The genotypic diversity of Coxiella burnetii in clinical samples obtained from the Dutch Q fever outbreak episodes of 2007-2010 was determined by using a 6-locus variable-number tandem repeat analysis panel. The results are consistent with the introduction of one founder genotype that is gradually diversifying over time while spreading throughout The Netherlands.

Q fever is a disease of humans, caused by Coxiella burnetii, and a large range of animals can be infected. This paper presents a review of the epidemiology of Q fever in humans and farm animals between 1982 and 2010, using case studies from four European countries (Bulgaria, France, Germany and the Netherlands). The Netherlands had a large outbreak between 2007 and 2010, and the other countries a history of Q fever and Q fever research. Within all four countries, the serological prevalence of C. burnetii infection and reported incidence of Q fever varies broadly in both farm animals and humans. Proximity to farm animals and contact with infected animals or their birth products have been identified as the most important risk factors for human disease. Intrinsic farm factors, such as production systems and management, influence the number of outbreaks in an area. A number of disease control options have been used in these four countries, including measures to increase diagnostic accuracy and general awareness, and actions to reduce spill-over (of infection from farm animals to humans) and human exposure. This study highlights gaps in knowledge, and future research needs.

b Real-time PCR shows the widespread presence of Coxiella burnetii DNA in a broad range of commercially available milk and milk products. MLVA genotyping shows that this is the result of the presence of a predominant C. burnetii genotype in the dairy cattle population.

Since the Neolithic period, humans have domesticated herbivores to have food readily at hand. The cohabitation with animals brought various advantages that drastically changed the human lifestyle but simultaneously led to the emergence of new epidemics. The majority of human pathogens known so far are zoonotic diseases and the development of both agricultural practices and human activities have provided new dynamics for transmission. This article provides a general overview of some factors that influence the epidemic potential of a zoonotic disease, Q fever. As an example of a disease where the interaction between the environment, animal (domestic or wildlife) and human populations determines the likelihood of the epidemic potential, the management of infection due to the Q fever agent, Coxiella burnetii, provides an interesting model for the application of the holistic One Health approach.

Following a request from the European Commission, a scientific opinion was prepared by EFSA's Animal Health and Welfare Panel to determine the magnitude, distribution, impact and significance of infection and disease in domestic ruminants and humans, risk factors for the maintenance (in domestic ruminant populations) and spillover (from these populations to humans) of Coxiella burnetii (the causative agent of Q fever), and control options in domestic ruminant populations. A range of approaches were used, including an assessment of monitoring/surveillance data, the development of a simple conceptual model, a critical review of available literature, and several country case studies. Control options for C. burnetii infection in small ruminants were qualitatively assessed. Infection is endemic in domestic ruminants in most, if not all, EU member states, however, disease is rare and impact is limited. In the EU, Q fever is a zoonotic disease with limited public health impact, except under certain epidemiological circumstances and for particular risk groups. Human cases are often associated with proximity to small ruminants (particularly at parturition or during abortions) and dry, windy weather. Currently, there is no clear evidence of an association between bacterial genotypes/isolates and virulence. A number of longer-term options to control C. burnetii infection in domestic ruminants were identified; these should be considered in those situations where the public health risk is considered unacceptable. Some additional options were not considered sustainable for long-term control, but may have a role in the face of an outbreak. Persistent environmental contamination may confound animal-based control efforts. Vaccination should be considered a longterm control option, noting that effectiveness may not be observed in the short-term. Antibiotic treatment of animals is not recommended. There is no conclusive evidence that the consumption of milk and milk products containing C. burnetii has resulted in clinical Q fever in humans. (ECDC) and the EFSA staff members Ana Afonso, Milen Georgiev and Jane Richardson for the support provided to this EFSA scientific output. Thank you also for the valuable information made available by the Zoonoses task force, the EFSA Animal Health and Welfare network, Prof. S. Martinov and I. Yordanov.This opinion was the result of a fruitful collaboration with ECDC in relation to public health aspects. The BIOHAZ Panel wishes to thank the EFSA staff member Bart Goossens for the support provided to Chapter 4 of this EFSA scientific output. Q fever 2 EFSA Journal 2010; 8 (5):1595 SUMMARYThe recent developments in the EU, especially the increase in confirmed human cases of Q fever in the Netherlands, call for special consideration as regards the risks posed by Q fever for humans and animals. The European Commission requested further scientific advice and risk assessment, as regards Q fever in animals. The mandate posed three questions:to assess the significance of the occurrence of Q fever in the ...