{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:38:53Z","timestamp":1792579133785,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Q fever is a zoonotic disease caused by Coxiella burnetii. In Italy, serologic evidence shows exposure in humans and livestock, but surveillance data are sparse, and underreporting is likely. We aimed to characterize Q fever-related hospitalizations in Italy during 2014\u20132023 and examine environmental risk correlates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a nationwide retrospective study using the Italian National Hospital Discharge Database. Hospitalizations with ICD-9-CM code 083.0 as primary or secondary diagnosis were included. We calculated hospitalization rates by age, sex, and region and described clinical characteristics. We linked hospitalizations with climatic, livestock, and land-use data; for Sardinia, we fitted Bayesian spatial regression models including bovine, ovine, and caprine density, temperature, precipitation, and land use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 428 hospitalizations (67% male), corresponding to a rate of 0.07 per 100 000 person-years. Rates were highest in children and older adults. The overall case fatality ratio was 2.4%. The most frequent Q fever-related concomitant diagnosis was pneumonia. Sardinia had the highest case count and adjusted hospitalization rate, 7-fold the national rate (0.55 vs 0.07). Spatial models for Sardinia showed hotspots in the north of the island and a 12% increase in spatial hospitalization risk per 10 bovine heads\/km2 (adjusted relative risk 1.12, 95% credible interval 1.03\u20131.24).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Q fever causes an underrecognized burden of hospitalizations in Italy, with marked regional heterogeneity and a Sardinian hotspot associated with high cattle density areas. Clinical awareness, surveillance, and One Health interventions are warranted in high-risk areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag667","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T09:47:36Z","timestamp":1792576056000},"source":"Crossref","is-referenced-by-count":0,"title":["Nationwide Q Fever Hospitalizations in Italy, 2014\u20132023: Evidence of Underrecognition and a Sardinian Hotspot"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9339-3306","authenticated-orcid":false,"given":"Daniel","family":"Cifo","sequence":"first","affiliation":[{"name":"Madrid Health Service (SERMAS) Primary Care Research Unit, , Madrid ,","place":["Spain"]},{"name":"Biomedical Sciences and Public Health Doctorate Program, UNED \u2013 ENS Mixed Research Institute (IMIENS) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5083-8854","authenticated-orcid":false,"given":"David","family":"Gonz\u00e1lez-Barrio","sequence":"additional","affiliation":[{"name":"National Centre of Microbiology (ISCIII-CNM) , Carlos III Health Institute, Madrid ,","place":["Spain"]},{"name":"Consortium for Biochemical Research in Infectious Diseases (CIBERINFEC) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0480-8723","authenticated-orcid":false,"given":"Alberto","family":"Mateo-Urdiales","sequence":"additional","affiliation":[{"name":"Istituto Superiore di Sanit\u00e0 Dipartimento Malattie Infettive, , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0805-2927","authenticated-orcid":false,"given":"Patrizio","family":"Pezzotti","sequence":"additional","affiliation":[{"name":"Istituto Superiore di Sanit\u00e0 Dipartimento Malattie Infettive, , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0664-9375","authenticated-orcid":false,"given":"Alessandra","family":"Ciervo","sequence":"additional","affiliation":[{"name":"Istituto Superiore di Sanit\u00e0 Dipartimento Malattie Infettive, , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8204-1230","authenticated-orcid":false,"given":"Angela","family":"Fanelli","sequence":"additional","affiliation":[{"name":"European Commission, Joint Research Centre (JRC) , Seville ,","place":["Spain"]},{"name":"Facultad de Veterinaria, Universidad Alfonso X el Sabio (UAX) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2104-4531","authenticated-orcid":false,"given":"Alda","family":"Natale","sequence":"additional","affiliation":[{"name":"Istituto Zooprofilattico Sperimentale delle Venezie , Legnaro ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7388-1767","authenticated-orcid":false,"given":"Diana","family":"G\u00f3mez-Barroso","sequence":"additional","affiliation":[{"name":"National Centre of Epidemiology (ISCIII-CNE) , Carlos III Health Institute, Madrid ,","place":["Spain"]},{"name":"Consortium for Biochemical Research in Epidemiology and Public Health (CIBERESP) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5241-9725","authenticated-orcid":false,"given":"Rosa M","family":"Est\u00e9vez-Reboredo","sequence":"additional","affiliation":[{"name":"National Centre of Epidemiology (ISCIII-CNE) , Carlos III Health Institute, Madrid ,","place":["Spain"]},{"name":"Consortium for Biochemical Research in Epidemiology and Public Health (CIBERESP) , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"2026102105473103600_ofag667-B1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1128\/CMR.00045-16","article-title":"From Q fever to Coxiella burnetii infection: a paradigm change","volume":"30","author":"Eldin","year":"2017","journal-title":"Clin Microbiol Rev"},{"key":"2026102105473103600_ofag667-B2","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/tbed.13085","article-title":"Coxiella burnetii in wild mammals: a systematic review","volume":"66","author":"Gonzalez-Barrio","year":"2019","journal-title":"Transbound Emerg Dis"},{"key":"2026102105473103600_ofag667-B3","doi-asserted-by":"crossref","first-page":"3868","DOI":"10.1111\/tbed.14758","article-title":"The relevance of the wild reservoir in zoonotic multi-host pathogens: the links between Iberian wild mammals and Coxiella burnetii","volume":"69","author":"Gonz\u00e1lez-Barrio","year":"2022","journal-title":"Transbound Emerg Dis"},{"key":"2026102105473103600_ofag667-B4","doi-asserted-by":"crossref","DOI":"10.3389\/fvets.2022.1068129","article-title":"Coxiella burnetii in ticks, livestock, pets and wildlife: a mini-review","volume":"9","author":"Celina","year":"2022","journal-title":"Front Vet Sci"},{"key":"2026102105473103600_ofag667-B5","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/s12879-018-3135-4","article-title":"Airborne geographical dispersal of Q fever from livestock holdings to human communities: a systematic review and critical appraisal of evidence","volume":"18","author":"Clark","year":"2018","journal-title":"BMC 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A serological survey in the general population and occupationally exposed individuals in Northern Italy","volume":"14","author":"Fincato","year":"2025","journal-title":"Pathogens"},{"key":"2026102105473103600_ofag667-B17","first-page":"193","article-title":"Seroprevalence of Coxiella burnetii in dairy cattle and buffalo from Southern Italy","volume":"56","author":"Fanelli","year":"2020","journal-title":"Vet Ital"},{"key":"2026102105473103600_ofag667-B18","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1017\/S0950268819002115","article-title":"Cross-sectional serosurvey of Coxiella burnetii in healthy cattle and sheep from extensive grazing system in central Italy","volume":"148","author":"Barlozzari","year":"2020","journal-title":"Epidemiol Infect"},{"key":"2026102105473103600_ofag667-B19","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.prevetmed.2016.05.014","article-title":"Q fever seroprevalence and risk factors in sheep and goats in northwest 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