CDP_Q_Fever_Surveillance_Policy_Q_Neg_Wethers.pdf |title=USCF communicable disease prevention program animal exposure surveillance program |access-date=2007-05-08 |url-status=dead |archive-url=https://web.archive.org/web/20070701075855/http://cdp.ucsf.edu/fileUpload/UCSF_CDP_Q_Fever_Surveillance_Policy_Q_Neg_Wethers.pdf |archive-date=2007-07-01 }}</ref>

In 2001, Australia introduced a national Q&nbsp;fever vaccination program for people working in "at-risk" occupations. Vaccinated or previously exposed people may have their status recorded on the Australian Q&nbsp;Fever Register,<ref>{{cite web|title=Australian Q Fever Register|url=https://www.qfever.org|url-status=live|archive-url=https://web.archive.org/web/20160216183213/https://www.qfever.org/|archive-date=2016-02-16|access-date=12 February 2016|publisher=AusVet}}</ref> which may be a condition of employment in the meat processing industry or in [[University of Melbourne Faculty of Veterinary and Agricultural Sciences|veterinary research]].<ref>{{Cite web|date=2019-11-20|title=Q-Fever Vaccinations|url=https://fvas.unimelb.edu.au/students/general/q-fever|url-status=live|archive-url=https://web.archive.org/web/20190625021440/https://fvas.unimelb.edu.au/students/admin/q-fever|archive-date=2019-06-25|access-date=2020-07-11|website=Faculty of Veterinary and Agricultural Sciences {{!}} [[The University of Melbourne]]|language=en}}</ref> An earlier killed vaccine had been developed in the Soviet Union, but its side effects prevented its licensing abroad.{{citation needed|date=November 2020}}

Preliminary results suggest vaccination of animals may be a method of control. Published trials proved that use of a registered phase vaccine (Coxevac) on infected farms is a tool of major interest to manage or prevent early or late abortion, repeat breeding, [[anoestrus]], silent oestrus, [[metritis]], and decreases in milk yield when ''C.&nbsp;burnetii'' is the major cause of these problems.<ref>{{cite conference | vauthors = Camuset P, Remmy D |title=Q&nbsp;Fever (Coxiella burnetii) Eradication in a Dairy Herd by Using Vaccination with a Phase&nbsp;1 Vaccine| conference =XXV World Buiatrics Congress|year=2008|location=Budapest}}</ref><ref>{{cite journal | vauthors = Hogerwerf L, van den Brom R, Roest HI, Bouma A, Vellema P, Pieterse M, Dercksen D, Nielen M | display-authors = 6 | title = Reduction of Coxiella burnetii prevalence by vaccination of goats and sheep, The Netherlands | journal = Emerging Infectious Diseases | volume = 17 | issue = 3 | pages = 379–386 | date = March 2011 | pmid = 21392427 | pmc = 3166012 | doi = 10.3201/eid1703.101157 }}</ref>

Q fever is primarily transmitted to humans through inhalation of aerosols contaminated with Coxiella burnetii from infected animals, notably cattle, sheep, and goats. Occupational groups such as farmers, veterinarians, and abattoir workers are at heightened risk. Preventive strategies include:<ref>{{Cite web |last=CDC |date=2025-03-05 |title=Clinical Guidance for Q fever |url=https://www.cdc.gov/q-fever/hcp/clinical-guidance/index.html?utm_source=chatgpt.com |access-date=2025-03-23 |website=Q Fever |language=en-us}}</ref>

* '''Vaccination:''' In countries like Australia, where Q fever is endemic, vaccination programs targeting high-risk populations have been implemented. The vaccine has proven effective in reducing the incidence of the disease among these groups.   CDC
* '''Hygiene Measures:''' Implementing strict biosecurity and hygiene practices in livestock handling facilities can minimize environmental contamination. This includes proper disposal of animal waste and birthing products, which are known to harbor high concentrations of the bacteria.
* '''Public Awareness:''' Educating at-risk populations about Q fever transmission, symptoms, and preventive measures is crucial. Awareness campaigns can lead to early diagnosis and treatment, thereby reducing complications associated with the disease.<!--what is "Wannyn (2007) meant to be?-->

== Treatment ==
Treatment of acute Q&nbsp;fever with [[antibiotic]]s is very effective.<ref name="The Lecturio Medical Concept Library" /> Commonly used antibiotics include [[doxycycline]], [[tetracycline]], [[chloramphenicol]], [[ciprofloxacin]], and [[ofloxacin]]; the antimalarial drug [[hydroxychloroquine]] is also used.<ref name="The Lecturio Medical Concept Library" /> Chronic Q&nbsp;fever is more difficult to treat and can require up to four years of treatment with doxycycline and [[Quinolone antibiotic|quinolones]] or doxycycline with hydroxychloroquine.<ref name="The Lecturio Medical Concept Library" /> If a person has chronic Q fever, doxycycline and hydroxychloroquine will be prescribed for at least 18 months. Q&nbsp;fever in pregnancy is especially difficult to treat because doxycycline and ciprofloxacin are contraindicated in pregnancy. The preferred treatment for pregnancy and children under the age of eight is [[co-trimoxazole]].<ref>{{cite journal | vauthors = Carcopino X, Raoult D, Bretelle F, Boubli L, Stein A | title = Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy | journal = Clinical Infectious Diseases | volume = 45 | issue = 5 | pages = 548–555 | date = September 2007 | pmid = 17682987 | doi = 10.1086/520661 | doi-access = free }}</ref><ref>{{Cite web|date=20 July 2021|title=Query Fever - MARI REF|url=https://mariref.com/query-fever-professional/|url-status=live|archive-url=https://web.archive.org/web/20210827163844/https://mariref.com/query-fever-professional/|archive-date=2021-08-27|access-date=2021-08-27|website=Misdiagnosis Association and Research Institute|language=en-US}}</ref>

==Epidemiology==
[[Image:Coxiella burnetii 01.JPG|thumb|right|''C. burnetii'', the Q fever-causing agent]]

Q fever is a globally distributed [[Zoonosis|zoonotic disease]] caused by a highly sustainable and virulent bacterium. The pathogenic agent is found worldwide, with the exception of New Zealand<ref name="pmid171479572">{{cite journal |vauthors=Cutler SJ, Bouzid M, Cutler RR |date=April 2007 |title=Q fever |journal=The Journal of Infection |volume=54 |issue=4 |pages=313–318 |doi=10.1016/j.jinf.2006.10.048 |pmid=17147957}}</ref> and Antarctica.<ref name="Salifu-2019">{{Cite journal |last1=Salifu |first1=Samson Pandam |last2=Bukari |first2=Abdul-Rahman Adamu |last3=Frangoulidis |first3=Dimitrios |last4=Wheelhouse |first4=Nick |date=2019-05-01 |title=Current perspectives on the transmission of Q fever: Highlighting the need for a systematic molecular approach for a neglected disease in Africa |url=https://www.sciencedirect.com/science/article/pii/S0001706X19300889 |journal=Acta Tropica |volume=193 |pages=99–105 |doi=10.1016/j.actatropica.2019.02.032 |pmid=30831112 |s2cid=73461378 |issn=0001-706X}}</ref>  Understanding the transmission and risk factors of Q fever is crucial for public health due to its potential to cause widespread infection.

Recent data indicates that Q fever remains a significant public health concern worldwide. In 2019, the United States reported 178 acute Q fever cases and 34 chronic cases. Notably, in 2024, the state of Victoria, Australia, experienced a marked increase in Q fever cases, with 77 reported instances—a significant rise compared to the previous five years. This surge prompted health authorities to issue alerts emphasizing the importance of preventive measures and awareness.<ref>{{Cite web |last=CDC |date=2024-05-20 |title=Epidemiology and Statistics |url=https://www.cdc.gov/q-fever/data-research/index.html?utm_source=chatgpt.com |access-date=2025-03-23 |website=Q Fever |language=en-us}}</ref>

===Transmission and occupational risks===
Transmission primarily occurs through the inhalation of contaminated dust, contact with contaminated milk, meat, or wool, and particularly birthing products. [[Ticks]] can transfer the [[pathogen]]ic agent to other animals. While human-to-human transmission is rare, often associated with the transmission of birth products, sexual contact, and blood transfusion,<ref name="Salifu-2019" /> certain occupations pose higher risks for Q fever:<ref>{{Cite web |title=Q fever: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/000611.htm |url-status=live |archive-url=https://web.archive.org/web/20160728022742/https://medlineplus.gov/ency/article/000611.htm |archive-date=2016-07-28 |access-date=2018-04-17 |website=[[MedlinePlus]] |language=en}}</ref>

* [[Veterinary]] personnel
* [[Feedlot|Stockyard]] workers
* [[Farmer]]s
* [[Sheep shearer]]s
* Animal transporters
* Laboratory workers handling potentially infected veterinary samples or visiting [[abattoir]]s
* People who cull and process [[kangaroos]]
* Hide ([[Tanning (leather)|tannery]]) workers

It is important to note that anyone who has contact with animals infected with Q fever bacteria, especially people who work on farms or with animals, is at an increased risk of contracting the disease.<ref name="CDC-2021">{{Cite web |last=CDC |date=2021-08-06 |title=Q fever epidemiology and statistics {{!}} CDC |url=https://www.cdc.gov/qfever/stats/index.html |access-date=2023-11-21 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> Understanding these occupational risks is crucial for public health.

===Prevalence and risk factors===
Studies indicate a higher prevalence of Q fever in men than in women,<ref name="pmid105899062">{{cite journal |vauthors=Domingo P, Muñoz C, Franquet T, Gurguí M, Sancho F, Vazquez G |date=October 1999 |title=Acute Q fever in adult patients: report on 63 sporadic cases in an urban area |journal=Clinical Infectious Diseases |volume=29 |issue=4 |pages=874–879 |doi=10.1086/520452 |pmid=10589906 |doi-access=free}}</ref><ref name="pmid33017082">{{cite journal |vauthors=Dupuis G, Petite J, Péter O, Vouilloz M |date=June 1987 |title=An important outbreak of human Q fever in a Swiss Alpine valley |journal=International Journal of Epidemiology |volume=16 |issue=2 |pages=282–287 |doi=10.1093/ije/16.2.282 |pmid=3301708}}</ref> potentially linked to occupational exposure rates.<ref name="CDC20202">{{Cite web |date=2019-09-16 |title=Epidemiology and Statistics {{!}} Q Fever {{!}} CDC |url=https://www.cdc.gov/qfever/stats/index.html |url-status=live |archive-url=https://web.archive.org/web/20200529130025/https://www.cdc.gov/qfever/stats/index.html |archive-date=2020-05-29 |access-date=2020-05-27 |website=www.cdc.gov |language=en-us}}</ref> Other contributing risk factors include geography, age, and occupational exposure. Diagnosis relies on [[blood compatibility testing]], with treatment varying for acute and chronic cases. Acute disease often responds to [[doxycycline]], while chronic cases may require a combination of [[doxycycline]] and [[hydroxychloroquine]].<ref>{{Cite journal |last1=Hartzell |first1=Joshua D. |last2=Wood-Morris |first2=Robert N. |last3=Martinez |first3=Luis J. |last4=Trotta |first4=Richard F. |date=May 2008 |title=Q Fever: Epidemiology, Diagnosis, and Treatment |journal=Mayo Clinic Proceedings |volume=83 |issue=5 |pages=574–579 |doi=10.4065/83.5.574 |issn=0025-6196|doi-access=free |pmid=18452690 }}</ref> It is worth noting that Q fever was officially reported in the United States as a notifiable disease in 1999 due to its potential biowarfare agent status.<ref name="Patil-2023">{{Citation |last1=Patil |first1=Sachin M. |title=Q Fever |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK556095/ |work=StatPearls |access-date=2023-11-21 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32310555 |last2=Regunath |first2=Hariharan}}</ref>

Q fever exhibits global epidemiological patterns, with higher incidence rates reported in certain countries. In Africa, wild animals in rainforests primarily transmit the disease, making it [[Endemic (epidemiology)|endemic]].<ref name="Salifu-2019" /> Unique patterns are observed in Latin America, but reporting is sporadic and inconsistent between and among countries, making it difficult to track and address.<ref>{{Cite journal |last1=Fernandes |first1=Jorlan |last2=Sampaio de Lemos |first2=Elba Regina |date=2023-04-01 |title=The multifaceted Q fever epidemiology: a call to implement One Health approach in Latin America |journal=The Lancet Regional Health - Americas |volume=20 |pages=100463 |doi=10.1016/j.lana.2023.100463 |issn=2667-193X |pmc=10006848 |pmid=36915670}}</ref>

Recent outbreaks in European countries, including the Netherlands and France, have been linked to urbanized [[goat farming]], raising concerns about the safety of intensive [[livestock]] farming practices and the potential risks of zoonotic diseases. Similarly, in the United States, Q fever is more common in livestock farming regions, especially in the West and the Great Plains. California, Texas, and Iowa account for almost 40% of reported cases, with a higher incidence during the spring and early summer when livestock are breeding, regardless of whether the infection is acute or chronic.<ref name="CDC-2021" />

These outbreaks have affected a significant number of people, with immunocompromised individuals being more severely impacted.<ref name="Patil-2023" /> The global nature of Q fever and its association with livestock farming highlight the importance of implementing measures to prevent and control the spread of the disease, particularly in high-risk regions.

===Age and occupational exposure===
Older men in the West and Great Plains regions, involved in close contact with livestock management, are at a higher risk of contracting chronic Q fever.<ref name="CDC20202" /> This risk may be further increased for those with a history of cardiac problems.<ref name="CDC20202" /> The disease can manifest years after the initial infection, presenting symptoms such as non-specific fatigue, fever, weight loss, and [[endocarditis]].<ref name="Salifu-2019" /><ref name="CDC20202" /> Additionally, certain populations are more vulnerable to Q fever, including children living in farming communities, who may experience similar symptoms as adults.<ref>{{Cite journal |last1=Bwatota |first1=Shedrack Festo |last2=Cook |first2=Elizabeth Anne Jessie |last3=de Clare Bronsvoort |first3=Barend Mark |last4=Wheelhouse |first4=Nick |last5=Hernandez-Castor |first5=Luis E |last6=Shirima |first6=Gabriel Mkilema |date=2022-11-17 |title=Epidemiology of Q-fever in domestic ruminants and humans in Africa. A systematic review |journal=CABI One Health |language=en |doi=10.1079/cabionehealth.2022.0008 |s2cid=253662234 |issn=2791-223X|doi-access=free |hdl=20.500.11820/8b572652-80f8-4983-a0f0-c2586c7d1b9e |hdl-access=free }}</ref> There have also been reported cases of Q fever among United States military service members,<ref>{{cite web |last1=Anderson |first1=Alicia D. |last2=Smoak |first2=Bonnie |last3=Shuping |first3=Eric |last4=Ockenhouse |first4=Christopher |last5=Petruccelli |first5=Bruno |title=Q Fever and the US Military - Volume 11, Number 8—August 2005 - Emerging Infectious Diseases journal - CDC |url=https://wwwnc.cdc.gov/eid/article/11/8/05-0314_article |language=en-us |doi=10.3201/eid1108.050314|pmid=16110586 }}</ref> particularly those deployed to Iraq or Afghanistan, which further highlights the importance of understanding and addressing the occupational risks associated with Q fever.<ref>{{Cite journal |last=Hartzell |first=Joshua |date=May 2008 |title=Q Fever: Epidemiology, Diagnosis, and Treatment |journal=Concise Review for Physicians |volume=83 |issue=5 |pages=574–579|doi=10.4065/83.5.574 |pmid=18452690 }}</ref>

===Prevention and public health education===
Proper public health education is crucial in reducing the number of Q fever cases. Raising awareness about transmission routes, occupational risks, and preventive measures,<ref name="Patil-2023"/> such as eliminating unpasteurized milk products from the diet, can help prevent the spread of disease.<ref>{{Cite web |author=((CDC))|date=2019-01-15 |title=Prevention of Q fever {{!}} CDC |url=https://www.cdc.gov/qfever/prevention/index.html |access-date=2023-12-12 |website=Centers for Disease Control and Prevention |language=en-us}}</ref>

Interdisciplinary collaboration between medical personnel and farmers is critical when developing strategies for control and prevention in a community.<ref name="Ullah-2022">{{Cite journal |last1=Ullah |first1=Qudrat |last2=Jamil |first2=Tariq |last3=Saqib |first3=Muhammad |last4=Iqbal |first4=Mudassar |last5=Neubauer |first5=Heinrich |date=2022-07-28 |title=Q Fever—A Neglected Zoonosis |journal=Microorganisms |volume=10 |issue=8 |pages=1530 |doi=10.3390/microorganisms10081530 |issn=2076-2607 |pmc=9416428 |pmid=36013948 |doi-access=free }}</ref> Awareness campaigns should particularly target occupations that work with livestock, focusing on risk-reduction procedures such as herd monitoring, implementing sanitation practices and [[personal protective equipment]], and vaccinating animals.<ref name="Ullah-2022" /> Locating livestock farms at least 500 meters away from residential areas can also help reduce animal-to-human transmission.<ref name="Ullah-2022" />

== History ==
[[Image:Pneumonia x-ray.jpg|right|thumb|''Image&nbsp;A'': A normal [[chest X-ray]] ''Image&nbsp;B'': Q&nbsp;fever pneumonia]]
Q&nbsp;fever was first described in 1935 by [[Edward Holbrook Derrick]]<ref>{{cite journal| vauthors = Derrick EH |date=August 1937|title='Q'&nbsp;Fever a new fever entity: clinical features. diagnosis, and laboratory investigation|url=https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.1937.tb43743.x|journal=[[Medical Journal of Australia]]|volume=2|issue=8|pages=281–299|doi=10.5694/j.1326-5377.1937.tb43743.x}}</ref> in [[slaughterhouse]] workers in [[Brisbane]], [[Queensland]]. The "Q" stands for "query" and was applied at a time when the causative agent was unknown; it was chosen over suggestions of abattoir fever and Queensland rickettsial fever, to avoid directing negative connotations at either the cattle industry or the state of Queensland.<ref>{{cite book| vauthors = McDade JE |title=Q&nbsp;Fever: The Disease | volume = I|publisher=[[CRC Press]]|year=1990|isbn=978-0-8493-5984-2|page=8|language=en|chapter=Historical aspects of Q&nbsp;Fever}}</ref>

The [[pathogen]] of Q&nbsp;fever was discovered in 1937, when [[Frank Macfarlane Burnet]] and Mavis Freeman isolated the bacterium from one of Derrick's patients.<ref>{{cite journal | vauthors = Burnet FM, Freeman M | title = Experimental studies on the virus of "Q" fever | journal = Reviews of Infectious Diseases | volume = 5 | issue = 4 | pages = 800–808 | date = 1 July 1983 | pmid = 6194551 | doi = 10.1093/clinids/5.4.800 }}</ref> It was originally identified as a species of ''[[Rickettsia]]''. [[H.R. Cox]] and [[Gordon Davis (scientist)|Gordon Davis]] elucidated the transmission when they isolated it from [[tick]]s found in the US state of [[Montana]] in 1938.<ref>{{cite journal | vauthors =  | title = Public Health Weekly Reports for DECEMBER 30, 1938 | journal = Public Health Reports | volume = 53 | issue = 52 | pages = 2259–2309 | date = December 1938 | pmid = 19315693 | doi = 10.2307/4582746 | jstor = 4582746 | pmc = 2110862 }}</ref>  It is a [[zoonotic]] disease whose most common animal reservoirs are cattle, sheep, and goats. ''Coxiella burnetii'' – named for Cox and Burnet – is no longer regarded as closely related to the [[Rickettsiae]], but as similar to ''[[Legionella]]'' and ''[[Francisella]]'', and is a [[Gammaproteobacterium]].{{citation needed|date=July 2020}}

== Society and culture ==
An early mention of Q&nbsp;fever was important in one of the early [[Dr. Kildare]] films (1939, ''[[Calling Dr. Kildare]]''). Kildare's mentor Dr.&nbsp;Gillespie ([[Lionel Barrymore]]) tires of his protégé working fruitlessly on "exotic diagnoses" ("I think it's Q&nbsp;fever!") and sends him to work in a neighborhood clinic, instead.<ref>{{cite web|title=''Calling Dr.&nbsp;Kildare''|url=http://www.san.beck.org/MM/1939/CallingDrKildare.html|url-status=live|archive-url=https://web.archive.org/web/20120204042757/http://www.san.beck.org/MM/1939/CallingDrKildare.html|archive-date=2012-02-04|access-date=30 April 2013|publisher=Movie Mirrors Index}}</ref><ref>{{cite journal | vauthors = Kalisch PA, Kalisch BJ | title = When Americans called for Dr. Kildare: images of physicians and nurses in the Dr. Kildare and Dr. Gillespie movies, 1937-1947 | journal = Medical Heritage | volume = 1 | issue = 5 | pages = 348–363 | date = September 1985 | pmid = 11616027 | url = http://www.truthaboutnursing.org/images/kalisch/when_americans_called_dr_kildare.pdf | url-status = live | archive-url = https://web.archive.org/web/20101130235053/https://www.truthaboutnursing.org/images/kalisch/when_americans_called_dr_kildare.pdf | archive-date = 2010-11-30 }}</ref>

=== Biological warfare ===
''C.&nbsp;burnetii'' has been used to develop [[biological agent|biological weapon]]s.<ref name="pmid14592601">{{cite journal | vauthors = Madariaga MG, Rezai K, Trenholme GM, Weinstein RA | title = Q fever: a biological weapon in your backyard | journal = The Lancet. Infectious Diseases | volume = 3 | issue = 11 | pages = 709–721 | date = November 2003 | pmid = 14592601 | doi = 10.1016/S1473-3099(03)00804-1 }}</ref>

The United States investigated it as a potential biological warfare agent in the 1950s, with eventual standardization as agent&nbsp;OU. At Fort Detrick and Dugway Proving Ground, human trials were conducted on [[Operation Whitecoat|Whitecoat volunteers]] to determine the median infective dose (18&nbsp;MICLD<sub>50</sub>/person i.h.) and course of infection. The [[Deseret Test Center]] dispensed biological Agent&nbsp;OU with ships and aircraft, during [[Project 112]] and [[Project SHAD]].<ref name="Shady">{{Cite web|url=https://www.health.mil/Reference-Center/Fact-Sheets/2003/12/02/Shady-Grove-Revised|title=Deseret Test Center, Project&nbsp;SHAD, Shady Grove revised fact sheet}}</ref>  As a standardized biological, it was manufactured in large quantities at [[Pine Bluff Arsenal]], with 5,098&nbsp;gallons in the arsenal in bulk at the time of demilitarization in 1970.{{citation needed|date=January 2023}}

''C.&nbsp;burnetii'' is currently ranked as a "[[Bioterrorism#Types of agents|category&nbsp;B]]" [[bioterrorism]] agent by the [[Centers for Disease Control and Prevention|CDC]].<ref name="pmid12704232">{{cite journal | vauthors = Seshadri R, Paulsen IT, Eisen JA, Read TD, Nelson KE, Nelson WC, Ward NL, Tettelin H, Davidsen TM, Beanan MJ, Deboy RT, Daugherty SC, Brinkac LM, Madupu R, Dodson RJ, Khouri HM, Lee KH, Carty HA, Scanlan D, Heinzen RA, Thompson HA, Samuel JE, Fraser CM, Heidelberg JF | display-authors = 6 | title = Complete genome sequence of the Q-fever pathogen Coxiella burnetii | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 100 | issue = 9 | pages = 5455–5460 | date = April 2003 | pmid = 12704232 | pmc = 154366 | doi = 10.1073/pnas.0931379100 | bibcode = 2003PNAS..100.5455S | doi-access = free }}</ref> It can be contagious and is very stable in aerosols in a wide range of temperatures. Q&nbsp;fever microorganisms may survive on surfaces for up to 60&nbsp;days. It is considered a good agent in part because its ID<sub>50</sub> (number of bacilli needed to infect 50% of individuals) is considered to be one, making it the lowest known.{{Dubious|date=July 2020|reason=The CDC (https://www.cdc.gov/qfever/transmission/index.html) states that in some cases, fewer than ten bacteria are enough to cause an infection. There is no source here backing up the claim that one is enough 50% of the time.}}

==In animals==
Q fever can affect many species of domestic and wild animals, including ruminants (cattle, sheep, goats, bison,<ref>{{cite journal | vauthors = Didkowska A, Klich D, Hapanowicz A, Orłowska B, Gałązka M, Rzewuska M, Olech W, Anusz K | display-authors = 6 | title = Pathogens with potential impact on reproduction in captive and free-ranging European bison (Bison bonasus) in Poland - a serological survey | journal = BMC Veterinary Research | volume = 17 | issue = 1 | pages = 345 | date = November 2021 | pmid = 34736464 | doi = 10.1186/s12917-021-03057-8 | pmc = 8567710 | doi-access = free }}</ref> deer species<ref>{{cite journal | vauthors = Rijks JM, Roest HI, van Tulden PW, Kik MJ, IJzer J, Gröne A | title = Coxiella burnetii infection in roe deer during Q fever epidemic, the Netherlands | journal = Emerging Infectious Diseases | volume = 17 | issue = 12 | pages = 2369–2371 | date = December 2011 | pmid = 22172398 | doi = 10.3201/eid1712.110580 | pmc = 3311195 }}</ref><ref>{{cite journal | vauthors = Kirchgessner MS, Dubovi EJ, Whipps CM | title = Seroepidemiology of Coxiella burnetii in wild white-tailed deer (Odocoileus virginianus) in New York, United States | journal = Vector Borne and Zoonotic Diseases | volume = 12 | issue = 11 | pages = 942–947 | date = November 2012 | pmid = 22989183 | doi = 10.1089/vbz.2011.0952 }}</ref>...), carnivores (dogs, cats,<ref>{{cite journal | vauthors = Cyr J, Turcotte MÈ, Desrosiers A, Bélanger D, Harel J, Tremblay D, Leboeuf A, Gagnon CA, Côté JC, Arsenault J | display-authors = 6 | title = Prevalence of ''Coxiella burnetii'' seropositivity and shedding in farm, pet and feral cats and associated risk factors in farm cats in Quebec, Canada | journal = Epidemiology and Infection | volume = 149 | pages = e57 | date = February 2021 | pmid = 33583452 | doi = 10.1017/s0950268821000364 | pmc = 8060820 }}</ref> seals<ref>{{cite journal | vauthors = Conway R, Duncan C, Foster RA, Kersh GJ, Raverty S, Gelatt T, Frank C | title = Histologic lesions in placentas of northern fur seals (callorhinus ursinus) from a population with high placental prevalence of ''coxiella burnetii'' | journal = Journal of Wildlife Diseases | volume = 58 | issue = 2 | pages = 333–340 | date = April 2022 | pmid = 35245373 | doi = 10.7589/jwd-d-21-00037 | s2cid = 247236730 | pmc = 11290099 }}</ref>...), rodents,<ref>{{cite journal | vauthors = Pascucci I, Di Domenico M, Dall'Acqua F, Sozio G, Cammà C | title = Detection of Lyme Disease and Q Fever Agents in Wild Rodents in Central Italy | journal = Vector Borne and Zoonotic Diseases | volume = 15 | issue = 7 | pages = 404–411 | date = July 2015 | pmid = 26134933 | doi = 10.1089/vbz.2015.1807 | pmc = 4507354 }}</ref> reptiles and birds. However, [[ruminants]] (cattle, goats, and sheep) are the most frequently affected animals, and can serve as a reservoir for the bacteria.<ref>{{Cite journal |last1=Arricau-Bouvery |first1=Nathalie |last2=Rodolakis |first2=Annie |date=May 2005 |title=Is Q Fever an emerging or re-emerging zoonosis? |journal=Veterinary Research |volume=36 |issue=3 |pages=327–349 |doi=10.1051/vetres:2005010 |pmid=15845229 |issn=0928-4249|doi-access=free }}</ref>

=== Clinical signs ===
In contrast to humans, though a respiratory and cardiac infection could be experimentally reproduced in cattle,<ref>{{Cite journal|vauthors=Plommet M, Capponi M, Gestin J, Renoux G, Marly J, Sahuc D, Petit A|language=fr |title=FIÈVRE Q EXPÉRIMENTALE DES BOVINS|journal=Annales de Recherches Vétérinaires|oclc=862686843|year=1973|volume=4|issue=2|pages=325–346}}</ref> the clinical signs mainly affect the reproductive system. Q fever in ruminants is, therefore, mainly responsible for abortions, metritis, retained placenta, and infertility.

The clinical signs vary between species. In small [[ruminants]] (sheep and goats), it is dominated by abortions, premature births, stillbirths, and the birth of weak lambs or kids. One of the characteristics of abortions in goats is that they are very frequent and clustered in the first year or two after contamination of the farm. This is known as an abortion storm.<ref>{{cite journal | vauthors = Arricau-Bouvery N, Rodolakis A | title = Is Q fever an emerging or re-emerging zoonosis? | journal = Veterinary Research | volume = 36 | issue = 3 | pages = 327–349 | date = May 2005 | pmid = 15845229 | doi = 10.1051/vetres:2005010 | doi-access = free }}</ref>

In cattle, although abortions also occur, they are less frequent and more sporadic. The clinical picture is rather dominated by nonspecific signs such as placental retentions, metritis, and consequent fertility disorders.<ref>{{cite journal | vauthors = De Biase D, Costagliola A, Del Piero F, Di Palo R, Coronati D, Galiero G, Uberti BD, Lucibelli MG, Fabbiano A, Davoust B, Raoult D, Paciello O | display-authors = 6 | title = Coxiella burnetii in Infertile Dairy Cattle With Chronic Endometritis | journal = Veterinary Pathology | volume = 55 | issue = 4 | pages = 539–542 | date = July 2018 | pmid = 29566608 | doi = 10.1177/0300985818760376 | s2cid = 4268347 | doi-access = free }}</ref><ref>{{Cite web | vauthors = Valla G |title=Prevalenza di Coxiella burnetii nel latte di massa in allevamenti di bovine da latte italiani e possibile correlazione con problemi riproduttivi |url=https://www.vetjournal.it/images/archive/pdf_riviste/4649.pdf}}</ref><ref>{{Cite book | vauthors = Ordronneau S  |url= http://worldcat.org/oclc/836117348 |title=Impact de la vaccination et de l'antibiothérapie sur l'incidence des troubles de la reproduction et sur la fertilité dans des troupeaux bovins laitiers infectés par Coxiella Burnetii |oclc=836117348}}</ref>

=== Epidemiology ===
With the exception of New Zealand, which is currently free of Q fever, the disease is present throughout the world. Numerous epidemiological surveys have been carried out. They have shown that about one in three cattle farms and one in four sheep or goat farms are infected,<ref>{{cite journal | vauthors = Guatteo R, Seegers H, Taurel AF, Joly A, Beaudeau F | title = Prevalence of Coxiella burnetii infection in domestic ruminants: a critical review | journal = Veterinary Microbiology | volume = 149 | issue = 1–2 | pages = 1–16 | date = April 2011 | pmid = 21115308 | doi = 10.1016/j.vetmic.2010.10.007 }}</ref> but wide variations are seen between studies and countries. In China, Iran, Great Britain, Germany, Hungary, the Netherlands, Spain, the US, Belgium, Denmark, Croatia, Slovakia, the Czech Republic, Serbia, Slovenia, and Jordan, for example, more than 50% of cattle herds were infected with Q fever.<ref>{{cite journal | vauthors = Pexara A, Solomakos N, Govaris A | title = Q fever and seroprevalence of Coxiella burnetii in domestic ruminants | journal = Veterinaria Italiana | volume = 54 | issue = 4 | pages = 265–279 | date = December 2018 | pmid = 30681125 | doi = 10.12834/VetIt.1113.6046.3 }}</ref><ref>{{Cite journal | vauthors = Pexara A, Solomakos N, Govaris A |date=2018-01-01 |title=Q fever and prevalence of Coxiella burnetii in milk |journal=Trends in Food Science & Technology |language=en |volume=71 |pages=65–72 |doi=10.1016/j.tifs.2017.11.004 |issn=0924-2244}}</ref><ref>{{cite journal | vauthors = Dobos A, Gábor G, Wehmann E, Dénes B, Póth-Szebenyi B, Kovács ÁB, Gyuranecz M | title = Serological screening for Coxiella burnetii in the context of early pregnancy loss in dairy cows | journal = Acta Veterinaria Hungarica | volume = 68 | issue = 3 | pages = 305–309 | date = September 2020 | pmid = 33156002 | doi = 10.1556/004.2020.00035 | s2cid = 226269478 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Dobos A, Fodor I | title = Prevalence of Coxiella burnetii in bovine placentas in Hungary and Slovakia: Detection of a novel sequence type - Short communication | journal = Acta Veterinaria Hungarica | volume = 69 | issue = 4 | pages = 303–307 | date = October 2021 | pmid = 34735368 | doi = 10.1556/004.2021.00047 | s2cid = 243762186 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Obaidat MM, Kersh GJ | title = Prevalence and Risk Factors of Coxiella burnetii Antibodies in Bulk Milk from Cattle, Sheep, and Goats in Jordan | journal = Journal of Food Protection | volume = 80 | issue = 4 | pages = 561–566 | date = April 2017 | pmid = 28272921 | pmc = 6489127 | doi = 10.4315/0362-028X.JFP-16-377 }}</ref><ref>{{cite journal | vauthors = Espí A, Del Cerro A, Oleaga Á, Rodríguez-Pérez M, López CM, Hurtado A, Rodríguez-Martínez LD, Barandika JF, García-Pérez AL | display-authors = 6 | title = One Health Approach: An Overview of Q Fever in Livestock, Wildlife and Humans in Asturias (Northwestern Spain) | journal = Animals | volume = 11 | issue = 5 | pages = 1395 | date = May 2021 | pmid = 34068431 | pmc = 8153578 | doi = 10.3390/ani11051395 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Agger JF, Paul S | title = Increasing prevalence of Coxiella burnetii seropositive Danish dairy cattle herds | journal = Acta Veterinaria Scandinavica | volume = 56 | issue = 1 | pages = 46 | date = July 2014 | pmid = 25056416 | pmc = 4115160 | doi = 10.1186/s13028-014-0046-2 | doi-access = free }}</ref>

Infected animals shed the bacteria by three routes - genital discharge, faeces, and milk.<ref>{{cite journal | vauthors = Guatteo R, Beaudeau F, Joly A, Seegers H | title = Coxiella burnetii shedding by dairy cows | journal = Veterinary Research | volume = 38 | issue = 6 | pages = 849–860 | date = November 2007 | pmid = 17903418 | doi = 10.1051/vetres:2007038 | doi-access = free }}</ref>  Excretion is greatest at the time of parturition or abortion, and placentas and aborted fetuses are the main sources of bacteria, particularly in goats.

As ''C. burnetii'' is small and resistant in the environment, it is easily airborne and can be transmitted from one farm to another, even if several kilometres away.<ref>{{cite journal | vauthors = Hawker JI, Ayres JG, Blair I, Evans MR, Smith DL, Smith EG, Burge PS, Carpenter MJ, Caul EO, Coupland B, Desselberger U, Farrell ID, Saunders PJ, Wood MJ | display-authors = 6 | title = A large outbreak of Q fever in the West Midlands: windborne spread into a metropolitan area? | journal = Communicable Disease and Public Health | volume = 1 | issue = 3 | pages = 180–187 | date = September 1998 | pmid = 9782633 | url = https://pubmed.ncbi.nlm.nih.gov/9782633 }}</ref>

=== Control ===

==== Biosecurity measures ====
Based on the epidemiological data, [[biosecurity]] measures can be derived:<ref>{{Cite journal |last1=Plummer |first1=Paul J. |last2=McClure |first2=J.Trenton |last3=Menzies |first3=Paula |last4=Morley |first4=Paul S. |last5=Van den Brom |first5=René |last6=Van Metre |first6=David C. |date=September 2018 |title=Management of Coxiella burnetii infection in livestock populations and the associated zoonotic risk: A consensus statement |journal=Journal of Veterinary Internal Medicine |language=en |volume=32 |issue=5 |pages=1481–1494 |doi=10.1111/jvim.15229 |pmc=6189356 |pmid=30084178}}</ref>
* The spread of manure from infected farms should be avoided in windy conditions
* The level of hygiene must be very high during parturition and fetal annexes, and fetuses must be collected and destroyed as soon as possible

==== Medical measures ====
A vaccine for cattle, goats, and sheep exists. It reduces clinical expression such as abortions and decreases excretion of the bacteria by the animals leading to control of Q fever in herds.<ref>{{Cite web|url=https://www.ema.europa.eu/en/medicines/veterinary/EPAR/coxevac|title=Coxevac &#124; European Medicines Agency|date=17 September 2018 }}</ref>

In addition, vaccination of herds against Q fever has been shown to reduce the risk of human infection.<ref>{{cite journal | vauthors = Roest HI, Tilburg JJ, van der Hoek W, Vellema P, van Zijderveld FG, Klaassen CH, Raoult D | title = The Q fever epidemic in The Netherlands: history, onset, response and reflection | journal = Epidemiology and Infection | volume = 139 | issue = 1 | pages = 1–12 | date = January 2011 | pmid = 20920383 | doi = 10.1017/S0950268810002268 | s2cid = 29026616 | doi-access = free }}</ref>

== References ==
{{Reflist}}

== External links ==
{{Sister project links|auto=y}}
* [https://www.cdc.gov/qfever/index.html Q&nbsp;fever] at the [[Centers for Disease Control and Prevention|CDC]]
* [https://web.archive.org/web/20110727165631/http://patricbrc.org/portal/portal/patric/Taxon?cType=taxon&cId=777 ''Coxiella burnetii''] genomes and related information at [http://patricbrc.org/ PATRIC], a Bioinformatics Resource Center funded by [https://www.niaid.nih.gov/ NIAID]

{{U.S. biological weapons}}
{{Bacterial diseases}}
{{Bacterial cutaneous infections}}
{{Vaccines}}
{{Medical resources
| ICD10           = {{ICD10|A|78||a|75}}
| ICD9            = {{ICD9|083.0}}
| DiseasesDB      = 11093
| MedlinePlus     = 001337
| eMedicineSubj   = med
| eMedicineTopic  = 1982
| eMedicine_mult  = {{eMedicine2|ped|1973}}
| MeshID          = D011778
| Orphanet        = 781
}}
{{Authority control}}

{{DEFAULTSORT:Q Fever}}
[[Category:Atypical pneumonias]]
[[Category:Bacterial diseases]]
[[Category:Bacterium-related cutaneous conditions]]
[[Category:Biological agents]]
[[Category:Bovine diseases]]
[[Category:Rare infectious diseases]]
[[Category:Rodent-carried diseases]]
[[Category:Sheep and goat diseases]]
[[Category:Tick-borne diseases]]
[[Category:Zoonoses]]
[[Category:Zoonotic bacterial diseases]]