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Peer-reviewedCC BYOpen forum infectious diseases

Nationwide Q Fever Hospitalizations in Italy, 2014-2023: Evidence of Underrecognition and a Sardinian Hotspot.

  • Daniel Cifo1,2
  • David González-Barrio3,4
  • Alberto Mateo-Urdiales5
  • Patrizio Pezzotti5
  • Alessandra Ciervo5
  • Angela Fanelli6,7
  • Alda Natale8
  • Diana Gómez-Barroso9,10
  • Rosa M Estévez-Reboredo9,10
10 affiliations
  1. 1Primary Care Research Unit, Madrid Health Service (SERMAS), Madrid, Spain.
  2. 2Biomedical Sciences and Public Health Doctorate Program, UNED - ENS Mixed Research Institute (IMIENS), Madrid, Spain.
  3. 3National Centre of Microbiology (ISCIII-CNM), Carlos III Health Institute, Madrid, Spain.
  4. 4Consortium for Biochemical Research in Infectious Diseases (CIBERINFEC), Madrid, Spain.
  5. 5Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy.
  6. 6European Commission, Joint Research Centre (JRC), Seville, Spain.
  7. 7Facultad de Veterinaria, Universidad Alfonso X el Sabio (UAX), Madrid, Spain.
  8. 8Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy.
  9. 9National Centre of Epidemiology (ISCIII-CNE), Carlos III Health Institute, Madrid, Spain.
  10. 10Consortium for Biochemical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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Abstract

Background

Q fever is a zoonotic disease caused by Coxiella burnetii. In Italy, serologic evidence shows exposure in humans and livestock, but surveillance data are sparse, and underreporting is likely. We aimed to characterize Q fever-related hospitalizations in Italy during 2014-2023 and examine environmental risk correlates.Method

We conducted a nationwide retrospective study using the Italian National Hospital Discharge Database. Hospitalizations with ICD-9-CM code 083.0 as primary or secondary diagnosis were included. We calculated hospitalization rates by age, sex, and region and described clinical characteristics. We linked hospitalizations with climatic, livestock, and land-use data; for Sardinia, we fitted Bayesian spatial regression models including bovine, ovine, and caprine density, temperature, precipitation, and land use.Results

We identified 428 hospitalizations (67% male), corresponding to a rate of 0.07 per 100 000 person-years. Rates were highest in children and older adults. The overall case fatality ratio was 2.4%. The most frequent Q fever-related concomitant diagnosis was pneumonia. Sardinia had the highest case count and adjusted hospitalization rate, 7-fold the national rate (0.55 vs 0.07). Spatial models for Sardinia showed hotspots in the north of the island and a 12% increase in spatial hospitalization risk per 10 bovine heads/km² (adjusted relative risk 1.12, 95% credible interval 1.03-1.24).Conclusions

Q fever causes an underrecognized burden of hospitalizations in Italy, with marked regional heterogeneity and a Sardinian hotspot associated with high cattle density areas. Clinical awareness, surveillance, and One Health interventions are warranted in high-risk areas.

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Cite

BibTeXRIS
BibTeX
@article{cifo2026nationwide,
  title = {{Nationwide Q Fever Hospitalizations in Italy, 2014-2023: Evidence of Underrecognition and a Sardinian Hotspot.}},
  author = {Daniel Cifo and David González-Barrio and Alberto Mateo-Urdiales and Patrizio Pezzotti and Alessandra Ciervo and Angela Fanelli and Alda Natale and Diana Gómez-Barroso and Rosa M Estévez-Reboredo},
  journal = {Open forum infectious diseases},
  year = {2026},
  month = oct,
  doi = {10.1093/ofid/ofag667},
  url = {https://europepmc.org/article/MED/42909273},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Nationwide Q Fever Hospitalizations in Italy, 2014-2023: Evidence of Underrecognition and a Sardinian Hotspot.
AU  - Daniel Cifo
AU  - David González-Barrio
AU  - Alberto Mateo-Urdiales
AU  - Patrizio Pezzotti
AU  - Alessandra Ciervo
AU  - Angela Fanelli
AU  - Alda Natale
AU  - Diana Gómez-Barroso
AU  - Rosa M Estévez-Reboredo
PY  - 2026
DA  - 2026/10/21
JO  - Open forum infectious diseases
DO  - 10.1093/ofid/ofag667
UR  - https://europepmc.org/article/MED/42909273
AB  - Background  Q fever is a zoonotic disease caused by Coxiella burnetii. In Italy, serologic evidence shows exposure in humans and livestock, but surveillance data are sparse, and underreporting is likely. We aimed to characterize Q fever-related hospitalizations in Italy during 2014-2023 and examine environmental risk correlates.Method  We conducted a nationwide retrospective study using the Italian National Hospital Discharge Database. Hospitalizations with ICD-9-CM code 083.0 as primary or secondary diagnosis were included. We calculated hospitalization rates by age, sex, and region and described clinical characteristics. We linked hospitalizations with climatic, livestock, and land-use data; for Sardinia, we fitted Bayesian spatial regression models including bovine, ovine, and caprine density, temperature, precipitation, and land use.Results  We identified 428 hospitalizations (67% male), corresponding to a rate of 0.07 per 100 000 person-years. Rates were highest in children and older adults. The overall case fatality ratio was 2.4%. The most frequent Q fever-related concomitant diagnosis was pneumonia. Sardinia had the highest case count and adjusted hospitalization rate, 7-fold the national rate (0.55 vs 0.07). Spatial models for Sardinia showed hotspots in the north of the island and a 12% increase in spatial hospitalization risk per 10 bovine heads/km² (adjusted relative risk 1.12, 95% credible interval 1.03-1.24).Conclusions  Q fever causes an underrecognized burden of hospitalizations in Italy, with marked regional heterogeneity and a Sardinian hotspot associated with high cattle density areas. Clinical awareness, surveillance, and One Health interventions are warranted in high-risk areas.
SN  - 2328-8957
ER  -