{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:42:13Z","timestamp":1791564133081,"version":"4.3.4"},"reference-count":138,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Coxiella burnetii is a significant infectious pathogen that causes Q fever. Q fever is thought to be uncommon in the US and most human cases are believed to occur in agricultural livestock workers. However, the extent of US community exposure to C. burnetii is not known with certainty. Using nationally representative 2003\u20132004 US National Health and Nutrition Examination Survey serologic, demographic, and occupational history data, the magnitude of US adult general population exposure to C. burnetii, excluding agricultural-sector workers, was estimated. Exposure was defined as positive serum IgG antibodies in an immunofluorescence assay (e.g., current or past infection). A total of 3.0% (95% CI: 2.0\u20134.4) of the US population met the criteria for C. burnetii exposure, representing some 6.2 million persons. Overall, 86.9% (95% CI: 75.5\u201398.4) of the seropositive persons had no lifetime history of work in the agricultural sector (5.5 million persons). This was consistently true across all US demographic groups: aged 20\u201359 years, 87.3%; aged 60+ years, 85.7%; men, 86.1%; women, 87.6%; non-Hispanic Whites, 82%; non-Hispanic Blacks, 95.8%; Mexican Americans, 89.4%; immigrants from Mexico, 83.5%; and other immigrants, 96.8%. As a proportion of C. burnetii infections result in acute Q fever and chronic Q fever conveys significant mortality, the community-level risks to the general public may be significant. It is recommended that a 6-year sample of the most recent NHANES stored sera be analyzed to determine the current community C. burnetii exposure rates. Also, analyzing an additional 2005\u20132008 stored sera sample would provide an opportunity to assess the time trends and long-term health impacts.<\/jats:p>","DOI":"10.3390\/pathogens14050460","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T04:06:21Z","timestamp":1746677181000},"page":"460","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Q Fever-Related Community Infections: United States Exposure to Coxiella burnetii"],"prefix":"10.3390","volume":"14","author":[{"given":"Charles F.","family":"Dillon","sequence":"first","affiliation":[{"name":"Independent Researcher, Stamford, CT 06901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendolyn R.","family":"Dillon","sequence":"additional","affiliation":[{"name":"Department of Chemistry, University of California, Davis, CA 95616, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Diagnosis and management of Q fever\u2014United States, 2013: Recommendations from CDC and the Q fever working group","volume":"62","author":"Anderson","year":"2013","journal-title":"MMWR Recomm. Rep. RR-03"},{"key":"ref_2","unstructured":"CDC Wonder (2025, April 27). Notifiable Infectious Diseases and Conditions, United States: Annual Tables, Available online: https:\/\/wonder.cdc.gov\/nndss-annual-summary.html."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/S0140-6736(06)68266-4","article-title":"Q fever","volume":"367","author":"Parker","year":"2006","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Brooke, R.J., Kretzschmar, M.E., Mutters, N.T., and Teunis, S.P. (2013). Human dose response relation for airborne exposure to Coxiella burnetii. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-488"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.epidem.2017.06.001","article-title":"A human time dose response model for Q fever","volume":"21","author":"Heppell","year":"2017","journal-title":"Epidemics"},{"key":"ref_6","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":"ref_7","doi-asserted-by":"crossref","first-page":"4469","DOI":"10.1128\/AEM.00042-10","article-title":"Presence of Coxiella burnetii DNA in the environment of the United States, 2006 to 2008","volume":"76","author":"Kersh","year":"2010","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1089\/15303660260613747","article-title":"Q fever in humans and animals in the United States","volume":"2","author":"McQuiston","year":"2002","journal-title":"Vector Borne Zoonotic Dis."},{"key":"ref_9","unstructured":"National Association of State Public Health Veterinarians, National Assembly of State Animal Health Officials (2025, February 02). Prevention and Control of Coxiella burnetii Infection Among Humans and Animals: Guidance for a Coordinated Public health and Animal Health Response. Available online: http:\/\/nasphv.org\/Documents\/Q_Fever_2013.pdf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/zph.12896","article-title":"Acute and chronic Q fever national surveillance\u2014United States, 2008-2017","volume":"69","author":"Cherry","year":"2022","journal-title":"Zoonoses Public Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"691","DOI":"10.4269\/ajtmh.2009.09-0168","article-title":"Seroprevalence of Q fever in the United States, 2003\u20132004","volume":"81","author":"Anderson","year":"2009","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_12","unstructured":"US National Health and Nutrition Examination Survey (2025, February 02). Questionnaire: SP (2003-04) Occupation. OCQ-C, Available online: https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/public\/2003\/questionnaires\/sp_ocq_c.pdf."},{"key":"ref_13","first-page":"1","article-title":"National Health and Nutrition Examination Survey: Plan and operations, 1999\u20132010","volume":"56","author":"Zipf","year":"2013","journal-title":"Vital Health Stat 1"},{"key":"ref_14","first-page":"1","article-title":"The National Health and Nutrition Examination Survey: Sample design, 1999\u20132006","volume":"155","author":"Curtin","year":"2012","journal-title":"Vital Health Stat 2"},{"key":"ref_15","unstructured":"US National Health and Nutrition Examination Survey (2025, February 02). Unweighted Response Rates for NHANES 2003\u20132004 by Age and Gender, Available online: https:\/\/wwwn.cdc.gov\/nchs\/data\/ResponseRates\/RRT0102MF.pdf."},{"key":"ref_16","unstructured":"US National Health and Nutrition Examination Survey (2025, March 30). 2003\u20132004 Data Documentation, Codebook, and Frequencies Occupation (OCQ_C), Available online: https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/continuousnhanes\/default.aspx?BeginYear=2003."},{"key":"ref_17","unstructured":"National Institute for Occupational Safety and Health (2025, February 02). Collecting and Using Industry and Occupation Data, Available online: https:\/\/www.cdc.gov\/niosh\/occupation-industry-data\/about-data\/coding\/classification-systems.html?CDC_AAref_Val=https:\/\/www.cdc.gov\/niosh\/topics\/coding\/more.html."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"213","DOI":"10.2190\/JKRE-AH92-EDV8-VHYC","article-title":"Class matters: U.S. versus U.K. measures of occupational disparities in access to health services and health status in the 2000 U.S. National Health Interview Survey","volume":"35","author":"Krieger","year":"2005","journal-title":"Int. J. Health Serv."},{"key":"ref_19","unstructured":"(2025, April 27). U.S. Bureau of Labor Statistics. Labor Force Statistics from the Current Population Survey. Concepts and Definitions, Available online: https:\/\/www.bls.gov\/cps\/definitions.htm."},{"key":"ref_20","unstructured":"US National Health and Nutrition Examination Survey (2025, April 27). 2003\u20132004 Data Documentation, Codebook, and Frequencies. Coxiella burnetii (Q Fever) Antibodies\u2014Serum (Surplus) (SSQFEV_C), Update 2022, Available online: https:\/\/wwwn.cdc.gov\/Nchs\/Data\/Nhanes\/Public\/2003\/DataFiles\/SSQFEV_C.htm."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1007\/BF02148690","article-title":"Evaluation of the complement fixation and indirect immunofluorescence tests in the early diagnosis of primary Q fever","volume":"4","author":"Dupuis","year":"1985","journal-title":"Eur. J. Clin. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1128\/jcm.3.1.51-61.1976","article-title":"Microimmunofluorescence test for the serological study of rocky mountain spotted fever and typhus","volume":"3","author":"Philip","year":"1976","journal-title":"J. Clin. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Parker, J.D., Talih, M., Irimata, K.E., Zhang, G., Branum, A.M., Davis, D., Das, B., Hamilton, B.E., and Kochanek, K. (2023). National Center for Health Statistics data presentation standards for rates and counts. Vital Health Stat. 2, 200, Available online: https:\/\/stacks.cdc.gov\/view\/cdc\/124368.","DOI":"10.15620\/cdc:124368"},{"key":"ref_24","first-page":"1","article-title":"National Center for Health Statistics data presentation standards for proportions","volume":"175","author":"Parker","year":"2017","journal-title":"Vital Health Stat. 2"},{"key":"ref_25","unstructured":"US National Health and Nutrition Examination Survey (2025, April 27). NHANES Tutorials, Reliability of Estimates, Available online: https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/tutorials\/ReliabilityOfEstimates.aspx."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100667","DOI":"10.1016\/j.onehlt.2023.100667","article-title":"A systematic review of global Q fever outbreaks","volume":"18","author":"Tan","year":"2023","journal-title":"One Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1441","DOI":"10.1002\/vms3.1441","article-title":"Global and regional seroprevalence of coxiellosis in small ruminants: A systematic review and meta-analysis","volume":"10","author":"Ahaduzzaman","year":"2024","journal-title":"Vet. Med. Sci."},{"key":"ref_28","first-page":"125","article-title":"World distribution of Q fever: Human, animal and arthropod infection","volume":"57","author":"Berge","year":"1953","journal-title":"Am. J. Hyg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Gisbert, P., Garcia-Ispierto, I., Quintela, L.A., and Guatteo, R. (2024). Coxiella burnetii and reproductive disorders in cattle: A Systematic Review. Animals, 14.","DOI":"10.3390\/ani14091313"},{"key":"ref_30","first-page":"e000068","article-title":"Massive dispersal of Coxiella burnetii among cattle across the United States","volume":"2","author":"Olivas","year":"2016","journal-title":"Microb. Genom."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Toledo-Perona, R., Contreras, A., Gomis, J., Quereda, J.J., Garc\u00eda-Gal\u00e1n, A., S\u00e1nchez, A., and G\u00f3mez-Mart\u00edn, \u00c1. (2024). Controlling Coxiella burnetii in naturally infected sheep, goats and cows, and public health implications: A scoping review. Front. Vet. Sci., 11.","DOI":"10.3389\/fvets.2024.1321553"},{"key":"ref_32","unstructured":"Agency for Healthcare Quality and Research (2025, February 02). Overview of the National (Nationwide) Inpatient Sample (NIS), Available online: https:\/\/hcup-us.ahrq.gov\/nisoverview.jsp."},{"key":"ref_33","unstructured":"Centers for Disease Control and Prevention (2025, April 27). Q Fever Epidemiology and Statistics, Available online: https:\/\/www.cdc.gov\/q-fever\/data-research\/index.html."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"16670","DOI":"10.1038\/s41598-018-34702-2","article-title":"Trends in Q fever serologic testing by immunofluorescence from four large reference laboratories in the United States, 2012\u20132016","volume":"8","author":"Miller","year":"2018","journal-title":"Sci Rep."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Mohamad Alahmad, M.A., and Hammoud, K.A. (2023). Inpatient Q fever frequency is on the rise. Can. J. Infect. Dis. Med. Microbiol., 31.","DOI":"10.1155\/2023\/4243312"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Ebani, V.V. (2023). Coxiella burnetii Infection in Cats. Pathogens, 12.","DOI":"10.3390\/pathogens12121415"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/infdis\/164.1.202","article-title":"An outbreak of cat-associated Q fever in the United States","volume":"164","author":"Pinsky","year":"1991","journal-title":"J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1056\/NEJM198808113190607","article-title":"Poker Players\u2019 Pneumonia: An urban outbreak of Q fever following exposure to a parturient cat","volume":"319","author":"Langley","year":"1988","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1017\/S0950268800029757","article-title":"Truckin\u2019 pneumonia\u2014An outbreak of Q fever in a truck repair plant probably due to aerosols from clothing contaminated by contact with newborn kittens","volume":"102","author":"Marrie","year":"1989","journal-title":"Epidemiol. Infect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/clinids\/23.4.753","article-title":"A dog-related outbreak of Q fever","volume":"23","author":"Buhariwalla","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"McMillan, I.A., Norris, M.H., Golon, S.J., Franckowiak, G.A., Grinolds, J.M., Goldstein, S.M., Phelps, D.M., Bodenchuk, M.J., Leland, B.R., and Bowen, R.A. (2024). Serosurveillance of Coxiella burnetii in feral swine populations of Hawai\u2019i and Texas identifies overlap with human Q fever incidence. J. Clin. Microbiol., 62.","DOI":"10.1128\/jcm.00780-24"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.prevetmed.2011.05.003","article-title":"Coxiella burnetii (Q fever) in Rattus norvegicus and Rattus rattus at livestock farms and urban locations in the Netherlands; could Rattus spp. represent reservoirs for (re)introduction?","volume":"101","author":"Reusken","year":"2011","journal-title":"Prev. Vet. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/tbed.12211","article-title":"Coxiella burnetii (Q-Fever) Seroprevalence in Prey and Predators in the United Kingdom: Evaluation of Infection in Wild Rodents, Foxes and Domestic Cats Using a Modified ELISA","volume":"62","author":"Meredith","year":"2015","journal-title":"Transbound. Emerg. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1128\/AEM.03472-12","article-title":"Presence and persistence of Coxiella burnetii in the environments of goat farms associated with a Q fever outbreak","volume":"79","author":"Kersh","year":"2013","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1128\/AEM.07323-11","article-title":"Detection of Coxiella burnetii DNA on Small-Ruminant Farms during a Q fever Outbreak in the Netherlands","volume":"78","author":"Paauwe","year":"2012","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1111\/jam.12163","article-title":"Detection of Coxiella burnetii DNA in the environment during and after a large Q fever epidemic in the Netherlands","volume":"114","author":"Janse","year":"2013","journal-title":"J. Appl. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"101926","DOI":"10.1016\/j.ttbdis.2022.101926","article-title":"Prevalence of Coxiella-infections in ticks\u2014Review and meta-analysis","volume":"13","author":"Yessinou","year":"2022","journal-title":"Ticks Tick. Borne Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.pt.2015.06.014","article-title":"The Importance of Ticks in Q fever Transmission: What Has (and Has Not) Been Demonstrated?","volume":"31","author":"Duron","year":"2015","journal-title":"Trends Parasitol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"823","DOI":"10.31128\/AJGP-01-20-5195","article-title":"Q fever following a tick bite","volume":"49","author":"Graves","year":"2020","journal-title":"Aust. J. Gen. Pract."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1445-5994.1989.tb00258.x","article-title":"Pericarditis associated with tick-borne Q fever","volume":"19","author":"Beaman","year":"1989","journal-title":"Aust. N. Z. J. Med."},{"key":"ref_51","first-page":"916142","article-title":"Q fever with unusual exposure history: A classic presentation of a commonly misdiagnosed disease","volume":"2012","author":"Nett","year":"2012","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"619","DOI":"10.3201\/eid1104.041036","article-title":"Coxiella burnetii in bulk tank milk samples, United States","volume":"11","author":"Kim","year":"2005","journal-title":"Emerg. Infect. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1093\/cid\/cis690","article-title":"Q fever cluster among raw milk drinkers in Michigan, 2011","volume":"55","author":"Signs","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2307\/4586820","article-title":"Q fever studies in Southern California; an epidemiological study of 300 cases","volume":"14","author":"Beck","year":"1949","journal-title":"Public Health Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1111\/jam.12778","article-title":"Q fever through consumption of unpasteurised milk and milk products\u2014A risk profile and exposure assessment","volume":"118","author":"Gale","year":"2015","journal-title":"J. Appl. Microbiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1001\/jama.1950.02910390020006","article-title":"Q fever: Transmission from one human being to others","volume":"143","author":"Deutsch","year":"1950","journal-title":"J. Am. Med. Assoc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1093\/cid\/ciu151","article-title":"Suspected person-to-person transmission of Q fever among hospitalized pregnant women","volume":"58","author":"Amit","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1056\/NEJM199402033300518","article-title":"Q fever during pregnancy\u2014A risk for women, fetuses, and obstetricians","volume":"330","author":"Raoult","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/S0140-6736(49)91600-1","article-title":"Q fever in Great Britain; clinical account of eight cases","volume":"254","author":"Harman","year":"1949","journal-title":"Lancet"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S0195-6701(03)00111-7","article-title":"Nosocomial transmission of Q fever","volume":"54","author":"Osorio","year":"2003","journal-title":"J. Hosp. Infect."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1086\/321878","article-title":"Sexually transmitted Q fever","volume":"33","author":"Milazzo","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1093\/clinids\/22.6.1087","article-title":"Possible sexual transmission of Q fever among humans","volume":"22","author":"Kruszewska","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1089\/vbz.2009.0101","article-title":"A case of person-to-person transmission of Q fever from an active duty serviceman to his spouse","volume":"10","author":"Miceli","year":"2010","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1093\/cid\/ciu259","article-title":"Reevaluation of the risk of fetal death and malformation after Q fever","volume":"59","author":"Million","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ejogrb.2018.08.021","article-title":"Q fever first presenting as a septic shock resulting in intrauterine fetal death","volume":"229","author":"Levin","year":"2018","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_66","first-page":"54","article-title":"Chronic or fatal Q-fever infection: A review of 16 patients seen in North-East Scotland (1967-80)","volume":"52","author":"Ellis","year":"1983","journal-title":"Q. J. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/0002-9343(66)90085-4","article-title":"Laboratory-acquired Q fever. A report of fifty cases","volume":"41","author":"Johnson","year":"1966","journal-title":"Am. J. Med."},{"key":"ref_68","first-page":"1159","article-title":"Q Fever in Portugal. History, Clinical Observations, Diagnosis","volume":"3","author":"Fonseca","year":"1949","journal-title":"Clin. Contemp."},{"key":"ref_69","unstructured":"Anonymous (1950). Commentary: Experimental Q Fever in Man. Br. Med. J., 1, 1000."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"223","DOI":"10.14745\/ccdr.v41i10a01","article-title":"Q fever outbreak among travelers to Germany associated with live cell therapy\u2014United States and Canada, 2014: A co-publication","volume":"41","author":"Robyn","year":"2015","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/j.1537-2995.2012.03792.x","article-title":"Lookback procedures after postdonation notifications during a Q fever outbreak in the Netherlands","volume":"53","author":"Slot","year":"2013","journal-title":"Transfusion"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1111\/j.1537-2995.2012.03912.x","article-title":"Stability of Coxiella burnetii in stored human blood","volume":"53","author":"Kersh","year":"2013","journal-title":"Transfusion"},{"key":"ref_73","first-page":"86","article-title":"Q fever\u2014California","volume":"26","author":"Goldberg","year":"1977","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/j.1537-2995.2011.03250.x","article-title":"Coxiella burnetii infection among blood donors during the 2009 Q-fever outbreak in The Netherlands","volume":"52","author":"Hogema","year":"2012","journal-title":"Transfusion"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1111\/trf.12539","article-title":"Estimating the transfusion transmission risk of Q fever","volume":"54","author":"Oei","year":"2014","journal-title":"Transfusion"},{"key":"ref_76","first-page":"165","article-title":"Q fever following bone marrow transplantation","volume":"3","author":"Kanfer","year":"1988","journal-title":"Bone Marrow Transpl."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1159\/000357107","article-title":"Coxiella burnetii\u2014Pathogenic Agent of Q (Query) Fever. 2014","volume":"41","author":"Bauerfeind","year":"2014","journal-title":"Transfus. Med. Hemother."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"281","DOI":"10.5694\/j.1326-5377.1937.tb43743.x","article-title":"Q Fever a new fever entity: Clinical features. diagnosis, and laboratory investigation","volume":"2","author":"Derrick","year":"1937","journal-title":"Med. J. Aust."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1001\/jama.1950.02910300006002","article-title":"Epidemiologic Studies of Q fever in Southern California","volume":"142","author":"Bell","year":"1950","journal-title":"JAMA"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1001\/jama.1947.02880120001001","article-title":"Q fever in the United States: Epidemiologic Studies of an Outbreak Among Stock Handlers and Slaughterhouse Workers","volume":"133","author":"Topping","year":"1947","journal-title":"JAMA"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1093\/annweh\/wxad068","article-title":"Q fever infection is a preventable risk associated with pet food manufacturing","volume":"68","author":"Uren","year":"2024","journal-title":"Ann. Work Expo. Health"},{"key":"ref_82","unstructured":"National Institute for Occupational Safety and Health (NIOSH) (2025, February 02). Occupational Hazard Assessment: Criteria for Controlling Occupational Hazards Animal Rendering Processes, Available online: https:\/\/www.cdc.gov\/niosh\/docs\/81-133\/default.html."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e50","DOI":"10.1086\/501127","article-title":"Q fever outbreak at a cosmetics supply factory","volume":"42","author":"Wade","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.3201\/eid1712.101786","article-title":"Q fever in Woolsorters, Belgium","volume":"17","author":"Wattiau","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"524","DOI":"10.2105\/AJPH.40.5.524","article-title":"Q fever in a wool and hair processing plant","volume":"40","author":"Sigel","year":"1950","journal-title":"Am. J. Public Health Nations Health"},{"key":"ref_86","first-page":"35","article-title":"Q fever in California. IX. An outbreak aboard a ship transporting goats","volume":"54","author":"Clark","year":"1951","journal-title":"Am. J. Hyg."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Alonso, E., Eizaguirre, D., Lopez-Etxaniz, I., Olaizola, J.I., Ocabo, B., Barandika, J.F., Jado, I., \u00c1lvarez-Alonso, R., Hurtado, A., and Garc\u00eda-P\u00e9rez, A. (2019). A Q fever outbreak associated to courier transport of pets. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0225605"},{"key":"ref_88","first-page":"58","article-title":"Q fever as an occupational illness at the National Institutes of Health","volume":"97","author":"Bayer","year":"1982","journal-title":"Public Health Rep."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/S0140-6736(82)92001-3","article-title":"Laboratory outbreak of Q fever acquired from sheep","volume":"1","author":"Hall","year":"1982","journal-title":"Lancet"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1093\/infdis\/144.2.107","article-title":"Cryptic Epidemic of Q fever in a Medical School","volume":"144","author":"Meiklejohn","year":"1981","journal-title":"Infect Dis."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/0023677220965628","article-title":"Minimizing the risk of occupational Q fever exposure: A protocol for ensuring Coxiella burnetii-negative pregnant ewes are used for medical research","volume":"55","author":"Galganski","year":"2021","journal-title":"Lab. Anim."},{"key":"ref_92","first-page":"1013","article-title":"Q fever: Hazard from sheep used in research","volume":"130","author":"Simor","year":"1984","journal-title":"Can. Med. Assoc. J."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/0002-9378(72)90222-0","article-title":"Transmission of Q fever from experimental sheep to laboratory personnel","volume":"114","author":"Curet","year":"1972","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_94","unstructured":"Centers for Disease Control (1979). Q Fever at a University Research Center-California. Morb. Mortal. Wkly. Rep., 28, 333."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1136\/thx.41.12.974","article-title":"Q fever: Person to person transmission within a family","volume":"41","author":"Mann","year":"1986","journal-title":"Thorax"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Schimmer, B., Lenferink, A., Schneeberger, P., Aangenend, H., Vellema, P., Hautvast, J., and van Duynhoven, Y. (2012). Seroprevalence and risk factors for Coxiella burnetii (Q fever) seropositivity in dairy goat farmers\u2019 households in The Netherlands, 2009\u20132010. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0042364"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Proboste, T., Clark, N.J., Tozer, S., Wood, C., Lambert, S.B., and Soares Magalh\u00e3es, R.J. (2022). Profiling risk factors for household and community spatiotemporal clusters of Q fever notifications in Queensland between 2002 and 2017. Pathogens, 11.","DOI":"10.3390\/pathogens11080830"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1086\/596705","article-title":"Seroepidemiologic and occupational risk survey for Coxiella burnetii antibodies among US veterinarians","volume":"48","author":"Whitney","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/zph.12067","article-title":"Serosurvey and observational study of US Army Veterinary Corps officers for Q fever antibodies from 1989 to 2008","volume":"61","author":"Vest","year":"2014","journal-title":"Zoonoses Public Health"},{"key":"ref_100","first-page":"15","article-title":"Q fever in California. VI. Description of an epidemic occurring at Davis, California, in 1948","volume":"54","author":"Clark","year":"1951","journal-title":"Am. J. Hyg."},{"key":"ref_101","first-page":"76","article-title":"Q fever in laundry workers, presumably transmitted from contaminated clothing","volume":"49","author":"Oliphant","year":"1949","journal-title":"Am. J. Hyg."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.vetmic.2015.02.011","article-title":"Seroprevalence of Coxiella burnetii in domesticated and feral cats in eastern Australia","volume":"177","author":"Shapiro","year":"2015","journal-title":"Vet. Microbiol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/zph.12305","article-title":"Q fever (Coxiella burnetii) Knowledge and Attitudes of Australian Cat Breeders and Their Husbandry Practices","volume":"64","author":"Shapiro","year":"2017","journal-title":"Zoonoses Public Health"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Alonso, E., Lopez-Etxaniz, I., Hurtado, A., Liendo, P., Urbaneja, F., Aspiritxaga, I., Olaizola, J.I., Pi\u00f1ero, A., Arrazola, I., and Barandika, J.F. (2015). Q fever Outbreak among Workers at a Waste-Sorting Plant. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138817"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1089\/vbz.2012.1202","article-title":"First reported multistate human Q fever outbreak in the United States, 2011","volume":"14","author":"Bjork","year":"2014","journal-title":"Vector Borne Zoonotic Dis."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1017\/S0950268811001427","article-title":"Visits on \u2018lamb-viewing days\u2019 at a sheep farm open to the public was a risk factor for Q fever in 2009","volume":"140","author":"Whelan","year":"2012","journal-title":"Epidemiol. Infect."},{"key":"ref_107","first-page":"158","article-title":"Q-koorts op kinderboerderijen [Q fever on petting zoos]","volume":"136","author":"Valkenburgh","year":"2011","journal-title":"Tijdschr. Diergeneeskd."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Porten, K., Rissland, J., Tigges, A., Broll, S., Hopp, W., Lunemann, M., van Treeck, U., Kimmig, P., Brockmann, S.O., and Wagner-Wiening, C. (2006). A super-spreading ewe infects hundreds with Q fever at a farmers\u2019 market in Germany. BMC Infect. Dis., 6.","DOI":"10.1186\/1471-2334-6-147"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/zph.12923","article-title":"Identifying scenarios and risk factors for Q fever outbreaks using qualitative analysis of expert opinion","volume":"69","author":"Tan","year":"2022","journal-title":"Zoonoses Public Health"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2200824","DOI":"10.2807\/1560-7917.ES.2023.28.28.2200824","article-title":"A Q fever outbreak among visitors to a natural cave, Bizkaia, Spain, December 2020 to October 2021","volume":"28","author":"Hurtado","year":"2023","journal-title":"Euro Surveill."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.ijheh.2012.12.010","article-title":"Coxiella burnetii in sewage water at sewage water treatment plants in a Q fever epidemic area","volume":"216","author":"Schets","year":"2013","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Hermans, T., Jeurissen, L., Hackert, V., and Hoebe, C. (2014). Land-applied goat manure as a source of human Q-fever in the Netherlands, 2006\u20132010. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0096607"},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"van den Brom, R., Roest, H.J., de Bruin, A., Dercksen, D., Santman-Berends, I., van der Hoek, W., Dinkla, A., Vellema, J., and Vellema, P. (2015). A probably minor role for land-applied goat manure in the transmission of Coxiella burnetii to humans in the 2007\u20132010 Dutch Q fever outbreak. PLoS ONE, 27.","DOI":"10.1371\/journal.pone.0121355"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s10096-023-04687-6","article-title":"Increased recognition of Q fever aortitis as a chronic manifestation of Q fever in tropical North Queensland, Australia","volume":"42","author":"Price","year":"2023","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/S0140-6736(82)92000-1","article-title":"Q fever in an urban area","volume":"1","author":"Salmon","year":"1982","journal-title":"Lancet"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"e02314-20","DOI":"10.1128\/AEM.02314-20","article-title":"Multi-Scale Airborne Infectious Disease Transmission","volume":"87","author":"Dillon","year":"2021","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Dillon, M.B., and Dillon, C.F. (2021). Regional Relative Risk, a Physics-Based Metric for Characterizing Airborne Infectious Disease Transmission. Appl. Environ. Microbiol., 87.","DOI":"10.1128\/AEM.01262-21"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1017\/S0950268807009533","article-title":"Large Q fever outbreak due to sheep farming near residential areas, Germany, 2005","volume":"136","author":"Gilsdorf","year":"2008","journal-title":"Epidemiol. Infect."},{"key":"ref_119","first-page":"180","article-title":"A large outbreak of Q fever in the West Midlands: Windborne spread into a metropolitan area?","volume":"1","author":"Hawker","year":"1988","journal-title":"Commun. Dis. Public Health"},{"key":"ref_120","first-page":"67","article-title":"Hyperendemic focus of Q fever related to sheep and wind","volume":"50","author":"Torres","year":"1999","journal-title":"Am. J. Epidemiol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1093\/cid\/cis734","article-title":"Q fever: Single-Point Source Outbreak with High Attack Rates and Massive Numbers of Undetected Infections Across an Entire Region","volume":"55","author":"Hackert","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1111\/tbed.13505","article-title":"Q fever: Evidence of a Massive Yet Undetected Cross-Border Outbreak, with Ongoing Risk of Extra Mortality, in a Dutch-German Border Region","volume":"67","author":"Hackert","year":"2020","journal-title":"Transbound. Emerg. Dis."},{"key":"ref_123","first-page":"25","article-title":"Q fever in California VIII. An epidemic of Q fever in a small rural community in northern California","volume":"54","author":"Clark","year":"1951","journal-title":"Am. J. Hyg."},{"key":"ref_124","first-page":"E125","article-title":"Atypical outbreak of Q fever affecting low-risk residents of a remote rural town in New South Wales","volume":"41","author":"Archer","year":"2017","journal-title":"Commun. Dis. Intell. Q. Rep."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/978-94-007-4315-1_17","article-title":"Epidemic Q fever in humans in the Netherlands","volume":"984","author":"Morroy","year":"2012","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1574-695X.2011.00876.x","article-title":"The 2007\u20132010 Q fever epidemic in the Netherlands: Characteristics of notified acute Q fever patients and the association with dairy goat farming","volume":"64","author":"Dijkstra","year":"2012","journal-title":"FEMS Immunol. Med. Microbiol."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/zph.12054","article-title":"The effectiveness of Coxiella burnetii vaccines in occupationally exposed populations: A systematic review and meta-analysis","volume":"61","author":"Sargeant","year":"2014","journal-title":"Zoonoses Public Health"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/s41541-023-00727-6","article-title":"Q fever immunology: The quest for a safe and effective vaccine","volume":"8","author":"Sam","year":"2023","journal-title":"NPJ Vaccines"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"105655","DOI":"10.1016\/j.meegid.2024.105655","article-title":"Molecular and genotyping techniques in diagnosis of Coxiella burnetii: An overview","volume":"123","author":"Khademi","year":"2024","journal-title":"Infect. Genet. Evol."},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Zhan, S., Jin, H., Ji, H., Hou, X., Li, J., Zhang, Y., Zheng, J., and Cui, L. (2025). Clinical diagnosis of Q fever by targeted next-generation sequencing for identification of Coxiella burnetii. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-024-10437-6"},{"key":"ref_131","unstructured":"US Department of Agriculture Economic Research Service (2025, February 02). Farm Labor (See U.S. Employment in Agriculture and Support Industries, 2001\u20132023), Available online: https:\/\/www.ers.usda.gov\/topics\/farm-economy\/farm-labor#size."},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"Tapia, T., Olivares, M.F., Stenos, J., Iglesias, R., D\u00edaz, N., Vergara, N., Sotomayor, V., Gallegos, D., Soares Magalh\u00e3es, R.J., and Acevedo, J. (2021). National Seroprevalence of Coxiella burnetii in Chile, 2016\u20132017. Pathogens, 10.","DOI":"10.3390\/pathogens10050531"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1017\/S0950268811000136","article-title":"Low seroprevalence of Q fever in The Netherlands prior to a series of large outbreaks","volume":"140","author":"Schimmer","year":"2012","journal-title":"Epidemiol. Infect."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"2867","DOI":"10.1111\/trf.12749","article-title":"Screening of blood donors for chronic Coxiella burnetii infection after large Q fever outbreaks","volume":"54","author":"Slot","year":"2014","journal-title":"Transfusion"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1017\/S0950268820000084","article-title":"Q fever seroprevalence in Australia suggests one in twenty people have been exposed","volume":"148","author":"Gidding","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1863-2378.2008.01109.x","article-title":"Human seroprevalence to Coxiella burnetii (Q fever) in Northern Ireland","volume":"55","author":"McCaughey","year":"2008","journal-title":"Zoonoses Public Health"},{"key":"ref_137","first-page":"1","article-title":"National Health and Nutrition Examination Survey: Analytic Guidelines, 1999\u20132010","volume":"161","author":"Johnson","year":"2013","journal-title":"Vital Health Stat 2"},{"key":"ref_138","unstructured":"US National Health and Nutrition Examination Survey (2025, April 20). NHANES Biospecimen Program, Available online: https:\/\/www.cdc.gov\/nchs\/nhanes\/biospecimen\/index.html."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/5\/460\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:29:06Z","timestamp":1760030946000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/5\/460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,8]]},"references-count":138,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["pathogens14050460"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14050460","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,8]]}}}