Since 2007, the Netherlands is faced with the largest
outbreak of Q fever ever reported. In the last four
years, over 4000 cases have been reported. The course
of the epidemic and possible factors associated with
this sudden surge in cases of Q fever is described and
the preventive measures in the veterinary sector and
the outbreak management of this unique epidemic are
summarised. Finally, the latest data on clinical presentation and diagnostic and therapeutic dilemmas of Q fever in the Netherlands are reviewed.