The Epidemiology and Clinical Burden of Q Fever in Saudi Arabia: Insights from Human and Animal Studies

Abstract

Background: Coxiella burnetii, the agent of Q fever, is a neglected but emerging zoonosis in Saudi Arabia, affecting both humans and animals. Despite sporadic reports, a comprehensive synthesis of epidemiology, clinical burden, diagnosis, and public health relevance remains lacking. Aim: This review aims to investigate the epidemiology and the burden of Q fever in Saudi Arabia and to propose control and prevention measures that could be applied in the region. Methods: We conducted a narrative review of published literature describing human and animal infections in Saudi Arabia, integrating epidemiological studies, clinical case reports, diagnostic approaches, and outbreak investigations. Sources included seroprevalence surveys, case series of endocarditis, molecular detection in livestock, wildlife, ticks and public health screening initiatives across the country. Results: Findings reveal widespread seropositivity in domestic and wild ruminants, with camels, sheep, and goats frequently implicated. Human cases range from acute febrile illness to chronic endocarditis, often in high-risk populations. Molecular diagnostics (e.g., PCR) and serological assays (IFA/ELISA) enhance detection but remain inconsistently applied. Major diagnostic delays and underreporting suggest true incidence may be substantially underestimated. Notably, few coordinated One Health surveillance programs exist, and veterinary–public health integration is in early stages. Conclusions: Q fever represents a significant but underrecognized public health threat in Saudi Arabia. Enhanced surveillance in livestock, clinician awareness, and standardised diagnostics are essential. A One Health approach, integrating animal and human health systems, is recommended to improve detection, control, and prevention of Q fever in the region.