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Q fever. Available: <ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/nidss.cdc.gov.tw\/SingleDisease.aspx?Pt=s&dc=1&dt=4&disease=0830\" xlink:type=\"simple\">http:\/\/nidss.cdc.gov.tw\/SingleDisease.aspx?Pt=s&amp;dc=1&amp;dt=4&amp;disease=0830<\/ext-link>. Accessed 2014 April 01."},{"key":"ref49","doi-asserted-by":"crossref","first-page":"e2787","DOI":"10.1371\/journal.pntd.0002787","article-title":"Epidemiology of <italic>Coxiella burnetii<\/italic> Infection in Africa: A OneHealth Systematic Review","volume":"8","author":"S Vanderburg","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"ref50","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1749-6632.1990.tb42204.x","article-title":"Host factors in the severity of Q fever","volume":"590","author":"D Raoult","year":"1990","journal-title":"Ann NY Acad Sci"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/00005792-200003000-00005","article-title":"Q fever 1985\u20131998. 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