Q Fever in Africa: A Systematic Review of Prevalence, Zoonotic Potential and Disease Burden

Q fever, caused by Coxiella burnetii, is increasingly recognised in Africa, though its burden remains underestimated due to limited surveillance and underreporting. Reliable prevalence and epidemiological data are crucial for understanding the disease's distribution, identifying high-risk populations and developing effective control strategies, necessitating this systematic review.

The review protocol is registered in prospectively registered systematic reviews (PROSPERO) (ID: CRD42025625366). Research questions and inclusion/exclusion criteria were developed using the condition, context and population (CoCoPop) framework. Relevant articles from 2004 to 2024 were sourced from PubMed, Web of Science, Science Direct and Google Scholar. Data were extracted using the Kobo Toolbox, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess risk of bias. Descriptive analyses were conducted using R, and findings are presented in narrative form, with supporting tables and figures.

The review identified 136 articles which focused on domestic animals (66.9%), humans (33.1%), arthropods (25.0%) and wildlife (10.3%). Mean molecular prevalence varied among hosts as follows: goats (7.28% ± 8.84%), sheep (9.88% ± 11.95%) and cattle (8.20% ± 9.73%). Seroprevalence rates were higher, with camels showing the highest at 31.68% (standard deviation [SD] = 26.14). None of the studies addressed the economic burden of Q fever on human health and livestock production.

This review highlights the prevalence of Q fever across Africa. It suggests the persistence of the disease is driven by a complex interplay among diverse host species, with livestock as the primary source of human infections. Findings emphasise the need for a One Health approach in all surveillance and for assessing the economic impacts of C. burnetii to effectively target and control the disease.