Coxiella burnetii infection has been reported in most countries, but not in New Zealand or Polynesia.[5] Southern France and Spain have the highest rates.[6][7][8][9] The disease is endemic in Australia and strongly associated with the presence of livestock and abattoirs.[5][10] In the US, the incidence is high in the Midwest, although California has reported the highest number of total cases.[11] In 2017, 153 cases were reported in the US.[12] The largest outbreak recorded to date occurred in the Netherlands between 2007 and 2009, with more than 4,000 cases reported.[13][14][15][16][17] 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.[18][19][20]C burnetii infection has also been reported in US military personnel returning from Iraq, and less commonly from Afghanistan.[21][22][23] In addition, cases have been reported in travellers recently returned from the tropics and Australia.[24][25] Cases tend to occur more frequently in spring and early summer.

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