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.