265 Introduction Q fever is a zoonosis with a world‑wide distribution (except New Zealand) caused by Coxiella burnetii, an obligatory intracellular bacterium. Q or ‘query’ fever was first observed in slaughterhouse workers in Brisbane, Queensland, Australia in 1933 and was initially described by Derrick as a self‑limiting febrile illness of unknown etiology (Derrick 1937). At that time, the etiological agent was considered to be a virus and all trials to isolate the pathogen by inoculating guinea pigs with blood or urine of infected patients were unsuccessful (Derrick 1937). Burnet and Freeman (Burnet and Freeman 1937) isolated an intracellular bacterium from guinea pigs that had been previously injected with blood or urine from the infected slaughterhouse workers and named it Rickettsia burnetii. In the same period, a laboratory‑acquired fever infection occurred in the Rocky Mountain Laboratory in Hamilton, Montana, Laboratory of Hygiene of Foods of Animal Origin, Faculty of Veterinary Medicine, University of Thessaly, Greece * Corresponding author at: Laboratory of Hygiene of Foods of Animal Origin, Faculty of Veterinary Medicine, University of Thessaly, Greece. e‑mail: apexara@vet.uth.gr. Parole chiave Coxiella burnetii, Ruminanti domestici, Febbre Q, Sieroprevalenza. Riassunto La febbre Q è una zoonosi causata dal batterio gram‑negativo Coxiella burnetii, un patogeno intracellulare obbligato. I principali serbatoi e fonte di infezione umana sono i ruminanti ma l'infezione da C. burnetii è stata dimostrata in molte specie animali. Nei ruminanti è spesso asintomatica ma è stata anche associata a infertilità e aborti; nell'uomo, è stata considerata prevalentemente un rischio professionale, determinata dal contatto con prodotti infetti come placenta, urina, feci o latte. La febbre Q è tornata ad essere un'emergenza per la salute pubblica dopo la vasta epidemia avvenuta nei Paesi Bassi tra il 2007 e il 2009. Nonostante la sieroprevalenza di C. burnetii nei ruminanti sia comunemente rilevata dai vari test diagnostici utilizzati nei laboratori, non è ancora disponibile un metodo ufficiale per questo patogeno. Le numerose indagini condotte in vari paesi mostrano percentuali elevate di infezione nei ruminanti domestici specie nelle pecore e nella capre. L'unico paese con una prevalenza apparente zero è la Nuova Zelanda. Febbre Q e sieroprevalenza di Coxiella burnetii nei ruminanti domestici Keywords Coxiella burnetii, Domestic ruminants, Q fever, Seroprevalence. Summary Q fever is a zoonosis caused by Coxiella burnetii, an obligate intracellular gram‑negative bacterium. Infection by C. burnetii has been demonstrated in many animal species, but ruminants are the major reservoirs and the main sources of human infection. In ruminants, C. burnetii infection is often asymptomatic, but it has been also associated with infertility and abortions. In humans, Q fever was considered predominately an occupational hazard due to close contact with infected ruminants by means of their contaminated birth products, urine, feces or milk. Q fever has recently gained renewed attention after the large outbreak in the Netherlands in 2007‑2009, indicating its importance as an emerging public health threat. The seroprevalence of C. burnetii in ruminants is commonly detected by various tests but no official standard technique is still available. According to surveys conducted in many countries of the five continents, a relatively high proportion of farm ruminants are found seropositive to C. burnetii. The only country with an apparent zero prevalence is New Zealand. The seroprevalence in goats and sheep is usually higher than cattle. Andreana Pexara*, Nikolaos Solomakos and Alexander Govaris Q fever and seroprevalence of Coxiella burnetii in domestic ruminants Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Accepted: 01.12.2016 | Available on line: 31.12.2018 266 Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 primary infection more than half of the patients remain asymptomatic. Q fever may manifest as acute or chronic Q  fever with long‑term sequelae. Acute Q  fever usually develops as a non‑specific febrile illness, pneumonia or hepatitis (Karakousis and Trucksis 2006). Atypical pneumonia and hepatitis are usually the most classic forms of Q  fever. Hepatitis may be expressed as infectious‑like hepatitis or fever of unknown origin (FUO) with characteristic hepatic granulomas on liver biopsy. Less common manifestations of acute Q fever include myocarditis, pericarditis, meningoencephalitis and skin rash (Angelakis and Raoult 2010). The chronic infection can manifest itself as endocarditis, chronic fatigue syndrome and problems related to pregnancy (Arricau‑Bouvery and Rodolakis 2005). Q  fever was considered predominately an occupational hazard and close contact with ruminants appeared to be strongly associated with the disease in humans (Psaroulaki et al. 2006). Q fever has recently gained renewed attention after the largest‑ever recorded outbreak which involved over 4,000 human cases in the Netherlands in 2007‑2009 (Vanderburg et  al. 2014). This outbreak highlighted the importance of Q  fever as an emerging public health threat. Moreover, the widespread distribution of C.  burnetii in food producing animals and its occurrence in foods of animal origin, particularly in milk, necessitates the investigation of food as a significant vehicle for the transmission of this zoonotic bacterium to humans. Unpasteurized milk is the most significant source of C.  burnetii. There are epidemiological indications that consumption of milk and/or milk products containing C.  burnetii has been associated with sero‑conversion in humans. Moreover, unpasteurized milk and derived dairy products have been proposed by several authors as sources of human infection (Fishbein and Raoult 1992, Hatchette et  al. 2001, Maltezou et  al. 2004). However, the contribution of milk ingestion, mainly drinking unpasteurized milk, to Q fever infection in humans is difficult to establish. Moreover, C. burnetii was detected in animal products such as raw‑milk cheese and butter prepared from raw milk as well as in the meat of infected animals (Capuano et  al. 2012, Hirai et al. 2012, Eldin et al. 2013, Hilbert et al. 2015). The pathogen was detected even in chicken eggs from Japan and Iran (Tatsumi et  al. 2006, Rahimi and Doosti 2012). In addition to the adverse effects to human health, C.  burnetii infection in animals can result in the decrease of the livestock production with important socioeconomic effects (Perry et  al. 2011). This review summarizes the current knowledge on C.  burnetii infection in domestic ruminants with special focus on serological prevalence. USA (Davis and Cox 1938). As Dermacentor andersoni was collected near the infected guinea pigs with a febrile illness and enlarged spleens in Nine Mile creek, Montana, it was concluded that the fever was acquired by means of possible vectors (Cox 1938). The causative agent with filterable properties was characterized as the ‘Nine Mile agent’. The organism was observed intravacuolarly in infected tissue cultures and could be also transmitted to humans (Cox 1938). The American and Australian research groups then demonstrated that the Australian Q fever and the Nine Mile agents were in fact isolates of the same microorganism which was classified as Rickettia burnetii (Maurin and Raoult 1999). In 1948, Philip re‑classified R. burnetii according to cultural and biochemical characteristics. To honor both Cox and Burnet, the Q fever pioneers, they re‑named it as Coxiella burnetii (Philip 1948). In Europe, Q  fever was first reported in humans in Greece during the Second World War, when the microorganism was detected in sera of German soldiers who had febrile illness, known as the ‘Balkan flu’ (Caminopetros 1946). In 1945, American soldiers who returned to USA from Italy, developed an acute febrile illness accompanied by pneumonia. The cause of the epidemic was identified by serological test as Ricketsia of Q  fever (Commission on acute respiratory diseases 1946). Q  fever is listed within the category of multiple species diseases in the World Organisation for Animal Health list (OIE 2016). Several domestic and wild animals as well as birds, reptiles and arthropods (particularly ticks) can harbour the pathogen, but cattle, goats and sheep are the main reservoirs. In most animals the infection is asymptomatic, but abortions or stillbirths may occur. The bacteria are spread to the environment by secretions of infected animals (urine, feces and milk) but predominantly via the birth products (more than 109 bacteria/g placenta) (Arricau‑Bouvery and Rodolakis 2005). In humans, the airborne pathway is the main mode of transmission. The infection is usually caused by inhalation of infectious aerosols directly from birth fluids or via inhalation of dust contaminated by dried placental material, birth fluids and excreta of infected animals (Tissot‑Dupont and Raoult 2008). The bacterium can become airborne, traveling on wind currents for miles, resulting in outbreaks (Tissot‑Dupont et  al. 2004). Humans can also be infected by direct contact with infected animals particularly during abortion and parturition. The infection in humans by ingestion of unpasteurized milk or dairy products, has been also recorded (Tissot‑Dupont and Raoult 2008). In addition to ruminants, cats and dogs are also able to shed the organism. In humans, the main characteristic of Q  fever is its clinical polymorphism. Following Coxiella burnetii in domestic ruminants Pexara et al. 267Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 remain viable for several months in dairy products, meat and meat products, water, aborted foetuses, manure, wool, hay, equipment, and clothing during conditions of high humidity, low temperatures, and no sunlight (EFSA 2010). For example, C. burnetii can survive 12  to  16 months in wool, 120  days in dust, 49  days in dried urine and 30  days in dried sputum (NABC 2010). C.  burnetii has two distinct antigenic phases, phase I and phase II. Phase I and II variants are morphologically identical, but differ in some biochemical characteristics including their lipopolysaccharide (LPS) composition. LPS  II is of rough type in contrast to LPS  I, which is phenotypically smooth and contains a noticeable amount of two sugars virenose and dihydrohydroxystreptose (Narasaki and Toman 2012). Organisms isolated from infected animals or humans express phase I antigens and are highly infectious. Organisms expressing phase II antigens are less infectious and are obtained by repeated in ovo or in vivo passages. In experimentally infected animals, antibodies to phase II antigens are initially produced, while antibodies to phase I antigens are produced in later stages. C. burnetii is able to survive permanently inside the macrophages, causing an infection after an acute episode (Gwida et al. 2012). Q fever in domestic ruminants Domestic ruminants are the primary animal reservoirs of C. burnetii. Q  fever is an airborne disease and inhalation of infected aerosols and dust is the main route of infection of domestic ruminants (Tissot‑Dupont et  al. 2004). Also, ruminants may become infected by ingestion of contaminated pastures, hay and straw (Maurin and Raoult 1999). It is likely that C. burnetii contaminated manure plays a role on the maintenance of infection in animal populations (EFSA 2010). The pathogen has been isolated in several tick species (Maurin and Raoult 1999). Ticks appear to play an important role in enzootic transmission cycles in domestic ruminants (Beaman and Hung 1989). A strong correlation has been reported between seropositivity and ticks’ infestation in animals (Psaroulaki et al. 2006). The presence of Q fever in animals is also related to the characteristics of certain C.  burnetii strains, and in particular infectivity, virulence and resistance to environmental conditions (Barberio 2015). Maintenance of C.  burnetii infection in animal populations may be also affected by other factors such as manure management (capture, storage, treatment and utilization), farm characteristics (herd/flock size, animal and herd/flock density) and farm environmental conditions (temperature and relative humidity) (EFSA 2010). Characteristics of the bacterium Coxiella burnetii C.  burnetii is a small pleomorphic rod (0.2‑0.4  mm wide, 0.4‑1.0  mm long) with a membrane similar to that of a Gram‑negative bacterium (Maurin and Raoult 1999). It replicates to high numbers within a parasitophorous vacuole of eukaryotic host cells, with an estimated doubling time of 20‑45  h (Mertens and Samuel 2007). C.  burnetii was originally classified in the Rickettsiales order, the Rickettsiaceae family, and the Rickettsiae tribe together with the genera Rickettsia and Rochalimaea. To date, following philogenetic investigations based on genome comparison and 16s rRNA sequence analysis, the bacterium was reclassified from the order Rickettsiales to Legionellales, and falls in the gamma group of Proteobacteria (Raoult et al. 2005). The microrganism produces resistant spore‑like forms (Coleman et  al. 2004). This ability has been attributed to the existence of C.  burnetii cycle variants described in in vitro studies: large‑cell variants (LCV), small‑cell variants (SCV), and small dense cells (SDC) (Coleman et  al. 2004). The LCV is the larger and the metabolically active intracellular form of C.  burnetii. It undergoes sporogenic differentiation and produces the resistant, spore‑like forms. The SDC and SCV represent the small morphological variants of the bacteria likely to survive extracellularly as infectious particles, a trait that is important for persistence in the environment and transmission (ECDC 2010, Kersh et al. 2010). The environmentally stable SCV (or endospore) is the form phagocytosed by macrophages during early infection and the form associated to food‑borne risk (EFSA 2010). The endospores display a tropism for reproductive organs including the mammary gland, are secreted in the milk of infected animals, both from clinical cases and asymptomatic carriers and are also excreted in the detritus of normal births and abortions as well as in the urine and faeces of infected animals. Endospores are released after mother cell lysis and since they are metabolically inactive, they remain stable in soil and dust over many years (Angelakis and Raoult 2010) and can be spread in dust or windborne aerosols for up to 11 miles (18 km) (Hawker et al. 1998). C.  burnetii is resistant to acids (up to pH 4.5), temperature (62°C for 30 min), UV light and pressure (up to 300,000 kPa) (Frangoulidis 2010). Furthermore, the organism can survive for more than 6 months in 10% salt solutions. C.  burnetii is killed by exposure for 30 min to 5% H 2 O 2 , 0.5% hypochlorite, 70% ethanol, for less than 30  min to 5% chloroform or formaldehyde gas (in a 80% humidified environment). Pasteurization of milk (71.66°C for 15 s) is effective in killing C. burnetii (Frangoulidis 2010). Endospores can Pexara et al. Coxiella burnetii in domestic ruminants 268 Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Coxiella burnetii in domestic ruminants Pexara et al. in faeces (Rodolakis et  al. 2007). In asymptomatic herds, apparently healthy goats and cows may shed the bacterium in milk for several months or years (Rodolakis et  al. 2007). C.  burnetii has been also isolated in bull semen but the role of males in the persistence of infection has not extensively examined (Kruszewska et al. 1997). Q fever diagnosis in domestic ruminants Since C.  burnetii infection is frequently subclinical, Q fever disease in domestic ruminants remains unclear and not properly investigated. Reproductive disorders should trigger an investigation, considering Q  fever among the differential diagnoses. In many countries, diagnosis of Q fever in domestic ruminants still relies mainly on modified Ziehl‑Neelsen (MZN)‑stained smears of placental material from aborted fetuses, supplemented by immunohistochemistry (IHC) where appropriate, although polymerase chain reaction (PCR) is increasingly being used for disease confirmation in developed countries (Jones et  al. 2010). PCR can be used to detect C.  burnetii DNA in a wide range of samples, including placenta tissues, faeces, vaginal mucus and milk (Horigan et  al. 2011). High level of specifity and sensitivity were acquired by PCR method applied with the primers consisting of repetitive transposon‑like element (Kırkan et al. 2008). Real‑time PCR is now also commonly used to support a diagnosis of C. burnetii abortion/stillbirth in animals faeces, vaginal mucus and milk (Horigan et al. 2011). A variety of indirect methods (serologic assays) have been used to detect C.  burnetii antibodies in animal serum samples, including complement fixation test (CFT), enzyme linked immunosorbent assay (ELISA), microagglutination test (MA), indirect immunofluorescence assay (IFA) and indirect fluorescent antibody test (IFAT) (Roest et  al. 2013). The CFT is weakly sensitive and the antigen used in this test frequently fails to detect antibodies in sheep or goats (Horigan et  al. 2011). The ELISA is more sensitive than the CFT and is able to test a higher number of animals and flocks (Rodolakis 2006). A combination of both direct and indirect methods is recommended in current protocols to detect Q  fever on herd level; however, no official standard technique is still available (Roest et al. 2013). EFSA outlined the need for harmonized schemes for the passive and active monitoring/reporting of Q  fever in animals so that its prevalence/incidence could be compared over time and between countries (EFSA 2010). Recently, some proposals have been elaborated for the development of harmonized monitoring and reporting schemes for the seroprevalence of C. burnetii in various countries. Clinical signs of Q fever in domestic ruminants Although C. burnetii infection in domestic ruminants is common, clinical disease is rather rare. The infection is generally asymptomatic; but sometimes it can induce reproductive disorders, which differs among ruminant species. Infected sheep may deliver live or dead lambs as well as large abortion waves, mainly at the end of gestation, without specific signs until abortion is imminent (Roest et al. 2013). In contrast to ewes, goats remain chronically infected and can abort twice following an infection (Berri et  al. 2007). Martinov (Martinov 2007) has described also experimentally induced Q fever with respiratory manifestations in sheep. In cattle, yet the symptoms described have so far been inconsistent. Factors linked to the disease in cattle have been infertility, abortion and metritis and mastitis in many studies (Arricau‑Bouvery and Rodolakis 2005, Barlow et  al. 2008). Also, correlation between C.  burnetii seropositivity and fertility and a low abortion risk has been reported (Lopez‑Gatius et  al. 2012, Garcia‑Ispierto et  al. 2013). However, the presence of C. burnetii in dairy herds has been not yet clearly demonstrated to negatively affect reproductive performance. In fact, a recent study showed that seropositive shedding cows had better reproduction than non‑infected cows (Garcia‑Ispierto et al. 2013). Both symptomatic and asymptomatic infected ruminants shed C.  burnetii in large amount in the environment. Shedding of C.  burnetii into the environment mainly occurs during abortion and parturition; placentas of infected small ruminants can contain over 109 hamster infective doses or bacteria per gram of tissue (Fournier et  al. 1998). Goats may shed the bacterium in placenta and vaginal mucus in two successive parturitions after a Q fever infection (Berri et al. 2007). At their first kidding, young goats shed more C. burnetii cells than adults (de Cremoux et  al. 2012). A similar pattern is observed in cattle herds (Guatteo et  al. 2008). In contrast, ewes are usually show one abortion and did not shed the pathogen in vaginal mucus at subsequent lambing (Berri et  al. 2002). The pathogen excretion can also occur in faeces, milk and urine. C.  burnetii shedding can persist for a long time. In goats, shedding of C.  burnetii in vaginal mucus, faeces, and milk lasted 1 to 5 weeks, 2 to 5 weeks, and 1 day to 6 weeks, respectively. In sheep, the shedding lasted 71 days, 8 days after lambing and 8  days in vaginal mucus, faeces, and milk, respectively. In cows, longest observed duration of excretion of C. burnetii in faeces and milk was 14 days and 13  months, respectively (Arricau‑Bouvery and Rodolakis 2005). Goats and cows mostly shed C.  burnetii in milk (Guatteo et  al. 2006, Rodolakis et al. 2007) whereas ewes shed the pathogen mostly 269Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Pexara et al. Coxiella burnetii in domestic ruminants summarized in Table I. In the Netherlands, according to an early (1987) survey of seroprevalence of Q fever by using ELISA showed values of 3.5% and 1% in sheep and goats, respectively (Houwers and Richardus 1987). More recently, according to results of a serological study in Dutch cattle, C.  burnetii antibodies were present in 16% of lactating cows, but only in 1.0% of young animals (Muskens et  al. 2011). In Switzerland, Magouras and colleagues (Magouras et  al. 2017) reported a herd‑level seroprevalence of 5.0% in sheep flocks and 11.1% in goat farms. Animal‑level seroprevalence was 1.8% in sheep and 3.4% in goats. In Germany (Southern Bavaria), seroprevalence of C.  burnetii in cattle tested by ELISA was estimated 11.8% at animal‑level and 81.0% at herd‑level (Rehácek et al. 1993). In another study conducted in Germany, 7.8% of cattle, 1.3% of sheep and 2.5% of goats were found to be infected with C. burnetii (Hartung 1999). In a study conducted in France, seroprevalence was found in 13/14 and 24/28 of dairy goat herds in 2006 and 2008, respectively (Dubuc‑Forfait et  al. 2009). In Demark, serum samples taken from 164  high‑risk cows with abortion problems showed a prevalence of 10% by CFT and 18% by ELISA, in 2003. In Denmark, Given the lack of a standard technique, efforts are encouraged both for the validation of the methods and for development of reference reagents for quality control, proficiency and harmonization purposes. The seroprevalence of C. burnetii in domestic ruminants Q fever in animals has been detected worldwide, whilst the only country with an apparent zero prevalence is New Zealand (Guatteo et  al. 2011). Although a great number of C.  burnetii seroprevalence studies have been conducted throughout the world, the extent of disease in productive ruminants is difficult to quantify. Data reported are mostly based on herds with high increase in abortion (Georgiou 2013). Published data revealed differences in seroprevalence in the animal population in various countries. Europe Accomplished data on the serological prevalence of C.  burnetii in domestic ruminants from published studies conducted in European countries are Table I. The serological prevalence of C. burnetii in domestic ruminants from published studies conducted in European countries. — cont’d Country Year of study Animal species Number tested % positive Method Reference Animals (n) Herds (n) Animals Herds Albania 1995‑1997 cattle 311 ‑ 10.9 ‑ ELISA Cekani et al. 2008 1995‑1997 sheep 350 ‑ 8.8 ‑ ELISA Cekani et al. 2008 1995‑1997 goat 443 ‑ 8.9 ‑ ELISA Cekani et al. 2008 1999 cattle 552 ‑ 8.5 ‑ ELISA Cekani et al. 2008 1999 sheep 292 ‑ 12.3 ‑ ELISA Cekani et al. 2008 1999 goat 260 ‑ 4.2 ‑ ELISA Cekani et al. 2008 Austria ‑ sheep ‑ 70 ‑ 2.86 CFT Wagner et al. 2005 ‑ goat ‑ 30 ‑ 16.7 CFT Wagner et al. 2005 Bulgaria 2002‑2006 cattle 15,866 ‑ 8.53 ‑ CFT Martinov 2007 2002‑2006 sheep 8,727 ‑ 11,59 ‑ CFT Martinov 2007 2002‑2006 goat 3,928 ‑ 13,69 ‑ CFT Martinov 2007 Cyprus ‑ cattle 75 ‑ 24 ‑ IFA Psaroulaki et al. 2006 ‑ sheep 481 ‑ 18.9 ‑ IFA Psaroulaki et al. 2006 ‑ goat 417 ‑ 48,2 ‑ IFA Psaroulaki et al. 2006 Denmark 2003 cattle 164 10 CFT Christoffersen 2007 18 ELISA 2004 cattle 80 ‑ 35 ‑ ELISA Christoffersen 2007 2006 cattle 266 ‑ 25 ‑ ELISA Christoffersen 2007 France 2006 goat 359 14 36 92.9 ELISA Dubuc‑Forfait et al. 2009 2008 goat 1,057 28 32 85.7 ELISA Dubuc‑Forfait et al. 2009 Germany 1991 cattle 1,095 ‑ 12 ‑ ELISA Rehácek et al. 1993 1998 cattle 21,191 ‑ 7.8 ‑ ELISA Hartung 1999 1998 sheep 1,346 ‑ 1.3 ‑ ELISA Hartung 1999 1998 goat 278 ‑ 2.5 ‑ ELISA Hartung 1999 IFA = Indirect Immunofluorescence assay; IFAT = Indirect Fluorescent Antibody Test; ELISA = Enzyme Linked Immunosorbent assay; CFT = Complement Fixation test; MAT = Microagglutination test. continued 270 Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Coxiella burnetii in domestic ruminants Pexara et al. 38% and 47% of sheep and goat herds, respectively (Masala et  al. 2004). In Northern Italy, 44.9% out of 650  cattle with experienced abortion were seropositive for C.  burnetii (Cabassi et  al. 2006). In Northwest Italy, the animal level seroprevalence was 15.5% in sheep and 16.2% in goats. The sheep‑farm and goat‑farm seroprevalence was 38.7% and 19.5%, respectively (Rizzo et al. 2016). In Northern Ireland, 6.2% of cattle and 48.4% of tested herds were seropositive in 2009 (McCaughey et  al. 2010). In Great Britain, estimates of animal and flock/herd seroprevalences were 0.9% and 10.2%, respectively, for sheep and 0.8% and 3%, respectively, for goats (Lambton et al. 2016). a seroprevalence of 35% was found in blood samples from 80 cattle in 2004, and 25% in 266 cattle in 2006 (Christoffersen 2007). In Austria, Wagner and colleagues (Wagner et  al. 2005) examined blood samples from 70 Styrian sheep by CFT and found that 1.5 % of the samples contained antibodies to C. burnetii. In Italy (Emilia‑Romagna Region), the Q  fever seroprevalence in cattle was 13.1% at herd level and 4.4% at animal level (Martini et al. 1994). In Italy (Campania), Capuano and colleagues (Capuano et  al. 2004) reported a seroprevalence of 11.8% in sheep, 6.3% in goats and 14% in cattle. In Sardinia, Italy, antibodies to C. burnetii have been detected in Table I. The serological prevalence of C. burnetii in domestic ruminants from published studies conducted in European countries.— cont’d Country Year of study Animal species Number tested % positive Method Reference Animals (n) Herds (n) Animals Herds Greece ‑ sheep 554 ‑ 10.5 ‑ IFA Pape et al. 2009 ‑ goat 61 ‑ 6.6 ‑ IFA Pape et al. 2009 Italy ‑ cattle 711 99 4.4 13.1 CFT Martini et al. 1994 ‑ cattle ‑ ‑ 14 ‑ IFAT Capuano et al. 2004 ‑ sheep ‑ ‑ 11.8 ‑ IFAT Capuano et al. 2004 ‑ goat ‑ ‑ 6.3 ‑ IFAT Capuano et al. 2004 1999‑2002 sheep ‑ 675 ‑ 38 ELISA Masala et al. 2004 1999‑2002 goat ‑ 82 ‑ 47 Masala et al. 2004 ‑ cattle 650 ‑ 44.9 ‑ ELISA Cabassi et al. 2006 2012 sheep 2,553 111 15.5 38.7 ELISA Rizzo et al. 2016 2012 goat 3,185 206 16.2 19.5 ELISA Rizzo et al. 2016 Montenegro ‑ sheep 954 ‑ 5.03 ‑ MAT & IFA Lausevic 2001 Netherlands 1987 sheep 3,603 191 3.5 27.2 ELISA Houwers and Richardus 1987 1987 goats 594 ‑ 1 ‑ ELISA Houwers and Richardus 1987 2008 cattle 2,936 ‑ 16 ‑ ELISA Muskens et al. 2011 2008 cattle (young animal) 1,831 ‑ 1 ‑ ELISA Muskens et al. 2011 Spain 2007‑2008 cattle 626 46 6.7 43 ELISA Ruiz‑Fons et al. 2010 2007‑2008 sheep 1,379 42 11.8 74 ELISA Ruiz‑Fons et al. 2010 2007‑2008 goat 115 11 8.7 45 ELISA Ruiz‑Fons et al. 2010 2005 sheep 1,011 34 8.9 67.6 ELISA Garcia‑Perez et al. 2009 2009‑2010 cattle 1,306 ‑ 12.3 ‑ ELISA Astobiza et al. 2012 Slovakia 2000 sheep 269 ‑ 37.22 ‑ ELISA Dorko et al. 2010 2009 sheep 269 ‑ 58.42 ‑ ELISA Dorko et al. 2010 Switzerland ‑ sheep ‑ 100 1.8 5 ELISA Magouras et al. 2015 ‑ goat ‑ 72 3.4 11.1 ELISA Magouras et al. 2015 Poland ‑ goat 98 ‑ 79.6 ‑ MAT Platt‑Samoraj et al. 2005 2011‑2012 cattle 169 ‑ 11.83 ‑ ELISA Bielawska‑Drózda et al. 2014 2011‑2012 cattle 169 ‑ 10.65 ‑ CFT Bielawska‑Drózda et al. 2014 UK (Ireland) 2009 cattle 5,182 273 6.2 48.4 ELISA McCaughey et al. 2010 ‑ sheep 1,022 58 12.3 62.1 IFA McCaughey et al. 2010 ‑ goat 54 7 9.3 42.9 IFA McCaughey et al. 2010 UK (Great Britain) ‑ goat 5791 384 0.9 10.2 ELISA Lambton et al. 2016 sheep 522 145 0.8 3 ELISA Lambton et al. 2016 IFA = Indirect Immunofluorescence assay; IFAT = Indirect Fluorescent Antibody Test; ELISA = Enzyme Linked Immunosorbent assay; CFT = Complement Fixation test; MAT = Microagglutination test. 271Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Pexara et al. Coxiella burnetii in domestic ruminants in 2000 and 58.42% in 2009 (Dorko et  al. 2010). In Poland, Platt‑Samoraj and colleagues (Platt‑Samoraj et  al. 2005) examined serum samples from a goat farm with animals affected with reproductive disorders and found that 79.6% of the samples had C. burnetii antibodies in a more recent survey 11.83% and 10.65% of cattle had C.  burnetii antibodies when serum samples were tested by ELISA and CFT method, respectively (Bielawska‑Drózda et al. 2014). In Greece, Pape and colleagues (Pape et  al. 2009) found C. burnetii antibodies in 10% of the animals examined. The seroprevalence was higher in sheep flocks (10.4%) compared to goats’ herds (6.5%). In Cyprus, the prevalence of antibodies against C.  burnetii was 48.2% in goats, 18.9% in sheep, and 24% in cattle (Psaroulaki et al. 2006). Asia, Africa, America and Oceania Data on seroprevalence of C.  burnetii in domestic ruminants collected from studies conducted in countries in Asia are presented in Table II. In Turkey, Cetinkaya and colleagues (Cetinkaya et al. 2000) in 1998, found a seroprevalence In Spain (Basque region), a serosurvey conducted during the years 2007‑2008 showed a prevalence of 11.8%, 8.7% and 6.7% in sheep, goats and beef cattle, respectively (Ruiz‑Fons et  al. 2010). In the same study, a C.  burnetii prevalence of 74%, 45% and 43% for ovine, caprine and bovine herds, respectively, was also recorded (Ruiz‑Fons et  al. 2010). In Northern Spain, 8.9% of the sheep were seropositive, 67.6% of the flocks had at least one seropositive animal, but only 14.7% of them showed a seroprevalence higher than 25% (Garcia‑Perez et al. 2009). In Northern Spain, in a study conducted by Astobiza et al. (2012) cows showed a statistically significantly higher seroprevalence (12.3%) than heifers (1.1 %) and calves (0%) (Astobiza et al. 2012). In Albania, Cekani and colleagues (Cekani et  al. 2008) conducted a survey on C.  burnetii and reported that the seroprevalence detected in sheep and goats (9.8%) was higher than in cattle (7.9%). In Bulgaria, Martinov (Martinov 2007) found that the seropositivity for C.  burnetii was 8.53% in cattle, 11.59% in sheep and 13.69% in goats. In Montenegro, Lausevic (Lausevic 2001) reported a 5.03% seroprevalence of C.  burnetii in sheep. In Slovakia, the seropositivity in sheep was 37.22% Table II. The serological prevalence of C. burnetii in domestic ruminants from published studies conducted in Asian countries. — cont’d Country Year of study Animal species Number tested % positive Method Reference Animals (n) Herds (n) Animals Herds Bangladesh 2009‑2010 cattle 620 ‑ 0.65 ‑ ELISA Haider et al. 2015 2009‑2010 goats 529 ‑ 0.76 ‑ ELISA Haider et al. 2015 China ‑ cattle 1140 19 33 84 ELISA El‑Mahallawy et al. 2016 2011‑2013 sheep 2112 ‑ 14.39 ‑ ELISA Yin et al. 2015 Iran 2008 cattle 93 12 10.75 16.6 ELISA Khalili and Sakhaee 2009 2008 goats 76 9 65.78 100 ELISA Khalili and Sakhaee 2009 2009 sheep 85 29.42 ELISA Sakhaee and Khalili 2010 2010 cattle 246 19 22.3 78.9 ELISA Azizzadeh et al. 2011 2010‑2011 sheep 253 ‑ 23.7 ‑ ELISA Mostafavi et al. 2012 2011‑2012 sheep 1100 ‑ 19.5 ‑ ELISA Asadi et al. 2013 2011‑2012 goat 180 ‑ 27.2 ‑ ELISA Asadi et al. 2013 ‑ sheep 255 29 36.5 89.6 ELISA Keyvani et al. 2014 ‑ goat 205 28 29.8 78.5 ELISA Keyvani et al. 2014 2014 cattle 120 10 0.83 10 ELISA Edalati‑Shokat et al. 2015 2014 sheep 200 10 27.5 100 ELISA Edalati‑Shokat et al. 2015 2014 goat 50 10 54 100 ELISA Edalati‑Shokat et al. 2015 ‑ sheep 253 33.6 87.50 ELISA Esmaeili et al. 2014 Japan 1982‑1991 cattle 562 ‑ 46.6 ‑ IFAT Htwe et al. 1992 1974‑1989 sheep 256 ‑ 28.1 ‑ IFAT Htwe et al. 1992 1974‑1989 goat 85 ‑ 23.5 ‑ IFAT Htwe et al. 1992 Korea 2010 cattle 1000 ‑ 1.3 ‑ ELISA Jang et al. 2011 2010‑2013 cattle 1,095 ‑ 6.2 ‑ ELISA Kim et al. 2014 ‑ goat 575 ‑ 19.1 ‑ ELISA Jung et al. 2014 IFA = Indirect Immunofluorescence assay; IFAT = Indirect Fluorescent Antibody Test; ELISA = Enzyme Linked Immunosorbent assay; CFT = Complement Fixation test; MAT = Microagglutination test. continued 272 Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Coxiella burnetii in domestic ruminants Pexara et al. of C. burnetii of 5.8% and 35.4% in cattle at herd and animal level, respectively, and a seroprevalence of 10.5% and 44.7% at flock and animal level, respectively. In the same country, Kalender (Kalender 2001) reported a C. burnetii seropositivity of 38.59% in aborted ewes and of 11.01% in non aborted ewes. In Western Turkey, Kilic and colleagues (Kilic et  al. 2005) found a relative low seropositivity in sheep (3%). In the same country, according to a study of Seyitoğlu and colleagues (Seyitoğlu et al. 2006), the seropositivity was 5.6% in healthy cattle and 22.6% in cattle with an abortion history. In eastern Turkey, the seropositivity was found to be 16.3% in cattle and 5.4% in sheep (Ceylan et  al. 2009). Two other separate studies in sheep showed a seroprevalence of C.  burnetii of 21.07% (Karaca et  al. 2009) and 20% (Kennerman et  al. 2010). More recently, a seroprevalence of 12.4% was found in dairy cattle (Gazyagci et al. 2011) and of 20.0%, 29.0% and 21.0% in cattle, sheep and goats, respectively, when tested by ELISA. In the same animals the prevalence was of 22.0%, 29.0% and 23.0%, respectively when tested by IFA (Parin and Kaya 2015). In Southeast Iran, in 2008, a significantly higher average seroprevalence (65.78%) was observed in goats than in cattle (10.75%) (Khalili and Sakhaee 2009). The seroprevalence of C.  burnetii was 29.42% and 23.7% in sheep in two studies conducted in Southeast Iran (Sakhaee and Khalili 2010) and Northen Iran, respectively (Mostafavi et  al. 2012). In Eastern Iran, 22.3% of dairy cattle were found seropositive to C.  burnetii according to a study conducted by Azizzadeh and colleagues (Azizzadeh et  al. 2011), in 2010. In Northeastearn Iran, seroprevalence of C.  burnetii at animal level was 36.5% for sheep and 29.8% for goat populations (Keyvani et  al. 2014). In Northwestern Iran, 33.6% of sheep and 87.50% of sheep herds were found positive for C. burnetii (Esmaeili et al. 2014). Recently, in Western Iran, antibodies to C.  burnetii were detected in 27.5% of sheep, in 54% of goats and in 0.83% of dairy cattle (Edalati‑Shokat et  al. 2015). In Iran, according to a study conducted by Asadi and colleagues (Asadi et  al. 2013), the seroprevalence of C.  burnetii in sheep and goats with a history of abortion was 19.5% and 27.2%, respectively. In Pakistan, seroprevalence was 26.9% and 34.9% for sheep and goat, respectively (Zahid et  al. 2016). In Bangladesh, a low seropositivity in cattle and goats (0.65% and 0.76%, respectively) was recorded by Haider and colleagues (Haider et al. 2016). In Japan, a survey on prevalence of C. burnetii antibodies in healthy ruminant farms showed values of 25.4% in cattle, 28.1% in sheep and 23.5% in goats. In this study, the seroprevalence reached values of 84.3% in bovine herds with reproductive disorders (Htwe et  al. 1992). In China, C.  burnetii seropositive cattle (33% of studied animals) were detected in 13 of the 15 surveyed provinces and in 16 of the 19 herds (84%) (El‑Mahallawy et  al. 2016). In the same Table II. The serological prevalence of C. burnetii in domestic ruminants from published studies conducted in Asian countries. — cont’d Country Year of study Animal species Number tested % positive Method Reference Animals (n) Herds (n) Animals Herds Pakistan ‑ sheep 271 ‑ 26.9 ‑ ELISA Zahid et al. 2016 ‑ goat 271 ‑ 34.9 ‑ ELISA Zahid et al. 2016 Turkey 1998 cattle 416 48 5.8 35.4 IFAT Cetinkaya et al. 2000 1998 sheep 411 47 10.5 44.7 IFAT Cetinkaya et al. 2000 ‑ sheep 184 ‑ 38.59 ‑ IFA Kalender 2001 ‑ sheep 224 ‑ 11.01 ‑ IFA Kalender 2001 ‑ cattle 177 ‑ 5.6 ‑ ELISA Seyitoğlu et al. 2006 ‑ cattle 53 22.6 ELISA Seyitoğlu et al. 2006 2006‑2008 cattle 92 ‑ 26.3 ‑ ELISA Ceylan et al. 2009 2006‑2008 sheep 92 ‑ 5.4 ‑ ELISA Ceylan et al. 2009 ‑ sheep 465 ‑ 21.07 ELISA Karaca et al. 2009 2001‑2004 sheep 743 42 20 81 ELISA Kennerman et al. 2010 2002 sheep 100 3 CFT Kilic et al. 2005 ‑ cattle 200 ‑ 20 ELISA Parin and Kaya 2015 ‑ sheep 200 ‑ 29 ELISA Parin and Kaya 2015 ‑ goats 200 ‑ 21 ELISA Parin and Kaya 2015 ‑ cattle 200 ‑ 22 IFA Parin and Kaya 2015 ‑ sheep 200 ‑ 29 IFA Parin and Kaya 2015 ‑ goats 200 ‑ 23 IFA Parin and Kaya 2015 IFA = Indirect Immunofluorescence assay; IFAT = Indirect Fluorescent Antibody Test; ELISA = Enzyme Linked Immunosorbent assay; CFT = Complement Fixation test; MAT = Microagglutination test. 273Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Pexara et al. Coxiella burnetii in domestic ruminants 2003). In Gambia, goats had a significantly higher seroprevalence (24.2%) than sheep (18.5%) (Klaasen et al. 2014). In a serological study conducted in Egypt, 22.5% of sheep and 16.5% of goats were found seropositive to C. burnetii (Mazyad and Hafez 2007). In Egypt, Nahed and Khaled (Nahed and Khaled 2012) reported a seroprevalence of 13%, 32.7%, and 23.3% in cattle, sheep and goats, respectively. More recently, in Egypt, anti‑Coxiella antibodies were detected in 13.2% of cattle (Gwida et al. 2014). Data on the serological prevalence of C.  burnetii in animals from published studies conducted in countries of America and Oceania are summarized in Table IV. In the USA, goats were found to have a significantly higher average seroprevalence (41.6%) than sheep (16.5%) or cattle (3.4%) (McQuiston and Childs 2002). In California (USA), DeForce and Cone (DeForce and Cone 2006) estimated the seroprevalence of C.  burnetii in bighorn sheep at a level of 10%. In Missouri (USA), blood samples from Boer goats were tested by ELISA and animal and herd‑level seroprevalence estimates for C.  burnetii were 1.2% and 4.2%, respectively (Baker and Pithua country, 14.39% of the examined Tibetan sheep were C. burnetii seropositive (Yin et al. 2015). In Korea, two separate studies in cattle showed a seroprevalence of C. burnetii of 1.3% (Jang et al. 2011) and 6.2% (Kim et  al. 2014). In Korea, the estimated seroprevalence in native goats was 19.1% (Jung et al. 2014). In Africa, summarized data on seroprevalence of C. burnetii in animals are shown in Table III. In Nigeria, an antibody prevalence of 59.8% was detected among 306 dairy cows (Adesiyun et  al. 1984). In Zimbabwe, serological evidence of Q fever infection was found in 39% of cattle and in 10% of goats (Kelly et  al. 1993). In South Africa’s Transvaal Province, 8,900 cattle were examined for antibodies to C. burnetii and 7.78% were found positive (Gummow et  al. 1987). In Cameroon, Q  fever in cattle had a seroprevalence of 31.3% (Scolamacchia et al. 2010). In Sudan, Hussein and colleagues (Hussein et  al. 2012) reported a C.  burnetii prevalence of 24.22% in caprine serum samples from 8 states. In Togo, Dean and colleagues (Dean et  al. 2013) reported a C.  burnetii seroprevalence of 14.8%, 14.4% and 8.3% in cattle, sheep and goats, respectively. In Chad, the seroprevalence was 4%, 11% and 13% in cattle, sheep and goats, respectively (Schelling et al. Table III. The serological prevalence of C. burnetii in domestic ruminants from published studies conducted in African countries. Country Year of study Animal species Number tested % positive Method Reference Animals (n) Herds (n) Animals Herds Cameroon 2000 cattle 13,377 146 31.3 68 ELISA Scolamacch et al. 2010 Chad 1999‑2000 cattle 195 ‑ 4 ‑ ELISA Schelling et al. 2003 1999‑2000 sheep 142 11 ‑ ELISA Schelling et al. 2003 1999‑2000 goat 134 ‑ 13 ELISA Schelling et al. 2003 ‑ goat 72 ‑ 16.8 ‑ IFA Mazyad and Hafez 2007 ‑ cattle 54 ‑ 13 ‑ ELISA Nahed and Khaled 2012 ‑ sheep 55 ‑ 32.7 ‑ ELISA Nahed and Khaled 2012 ‑ goat 30 ‑ 23.3 ‑ ELISA Nahed and Khaled 2012 Egypt ‑ sheep 89 ‑ 22.5 ‑ IFA Mazyad and Hafez 2007 2012‑2013 cattle 1,194 ‑ 13.2 ‑ ELISA Gwida et al. 2014 2012‑2013 cattle 1,194 9 13.2 100 ELISA Gwida et al. 2014 Gambia 2012 sheep 398 ‑ 18.5 ‑ ELISA Klaasen et al. 2014 2012 goat 490 ‑ 24.2 ‑ ELISA Klaasen et al. 2014 Japan 1982‑1991 cattle 562 ‑ 46.6 ‑ IFAT Htwe et al. 1992 1974‑1989 sheep 256 ‑ 28.1 ‑ IFAT Htwe et al. 1992 1974‑1989 goat 85 ‑ 23.5 ‑ IFAT Htwe et al. 1992 Nigeria ‑ cattle 306 ‑ 59.8 ‑ CAT Adesiyun et al. 1984 Transvaal 1985‑1986 cattle 8,900 ‑ 7.78 ‑ CFT Gummow et al. 1987 Sudan 2010‑2011 goat 460 ‑ 24.22 ‑ ELISA Hussien et al. 2012 Togo 2011 cattle 242 ‑ 14.8 ‑ ELISA Dean et al. 2013 2011 sheep 207 ‑ 14.4 ‑ ELISA Dean et al. 2013 2011 goat 198 ‑ 8.3 ‑ ELISA Dean et al. 2013 Zimbabwe ‑ cattle 180 ‑ 39 ‑ IFA Kelly et al. 1993 ‑ goat 180 ‑ 10 ‑ IFA Kelly et al. 1993 IFA = Indirect Immunofluorescence assay; IFAT = Indirect Fluorescent Antibody Test; ELISA = Enzyme Linked Immunosorbent assay; CFT = Complement Fixation test; MAT = Microagglutination test. 274 Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Coxiella burnetii in domestic ruminants Pexara et al. The seroprevalence was higher in dairy sheep (24.3%) than in meat sheep (10.2%). In the same study, 48.6% of farms had at least one seropositive sheep. In Australia (Queensland), in a study conducted by Cooper and colleagues (Cooper et al. 2011), 16.8% beef cattle were positive to C.  burnetii antibodies. In Mexico, the 28% of the dairy cattle, 10% of beef cattle, 40% of sheep and 35% of goats were seropositive (Salinas‑Malendez et  al. 2002). In Colombia, Lorbacher de Ruiz (Lorbacher de Ruiz 1977) found that 25% and 17% of tested dairy cows and beef cattle heifers, respectively, were seropositive. In Venezuela, a high seropositivity (60.23%) was recorded in goats belonging to herds with a history of high percentage of abortions (Oropeza et  al. 2010). In Ecuador, the prevalence of C. burnetii reached 12.6% with a herd prevalence of 46.9% (Carbonero et al. 2015). In Australia, extremely low prevalence values (0.67% and 0.5%) were recorded in cattle by Banazis and colleagues (Banazis et  al. 2010) and Hore and Kovesdy (Hore and Kovesdy 1972), respectively; 2014). In a study conducted in Washington State (USA), the results identified C.  burnetii antibodies in 8.0% of goat serum samples, 8.6% of goat herds, and 25.8% of counties (Sondgeroth et  al. 2013). In an epidemiological investigation of a Q  fever outbreak conducted in Washington, Montana, and Oregon (USA), Anderson and colleagues (Anderson et al. 2015) tested 567 goats from 17 herds finding a C. burnetii seroprevalence of 12%. In Canada (Newfoundland), 55.8% of the examined goats were seropositive to C.  burnetii (Hatchette et  al. 2001). In the same area of Canada, Hatchette and colleagues (Hatchette et  al. 2002) found that seropositivity increased in sheep from 3.1% in 1997 to 23.5% in 1999‑2000. They also observed a seroprevalence of C.  burnetii of 24% and 15.6% in examined cows and goats, respectively. In Canada (Ontario), the seroprevalence of C.  burnetii ranged between 33 and 82% in cattle herds and between 0 and 35% in sheep flocks (Martin and Innes 2002). Recently, also in Ontario, in a study conducted by Meadows and colleagues (Meadows et  al. 2015), 14.7% of sheep were found infected with C. burnetii. Table IV. The serological prevalence of C. burnetii in domestic ruminants from published studies conducted in countries of America and Oceania. Country Year of study Animal species Number tested % positive Method Reference Animals (n) Herds (n) Animals Herds AMERICA Canada 1997 sheep 234 ‑ 3.1 ‑ MIF Hatchette et al. 2002 1999 goat 147 ‑ 55.8 ‑ IFA Hatchette et al. 2001 2000‑2001 cattle 75 ‑ 24 ‑ MIF Hatchette et al. 2002 2000 sheep 34 ‑ 23.5 ‑ MIF Hatchette et al. 2002 2000 goat 64 ‑ 15.6 ‑ MIF Hatchette et al. 2002 2010‑2012 sheep 2,363 72 14.7 48.6 ELISA Meadows et al. 2015 Colombia ‑ cattle 357 ‑ 25 ‑ CFT Lorbacher de Ruiz 1977 ‑ cattle 125 ‑ 17 ‑ CFT Lorbacher de Ruiz 1977 Ecuador 2008‑2010 cattle 2,668 386 12.6 46.9 ELISA Carbonero et al. 2015 Mexico ‑ cattle NA ‑ 28 ‑ ELISA Salinas‑Malendez et al. 2002 ‑ cattle NA ‑ 10 ‑ ELISA Salinas‑Malendez et al. 2002 ‑ sheep NA ‑ 40 ‑ ELISA Salinas‑Malendez et al. 2002 ‑ goat NA ‑ 35 ‑ ELISA Salinas‑Malendez et al. 2002 USA (California) 1992 ‑1999 sheep 268 ‑ 10 ‑ CFT DeForge and Cone 2006 (Washington) 2010‑2011 goat 1794 105 8 8.6 ELISA Sondgeroth et al. 2013 (Missouri) 2012 goat 249 24 1.2 4.2 ELISA Baker and Pithua 2014 (Washington, Montana, and Oregon) goat 567 ‑ 12 ‑ ELISA Anderson et al. 2015 Venezuela ‑ goat 315 ‑ 60.63 ‑ ELISA Oropeza et al. 2010 OCEANIA Australia (Victoria) 1970 cattle 1576 49 0.5 12.2 CFT Hore and Kovesdy 1972 Australia (Western) NA cattle 329 ‑ 0.61 ‑ ELISA Banazis et al. 2010 NA sheep 50 ‑ 0 ‑ ELISA Banazis et al. 2010 New Zealand 1990‑1992 cattle 2181 ‑ 0 ‑ CFT Hilbink et al. 1993 IFA = Indirect Immunofluorescence assay; IFAT = Indirect Fluorescent Antibody Test; ELISA = Enzyme Linked Immunosorbent assay; CFT = Complement Fixation test; MAT = Microagglutination test. 275Veterinaria Italiana 2018, 54 (4), 265‑279. doi: 10.12834/VetIt.1113.6046.3 Pexara et al. Coxiella burnetii in domestic ruminants of domestic ruminants and, in particular, sheep and goats. Vaccination of domestic ruminants is reported to be effective in preventing abortion and reducing bacterial shedding, especially after several years of administration (Roest et  al. 2013). The implementation of good hygiene and other management practices including manure management and risk materials handling, may also reduce the environmental load and, in turn, may result in a decrease of C. burnetii human and animal infection (Roest et al. 2013). conversely, no seropositive sheep were found in 2009 (Banazis et  al. 2010). In New Zealand, in the study of Hilbink and colleagues (Hilbink et al. 1993), all tested animals were seronegative. In conclusion, despite the observed differences, a relatively high proportion of domestic ruminants has C.  burnetii antibodies worldwide. Effective control strategies are necessary to limit the impact of the zoonotic risk of Q  fever. 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