Coxiella burnetii infection has been reported in most countries, but not in New Zealand or Polynesia. Southern France and Spain have the highest rates. The disease is endemic in Australia and strongly associated with the presence of livestock and abattoirs. In the US, the incidence is high in the Midwest, although California has reported the highest number of total cases. In 2017, 153 cases were reported in the US. The largest outbreak recorded to date occurred in the Netherlands between 2007 and 2009, with more than 4,000 cases reported. The outbreak was mainly confined to the south of the country, and dairy goats were implicated as the source. Clusters of cases have been reported in Israel (including a school outbreak) and Taiwan.C burnetii infection has also been reported in US military personnel returning from Iraq, and less commonly from Afghanistan. In addition, cases have been reported in travellers recently returned from the tropics and Australia. Cases tend to occur more frequently in spring and early summer.
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