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Original Articles
Spatial analysis of human Coxiella burnetii infection and populations of goat and cattle in Korea, 2015-2024
Seung-Bum Kang, Dae Sung Yoo
Epidemiol Health. 2025;47:e2025068.   Published online December 9, 2025
DOI: https://doi.org/10.4178/epih.e2025068
  • 2,557 View
  • 85 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Q fever is a bacterial zoonosis that occurs worldwide. Although several studies have reported associations between goat populations and human Q fever outbreaks in Korea, spatial correlation analyses remain limited. Therefore, this study examined the geographic correlation between human Q fever outbreaks and the distributions of goats and cattle in Korea.
METHODS
This study covered a 10-year period (2015-2024), using each of the 250 districts in Korea as the unit of analysis. Data were divided into 2 time periods: 2015-2019 and 2020-2024. Hotspots for the standardized incidence ratio (SIR) were identified using Getis-Ord Gi*. Spatial correlations between SIR and goat and cattle populations were evaluated using a multivariable spatial error model, and the associations between hotspot variables and livestock abundance were assessed using a multivariable Leroux conditional autoregressive model.
RESULTS
SIRs for human Q fever showed significant positive spatial associations with goat populations in 2016 (coefficient=46.52, p<0.01) and 2021 (coefficient=70.97, p<0.01). The associations between goat populations (2016 and 2021) and hotspot classifications were consistent across both periods, with the odds ratio increasing from 1.87 (95% credible interval [CrI], 1.23 to 2.85) in 2015-2019 to 2.33 (95% CrI, 1.55 to 3.64) in 2020-2024. No significant associations were observed between human Q fever and cattle populations.
CONCLUSIONS
Goat populations are becoming more strongly spatially correlated with human Q fever incidence. These findings underscore the need for enhanced preventive management of goat farms to mitigate future outbreaks.
Summary
Korean summary
본 연구는 2015~2024년 국내 사람 큐열 발생과 가축 개체수 간의 공간적 상관관계를 분석한 최초의 연구이다. 분석 결과, 사람 큐열 발생은 염소 개체수와 유의한 양의 상관관계를 보였으며 그 연관성은 최근 더욱 강화된 반면, 소 개체수와는 유의미한 연관성이 나타나지 않았다. 이는 향후 인수공통감염병 발생 억제를 위해 염소 농가에 특화된 예방적 관리와 방역 교육이 필수적임을 시사한다.
Key Message
This study is the first to analyze the spatial correlation between human Q fever outbreaks and livestock populations in South Korea from 2015 to 2024. The results reveal a significant positive spatial association between human Q fever incidence and goat populations, which strengthened over the 10-year period, whereas no such correlation was found with cattle. These findings highlight the urgent need for enhanced preventive management and biosecurity education specifically for goat farms to mitigate future zoonotic outbreak.
Risk factors for Q fever incidence in Korea: a comparative analysis using frequentist and Bayesian methods
Ji-Hyun Son, Sung-Dae Park
Epidemiol Health. 2025;47:e2025046.   Published online August 20, 2025
DOI: https://doi.org/10.4178/epih.e2025046
  • 4,153 View
  • 75 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study investigated the principal determinants of human Q fever incidence and explored regional variation between metropolitan cities and provinces in Korea.
METHODS
Panel data on human Q fever incidence, livestock populations, and facility metrics were collected across 17 metropolitan cities and provinces from 2017 to 2024. Analytical approaches included frequentist models (ordinary least squares [OLS], random effects [RE], fixed effects [FE]) and Bayesian models.
RESULTS
Frequentist panel analysis indicated that slaughterhouse count was positively associated with Q fever incidence in both pooled OLS (β=1.20, p<0.001) and RE models (β=1.03, p<0.001), but not in the FE model (β=0.14, p=0.65). After correcting for serial correlation using Driscoll-Kraay standard errors, livestock population (β=0.55, p<0.01), livestock market count (β=-2.01, p<0.05), and livestock Q fever cases (β=-0.11, p<0.01) were significantly associated with human incidence. A Bayesian FE model confirmed a significant relationship between slaughterhouses and human Q fever incidence (posterior mean: 0.87; 95% credible interval [CrI], 0.21 to 1.42), providing more stable inference with limited samples and allowing probabilistic uncertainty estimation. A Bayesian hierarchical model revealed a stronger association in metropolitan cities (posterior mean, 1.46; 95% CrI, 0.34 to 2.57) than in provinces (1.22), while livestock population remained significant in provinces (0.94; 95% CrI, 0.15 to 1.74).
CONCLUSIONS
In Korea, slaughterhouse density was the main determinant of Q fever in metropolitan cities and livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies and reinforce the value of a One Health approach.
Summary
Korean summary
본 연구는 대한민국 내 큐열(Q fever) 발생의 주요 위험 요인이 지역별로 다르다는 것을 규명하였다. 광역시(metropolitan cities)에서는 도축장 밀도가, 도(provinces)에서는 가축 사육 밀도가 사람에서 큐열 발생의 주된 위험 요인으로 확인되었다. 이러한 결과는 사람, 동물, 환경의 건강을 통합적으로 고려하는 원헬스(One Health) 접근법에 기반하여 각 지역 특성에 맞는 예방 전략이 필요함을 강조한다.
Key Message
This study identified that the primary risk factors for Q fever in Korea vary by region. Slaughterhouse density was the main determinant of human Q fever incidence in metropolitan cities, whereas livestock density was the primary risk factor in provinces. These findings underscore the need for region-specific preventive strategies based on a One Health approach, which integrally considers human, animal, and environmental health.
Systematic Review
The prevalence of Q fever in the Eastern Mediterranean region: a systematic review and meta-analysis
Mozhgan Ahmadinezhad, Leila Mounesan, Amin Doosti-Irani, Manijeh Yousefi Behzadi
Epidemiol Health. 2022;44:e2022097.   Published online October 28, 2022
DOI: https://doi.org/10.4178/epih.e2022097
  • 28,206 View
  • 211 Download
  • 14 Web of Science
  • 16 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the first systematic review and meta-analysis on its prevalence in humans, animals, and ticks in the Eastern Mediterranean region.
METHODS
Major Iranian and international databases were searched from 2000 to 2021. We extracted the prevalence of Q fever in blood samples from animals and milk samples from animals, ticks, and humans as the main outcome. We reported the prevalence of seropositivity and molecular positivity as point estimates and 95% confidence intervals (CIs).
RESULTS
In this review, 112 papers were identified. The overall seroprevalence of Q fever was 22.4% (95% CI, 19.8 to 25.1). The pooled prevalence of Q fever in ticks was 17.5% (95% CI, -1.3 to 36.4). The prevalence was 25.5% (95% CI, 16.1 to 34.9) in humans. The prevalence of Q fever in animal blood samples from goats, sheep, camels, cattle, cats, dogs, horses, and buffalo were 28.1%, 25.1%, 25.0%, 20.1%, 9.8%, 8.4%, 6.5%, and 6.3%, respectively. Furthermore, the prevalence of Q fever in milk samples of animals was higher in cattle (20.3%) than in sheep (20.0%), goats (16.4%), and camels (3.3%).
CONCLUSIONS
Coxiella burnetii infections are common in humans and in a wide range of animal species, but they are still not recognized in many countries in the Eastern Mediterranean region, thus presenting a significant threat to human and animal health in the region.
Summary

Citations

Citations to this article as recorded by  
  • Acute Q Fever Presenting with Severe Cholestatic Jaundice and Acute Kidney Injury in the Absence of Classic Exposure: A Rare Case Report
    Karim Zodeh, Tya Youssef, Philippe Attieh, Mahmoud Othman
    Clinical Medicine Insights: Case Reports.2026;[Epub]     CrossRef
  • Nationwide serological, molecular, and spatial assessment of Q fever in dromedary camels (Camelus dromedarius) in Jordan: A One Health perspective
    Ruba Alomari, Majid Hawawsheh, Shahin Baiomy, Nacira Ramdani
    Veterinary World.2026; : 678.     CrossRef
  • Occurrence of viral and bacterial pathogens in South American camelids in representative German flocks
    Christian Menge, Stefanie A. Barth, Eva-Maria Bartl, Christian Berens, Christa Ewers, Carsten Heydel, Hannah Hümmelchen, Heike Köhler, Patricia König, Alina Leisen, Svenja Mamerow, Falk Melzer, Katja Mertens-Scholz, Ulrich Methner, Aung Zaw Moe, Dennis Ru
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  • Seroprevalence of Q fever among humans and animals in East Africa: a systematic review and meta-analysis
    Simegnew Adugna Kallu, Ambachew Motbaynor Wubaye, Simachew Getaneh Endalamew, Andnet Yirga Assefa, Alebachew Tilahun Wassie, Migbaru Keffale Bezabih, Yihenew Getahun Ambaw
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  • Benchmarking Q fever transmission in czech republic and serbia: A one health sub-national population study
    Ondřej Holý, Sara Savić, Jaroslav Bzdil, Jeadran Malagon, Ekaterina Ryzhova, Hana Dostálová, Michal Křupka, Tatjana Pustahija, Dejan Bugarski, Tereza Schovánková, Laith Hussain-Alkhateeb, Snežana Medić
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    Md Mazharul Islam, Pronesh Dutta, Devendra Bansal, Gyanendra Gongal, Elmoubashar Farag, Ricardo J. Soares Magalhaes, John I. Alawneh, Jane Heller, Mohammad Mahmudul Hassan, Serafeim C. Chaintoutis
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    Mohamud Sheek-Hussein, Aboma Zewude, Aminu S. Abdullahi, Nabeeha Hassan Abdelgaleel, Hassan Zackaria Ali Ishag, Mohd Farouk Yusof, Mohammed Saleh ALBreiki, Asma Mohamed Abdi Shah, Jamila AlNeyadi, Babiker Osman, Amir Abdullah Hassen, Mervat Mari Al Nuaima
    Scientific Reports.2025;[Epub]     CrossRef
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    Cinzia Santucciu, Maria Paola Giordo, Antonio Tanda, Giovanna Chessa, Matilde Senes, Gabriella Masu, Giovanna Masala, Valentina Chisu
    Pathogens.2025; 14(8): 790.     CrossRef
  • Prevalence of Acute Q Fever Among High‐Risk Patients With Fever and Pneumonia Symptoms in Western Iran
    Amjad Ahmadi, Rasool Nasiri Kalmarzi, Behzad Mohsenpour, Parisa Esmaeili, Mina Latifian, Ahmad Ghasemi, Rashid Ramazanzadeh, Himen Salimizand, Daem Roshani, Saber Esameili, Ehsan Mostafavi, Rajib Chowdhury
    Journal of Tropical Medicine.2025;[Epub]     CrossRef
  • Prevalence, Risk Factors, and Relationship between Reproductive Performance and the Presence of Antibodies against Coxiellosis in Dairy Farm Milk Tanks in the Northwest of Spain
    Uxía Yáñez, Jacobo Álvarez, Cristina Pisón, Antía Acción, Juan J. Becerra, Antonio Jiménez, Philippe Gisbert, Pedro G. Herradón, Ana I. Peña, Alberto Prieto, José M. Díaz-Cao, Luis A. Quintela
    Animals.2024; 14(3): 367.     CrossRef
  • Molecular detection of Coxiella burnetii in tick and blood samples from small ruminants in northwest of Iran
    Ahmad Enferadi Ghazanabad, Negin Esfandiari, Mohammadreza Najafi, Shahryar Mehrabi, Saeedeh Sarani, Peyman Khademi, Max Maurin
    Experimental and Applied Acarology.2024; 92(3): 529.     CrossRef
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    Md Ahaduzzaman, Md Moktadir Billah Reza
    Veterinary Medicine and Science.2024;[Epub]     CrossRef
  • Two Cases of Acute Q Fever Diagnosed by mNGS and Literature Review
    娇 罗
    Advances in Clinical Medicine.2023; 13(07): 12005.     CrossRef
  • Zoonotic diseases transmitted from the camels
    Abdelmalik Ibrahim Khalafalla
    Frontiers in Veterinary Science.2023;[Epub]     CrossRef
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    Nick Wheelhouse, Richard Vazquez, Lorenzo Viora, Jo E. B. Halliday
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Original Articles
Fever screening and detection of febrile arrivals at an international airport in Korea: association among self-reported fever, infrared thermal camera scanning, and tympanic temperature
Kyung Sook Cho, Jangho Yoon
Epidemiol Health. 2014;36:e2014004.   Published online May 30, 2014
DOI: https://doi.org/10.4178/epih/e2014004
  • 43,394 View
  • 197 Download
  • 30 Web of Science
  • 26 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The purpose of this research was to measure fever prevalence and the effectiveness of a fever screening procedure in detecting febrile arrivals at an international airport in Korea.
METHODS
Data were retrieved from arrivals’ health declaration forms and questionnaires for febrile arrivals at an international airport collected by a national quarantine station during the year 2012. Self-reported health declaration forms were returned by 355,887 arrivals (61% of the total arrivals). Of these, 608 symptomatic arrivals (0.2%) including 6 febrile arrivals were analyzed.
RESULTS
Fever prevalence at an international airport in Korea was 0.002%. Self-reported fever was significantly positively associated with tympanic temperature (p<0.001). The difference between the thermal camera temperature (36.83°C) and tympanic (or ear) temperature (38.14°C) was not statistically significant.
CONCLUSIONS
The findings imply that a procedure for mass detection of fever such as self-reported questionnaires and thermal camera scanning may serve as an effective tool for detecting febrile arrivals at quarantine stations. Future research can benefit from looking at the sensitivity, specificity, positive predictive value, and negative predictive value of the entry screening system.
Summary
Korean summary
2003년 전 세계적인 SARS 대 유행 이후, 우리나라는 증상을 자가보고 하도록 하는 검역질문서, 열감지 카메라를 통한 체온 측정, 고막체온 측정 등과 같은 검역절차들이 상호 유기적으로 작용할 수 있도록 검역체계를 강화해 왔다. 그러나 이러한 검역절차들이 얼마나 효과적으로 작용하고 있는지, 그리고 이를 통해 실제로 발열환자가 얼마나 발견되고 있는지에 대한 연구는 전무하였다. 그러한 점에서 본 연구는 이러한 연구 질문에 대한 우리나라 최초의 시도로서, 검역 행정뿐만 아니라 향후 보다 발전된 후속 연구를 위한 기초자료로도 활용될 수 있을 것이다.

Citations

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Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003.
Hyun Sul Lim, Young Sun Min, Kwan Lee, Sang Hyuk Lim
Korean J Epidemiol. 2004;26(1):59-68.
  • 9,261 View
  • 28 Download
AbstractAbstract PDF
Abstract
Epidemiologic Investigation into an Outbreak of Typhoid Fever Recognized by Electronic Data Interchange in Gyeongsangbuk-do, 2003 PURPOSE: Fourteen cases of typhoid fever occurred in Gyeongsan-si, Gyeongsangbuk-do from May 22 to July 19, 2003. Especially, 6 cases were students of Y University located in Gyeongsan-si. This investigation was carried out to study the infection source and transmission of typhoid fever and to institute an effective prevention counterplan.
METHODS
The authors conducted an epidemiologic survey from June 25, 2003 among the 14 cases, restaurants and employees of the whole neighborhood of Y University. Widal test was carried out for the restaurant employees and schoolmates of the 13-year-old case Miss Kim. The authors executed a pulsed field gel electrophoresis (PFGE) for Salmonella typhi cultured from 9 cases. The authors collected data about chloride and turbid levels of treated water from April to June in Gyeongsan-si water treatment plant and repair work records of waterworks pipe line in Gyeongsan-si city hall.
RESULTS
All cases had used restaurants of the whole neighborhood of Y University within 2 months before the typhoid fever symptoms were developed, but the restaurant that was rarely visited by any of the patients had a case to be matched. In the results of the Widal test, 9 out of 45 of subjects (20.0%) were suspicious cases or showed a value to suggest past infection. In the results of PFGE test, there were 3 subtypes, and each subtype had a similar DNA fragments array. In all cases the patients drank tap water when they visited the restaurants. The restaurants provided drinking water from filtered tap water rather than boiled water, and all patients had drunk this water. The chlorine level of the treated water was the normal value in the Gyeongsan-si water treatment plant, but in 2 times the value was the minimum standard level. There was water pipe construction work in some regions of the whole neighborhood of Y University. The number of gastrointestinal patients in 2003 was approximately 2 times that in 2002 at the health center in Y University.
CONCLUSIONS
The possibility that typhoid fever was generated in the whole neighborhood of Y University is very high. Among various possibilities, the highest possibility is the pollution of tap water intake by water leakage of a water pipe. There was no case of patient infection after strengthening of the tap water disinfection. Thorough disinfection, boiled drinking water and a periodic carrier inspection are necessary to prevent additional local occurrences of these typhoid infections.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.
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