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Outbreaks involving large numbers of people are uncommon, but the increasing case incidence coupled with changing environmental and industry conditions that promote transmission of Q fever has raised concerns that large and serious outbreaks could become more frequent. The aim of this study was to use expert opinion to better understand how large Q fever outbreaks might occur in an Australian context and to document factors believed to be drivers of disease transmission. Focus groups were conducted with human and animal health professionals across several Australian states. All discussions were recorded, transcribed verbatim and imported into NVIVO for thematic analysis. Four anthropogenic risk factors (disease awareness, industry practices, land use, human behaviour) and three ecological risk factors (physical environment, agent dissemination, animal hosts) emerged from the data. Analysis of expert opinions pointed to the existence of numerous scenarios in which Q fever outbreaks could occur, many of which depict acquisition in the wider community outside of traditional at\u2010risk occupations. This perception of the expansion of Q fever from occupational\u2010acquisition to community\u2010acquisition is driven by greater overarching economic, political and socio\u2010cultural influences that govern the way in which people live and work. Findings from this study highlight that outbreaks are complex phenomena that involve the convergence of diverse elements, not just that of the pathogen and host, but also the physical, political and socioeconomic environments in which they interact. A review of the approaches to prevent and manage Q fever outbreaks will require a multisectorial approach and strengthening of community education, communication and engagement so that all stakeholders become an integrated part of outbreak mitigation and response.<\/jats:p>","DOI":"10.1111\/zph.12923","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T05:53:17Z","timestamp":1646373197000},"page":"344-358","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Identifying scenarios and risk factors for Q fever outbreaks using qualitative analysis of expert opinion"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6738-254X","authenticated-orcid":false,"given":"Tabita Su\u2010En","family":"Tan","sequence":"first","affiliation":[{"name":"Gulbali Institute Charles Sturt University  Wagga Wagga Australia"},{"name":"School of Animal and Veterinary Sciences Charles Sturt University  Wagga Wagga New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8803-9062","authenticated-orcid":false,"given":"Marta","family":"Hernandez\u2010Jover","sequence":"additional","affiliation":[{"name":"Gulbali Institute Charles Sturt University  Wagga Wagga Australia"},{"name":"School of Animal and Veterinary Sciences Charles Sturt University  Wagga Wagga New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5172-0281","authenticated-orcid":false,"given":"Lynne Maree","family":"Hayes","sequence":"additional","affiliation":[{"name":"Gulbali Institute Charles Sturt University  Wagga Wagga Australia"},{"name":"School of Animal and Veterinary Sciences Charles Sturt University  Wagga Wagga New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7872-934X","authenticated-orcid":false,"given":"Anke\u00a0Katrin","family":"Wiethoelter","sequence":"additional","affiliation":[{"name":"Faculty of Veterinary and Agricultural Sciences The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3239-1419","authenticated-orcid":false,"given":"Simon Matthew","family":"Firestone","sequence":"additional","affiliation":[{"name":"Faculty of Veterinary and Agricultural Sciences The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1890-9784","authenticated-orcid":false,"given":"Mark Anthony","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Faculty of Veterinary and Agricultural Sciences The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3993-0160","authenticated-orcid":false,"given":"Jane","family":"Heller","sequence":"additional","affiliation":[{"name":"Gulbali Institute Charles Sturt University  Wagga Wagga Australia"},{"name":"School of Animal and Veterinary Sciences Charles Sturt University  Wagga Wagga New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-018-04243-3"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/14927713.2011.549194"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vetmic.2009.07.016"},{"key":"e_1_2_9_5_1","volume-title":"Agricultural commodities, Australia, state\/territory and ASGS (Statistical Area 4) regions","author":"Australian Bureau of Statistics","year":"2016"},{"key":"e_1_2_9_6_1","unstructured":"Australian Government Department of Health. 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