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In June 2005 Coxiella burnetii-infected sheep, grazing and lambing on a meadow bordering a residential area, caused a large Q fever outbreak (331 cases) in Germany. Our outbreak investigation provided attack rates (AR) by distance between residence and meadow, sex and age groups. The AR of people living within 50 m of the meadow was 11.8%. It decreased the further the residence was from the meadow, falling to 1.3% at 350-400 m distance (RR 8.7, 95% CI 4.5-17.1). The AR was higher in men (RR 1.4, 95% CI 1.1-1.8). In the 25-64 years age group, the AR was 2.3 times higher compared to other age groups (95% CI 1.7-3.0). The distance-related AR showed a relationship between risk of infection and living close to the meadow. Ongoing urbanization will probably lead to further Q fever outbreaks, hence prevention activities undertaken by animal and public health practitioners should be aligned and strengthened.

Large Q fever outbreak due to sheep farming near residential areas, Germany, 2005