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. 2020 Nov 5;7:558481. doi: 10.3389/fvets.2020.558481

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Copyright © 2020 Devaux, Osman, Million and Raoult.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Schematic representation of human Q fever around the Mediterranean. Left panel: map of the Mediterranean basin. The Mediterranean Sea is bordered by 22 riparian countries. The countries of the Northern Mediterranean coast are represented in dark blue, and the countries of the Southern Mediterranean coast are represented in tanned brown. Right panel: confirmed human Q fever cases per country during the period 2013 to 2017 according to the ECDC (21). Q fever surveillance report, 2017. Values between brackets indicate the average number of Q fever cases per 100,000 inhabitants per year over the 5 years period. Regarding Italy, no data were available for the years 2013, 2014, and 2015. The number of cases of Q fever for Israel over the period 2013 to 2017 was extrapolated from the data published by Yarrow and colleagues (111). ND, not determined. Human Q fever occurs mostly in the form of sporadic cases. Sometimes outbreaks of Q fever were reported in humans. The main epidemics of Q fever described during the last 40 years in people living on the Northern coast of the Mediterranean basin are as follows: 2003 (60 cases), 2004 (16 cases), 2014 (50 cases) in Spain; 1992 (40 cases), 1996 (204 cases), 2002 (126 cases), 2009 (50 cases), 2014 (46 cases) in France; 1993 (58 cases), 2003 (133 cases) in Italy; 2007 (33 cases) in Slovenia; 2004 (14 cases) in Croatia; 2007 (42 cases) in Albania; 2009 (58 cases) in Greece; and 2002 (19 cases) in Turkey. Human Q fever outbreaks are poorly documented concerning the countries of the Southern Mediterranean Sea coast. An epidemics of Q fever was described in 1955 in Algeria with 175 cases.