{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T15:30:51Z","timestamp":1793892651924,"version":"4.8.0"},"reference-count":54,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,2,4]]},"abstract":"<jats:p>Q fever is a worldwide zoonosis historically associated with exposure to infected livestock. This study summarizes cases of Q fever, a notifiable disease in the United States, reported to the Centers for Disease Control and Prevention through two national surveillance systems with onset during 2000\u20132012. The overall incidence rate during this time was 0.38 cases per million persons per year. The reported case fatality rate was 2.0%, and the reported hospitalization rate was 62%. Most cases (61%) did not report exposure to cattle, goats, or sheep, suggesting that clinicians should consider Q fever even in the absence of livestock exposure. The prevalence of drinking raw milk among reported cases of Q fever (8.4%) was more than twice the national prevalence for the practice. Passive surveillance systems for Q fever are likely impacted by underreporting and underdiagnosis because of the nonspecific presentation of Q fever.<\/jats:p>","DOI":"10.4269\/ajtmh.14-0503","type":"journal-article","created":{"date-parts":[[2014,11,18]],"date-time":"2014-11-18T05:30:41Z","timestamp":1416288641000},"page":"247-255","source":"Crossref","is-referenced-by-count":47,"title":["Q Fever in the United States: Summary of Case Reports from Two National Surveillance Systems, 2000\u20132012"],"prefix":"10.4269","volume":"92","author":[{"given":"F. Scott","family":"Dahlgren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer H.","family":"McQuiston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Massung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia D.","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"R1","series-title":"PLoS ONE","first-page":"e48949","article-title":"Q Fever in pregnant goats: pathogenesis and excretion of Coxiella burnetii","volume":"7","author":"Roest","year":"2012"},{"key":"R2","series-title":"Ann N Y Acad Sci","first-page":"291","article-title":"Susceptibility of Coxiella burnetii to chemical disinfectants","volume":"590","author":"Scott","year":"1990"},{"key":"R3","series-title":"Commun Dis Public Health","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":"1998"},{"key":"R4","series-title":"Am J Epidemiol","first-page":"67","article-title":"Hyperendemic focus of Q fever related to sheep and wind","volume":"150","author":"Tissot-Dupont","year":"1999"},{"key":"R5","series-title":"Emerg Infect Dis","first-page":"225","article-title":"Public health assessment of potential biological terrorism agents","volume":"8","author":"Rotz","year":"2002"},{"key":"R6","series-title":"J Am Vet Med Assoc","first-page":"40","article-title":"Biological terrorism against animals and humans: a brief review and primer for action","volume":"221","author":"Noah","year":"2002"},{"key":"R7","series-title":"Lancet Infect Dis","first-page":"709","article-title":"Q fever: a biological weapon in your backyard","volume":"3","author":"Madariaga","year":"2003"},{"key":"R8","series-title":"Emerg Infect Dis","first-page":"1264","article-title":"Wind in November, Q fever in December","volume":"10","author":"Tissot-Dupont","year":"2004"},{"key":"R9","series-title":"J Med Microbiol","first-page":"9","article-title":"Q fever: the neglected biothreat agent","volume":"60","author":"Oyston","year":"2011"},{"key":"R10","series-title":"Can Dis Wkly Rep","first-page":"210","article-title":"Q fever transmitted by blood transfusion\u2014United States","volume":"3","author":"Anonymous","year":"1977"},{"key":"R11","series-title":"Clin Infect Dis","first-page":"1087","article-title":"Possible sexual transmission of Q fever among humans","volume":"22","author":"Kruszewska","year":"1996"},{"key":"R12","series-title":"Clin Infect Dis","first-page":"399","article-title":"Sexually transmitted Q fever","volume":"33","author":"Milazzo","year":"2001"},{"key":"R13","series-title":"Clin Infect Dis","first-page":"1387","article-title":"Q Fever cluster among raw milk drinkers in Michigan, 2011","volume":"55","author":"Signs","year":"2012"},{"key":"R14","series-title":"J Infect Dis","first-page":"354","article-title":"Concomitant human infection due to Rickettsia conorii and Coxiella burnetii","volume":"160","author":"Janbon","year":"1989"},{"key":"R15","series-title":"Am J Hyg","first-page":"23","article-title":"Q fever in the Mediterranean area; report of its occurrence in allied troops; epidemiology","volume":"44","author":"Robbins","year":"1946"},{"key":"R16","series-title":"Ann Intern Med","first-page":"28","article-title":"Report on an outbreak of Q fever at the National Institute of Health; clinical features","volume":"27","author":"Spicknall","year":"1947"},{"key":"R17","series-title":"J Am Med Assoc","first-page":"813","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"},{"key":"R18","series-title":"Am J Hyg","first-page":"185","article-title":"An outbreak of Q fever in a Chicago packing house","volume":"46","author":"Shepard","year":"1947"},{"key":"R19","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"223","article-title":"Q fever among slaughterhouse workers\u2014California","volume":"35","author":"Centers for Disease Control","year":"1986"},{"key":"R20","series-title":"Am J Infect Control","first-page":"345","article-title":"Q fever in animal laboratory workers: an outbreak and its investigation","volume":"17","author":"Graham","year":"1989"},{"key":"R21","series-title":"Clin Infect Dis","first-page":"e65","article-title":"Outbreak of Q fever among US military in western Iraq, June\u2013July 2005","volume":"46","author":"Faix","year":"2008"},{"key":"R22","series-title":"Medicine (Baltimore)","first-page":"109","article-title":"Q fever 1985\u20131998. Clinical and epidemiologic features of 1,383 infections","volume":"79","author":"Raoult","year":"2000"},{"key":"R23","series-title":"Vector Borne Zoonotic Dis","first-page":"179","article-title":"Q fever in humans and animals in the United States","volume":"2","author":"McQuiston","year":"2002"},{"key":"R24","series-title":"J Hyg Epidemiol Microbiol Immunol","first-page":"79","article-title":"Subacute rickettsial endocarditis: an unusual complication of Q fever","volume":"6","author":"Marmion","year":"1962"},{"key":"R25","series-title":"Q J Med","first-page":"193","article-title":"Chronic Q fever","volume":"45","author":"Turck","year":"1976"},{"key":"R26","series-title":"Q J Med","first-page":"669","article-title":"Subclinical chronic Q fever","volume":"57","author":"Fergusson","year":"1985"},{"key":"R27","series-title":"Clin Infect Dis","first-page":"489","article-title":"Q fever","volume":"20","author":"Raoult","year":"1995"},{"key":"R28","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"Diagnosis and management of Q fever\u2013United States, 2013: recommendations from CDC and the Q Fever Working Group","volume":"62","author":"Anderson","year":"2013"},{"key":"R29","article-title":"Placing Q Fever (Coxiella burnetii) Under National Surveillance in the United States Under the National Public Health Surveillance System (NPHSS)","author":"Council of State and Territorial Epidemiologists","year":"1999"},{"key":"R30","article-title":"Revision of the Surveillance Case Definition for Q Fever","author":"Council of State and Territorial Epidemiologists","year":"2007"},{"key":"R31","series-title":"Am J Trop Hyg","first-page":"36","article-title":"National surveillance and the epidemiology of human Q fever in the United States, 1978\u20132004","volume":"75","author":"McQuiston","year":"2006"},{"key":"R32","article-title":"Intercensal estimates of the resident population by single year of age and sex for states and the United States: April 1, 2000 to July 1, 2010","author":"United States Census Bureau","year":"2011"},{"key":"R33","article-title":"Annual state resident population estimates for 6 race groups by age, sex, and Hispanic origin: April 1, 2010 to July 1, 2012","author":"United States Census Bureau","year":"2013"},{"key":"R34","article-title":"SAS System for Windows [computer program]. Version 9.3","author":"SAS Institute","year":"2012"},{"key":"R35","article-title":"2010 Standard Occupational Classification Definitions","author":"Bureau of Labor Statistics, United States Department of Labor","year":"2013"},{"key":"R36","article-title":"Occupational Employment Statistics","author":"Bureau of Labor Statistics, United States Department of Labor","year":"2010"},{"key":"R37","series-title":"Cattle","author":"United States Department of Agriculture","year":"2010"},{"key":"R38","series-title":"Sheep and Goats","author":"United States Department of Agriculture","year":"2011"},{"key":"R39","series-title":"Part I: Reference of 1997 Beef Cow-Calf Management Practices","first-page":"49","article-title":"Beef 1997","author":"United States Department of Agriculture","year":"1997"},{"key":"R40","series-title":"Theriogenology","first-page":"997","article-title":"Calving and calving management of beef cows and heifers on cow-calf operations in the United States","volume":"61","author":"Dargatz","year":"2004"},{"key":"R41","series-title":"Part I: Reference of Goat Management Practices in the United States","first-page":"63","article-title":"Goat 2009","author":"United States Department of Agriculture","year":"2010"},{"key":"R42","series-title":"Part I: Reference of Sheep Management Practices in the United States, 2011","first-page":"87","article-title":"Sheep 2011","author":"United States Department of Agriculture","year":"2012"},{"key":"R43","series-title":"FEMS Immunol Med Microbiol","first-page":"3","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"},{"key":"R44","series-title":"Profile of the Military Community","author":"Office of the Deputy Under Secretary of Defense (Military Community and Family Policy) under contract with ICF International, Demographics","year":"2010"},{"key":"R45","series-title":"Am J Med","first-page":"427","article-title":"Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases","volume":"93","author":"Tissot Dupont","year":"1992"},{"key":"R46","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"361","article-title":"Q fever and pregnancy: disease, prevention, and strain specificity","volume":"32","author":"Angelakis","year":"2013"},{"key":"R47","series-title":"Foodborne Active Surveillance Network (FoodNet) Population Survey Atlas of Exposures","author":"Centers for Disease Control and Prevention","year":"2006\u20132007"},{"key":"R48","series-title":"Am J Hyg","first-page":"319","article-title":"Q fever in California. XI. An epidemiologic summary of 350 cases occurring in northern California during 1948\u20131949","volume":"54","author":"Clark","year":"1951"},{"key":"R49","series-title":"Am J Trop Med Hyg","first-page":"35","article-title":"A cluster of Coxiella burnetii infections associated with exposure to vaccinated goats and their unpasteurized dairy products","volume":"47","author":"Fishbein","year":"1992"},{"key":"R50","series-title":"Emerg Infect Dis","first-page":"619","article-title":"Coxiella burnetii in bulk tank milk samples, United States","volume":"11","author":"Kim","year":"2005"},{"key":"R51","series-title":"Foodborne Pathog Dis","first-page":"1453","article-title":"Detection of Coxiella burnetii in commercially available raw milk from the United States","volume":"7","author":"Loftis","year":"2010"},{"key":"R52","series-title":"Am J Trop Med Hyg","first-page":"765","article-title":"Coxiella burnetii DNA, but not viable bacteria, in dairy products in France","volume":"88","author":"Eldin","year":"2013"},{"key":"R53","series-title":"Am J Trop Med Hyg","first-page":"691","article-title":"Seroprevalence of Q fever in the United States, 2003\u20132004","volume":"81","author":"Anderson","year":"2009"},{"key":"R54","series-title":"Am J Trop Med Hyg","first-page":"244","article-title":"Q fever is underestimated in the United States: a comparison of fatal Q fever cases from two national reporting systems","volume":"92","author":"Dahlgren","year":"2015"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/92\/2\/article-p247.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/92\/2\/article-p247.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/92\/2\/article-p247.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T19:30:30Z","timestamp":1723059030000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/92\/2\/article-p247.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,4]]},"references-count":54,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.14-0503","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,4]]}}}