A systematic knowledge synthesis on the spatial dimensions of Q fever epidemics.

"see supporting information data s1 and s2 for a full description of the search queries and criteria.; the first search strategy yielded 234 publications (see supporting information data s1 and table s1 ).; the majority of these (67%) described various (small-scale) outbreaks amongst humans that had occurred worldwide of which half discussed the dutch q fever outbreak (see supporting information data s2 ) 3 3 1 until 2007 q fever cases were notified sporadically in the netherlands (karagiannis et al 2009 ).; in 2012 a study was performed at five goat farms of which three were affected by the culling measures2 years earlier (see supporting information data s3 ).; see supporting information data s4 for further recommendations on this.; due to a lack of information on top of a complex situation retrospective assessment of herd-to-herd transmission during the dutch q fever outbreak was hampered (see supporting information data s4 for recommendations on data collection).; therefore we recommend to collect as soon as there is suspicion of an outbreak within a farm besides veterinary samples also already environmental samples (see also supporting information data s4 ).; to increase knowledge on viability combination of qpcr analyses with methods to assess viability is recommended (see supporting information data s4 )."

"CONFLICT OF INTEREST No conflict of interests to declare."

"We thank Dr. Christianne Bruschke, Prof. Dr. Roel Coutinho, Dr. Hendrik‐Jan Roest, Dr. Yvonne van Duijnhoven, Dr. Wim van der Hoek, Drs. Stasja Valkenburgh and Drs. Stephanie Wiessenhaan for their critical input. The study was financially supported through a research grant of ZonMW (project number 50‐51800‐98‐035)."