title: Tularemia outbreak investigation in Kosovo: case control and environmental studies.
abstract: A large outbreak of tularemia occurred in Kosovo in the early postwar period, 1999-2000. Epidemiologic and environmental investigations were conducted to identify sources of infection, modes of transmission, and household risk factors. Case and control status was verified by enzyme-linked immunosorbent assay, Western blot, and microagglutination assay. A total of 327 serologically confirmed cases of tularemia pharyngitis and cervical lymphadenitis were identified in 21 of 29 Kosovo municipalities. Matched analysis of 46 case households and 76 control households suggested that infection was transmitted through contaminated food or water and that the source of infection was rodents. Environmental circumstances in war-torn Kosovo led to epizootic rodent tularemia and its spread to resettled rural populations living under circumstances of substandard housing, hygiene, and sanitation.
authors.affiliation: Institute of Public Health North Rhine-Westphalia, Muenster, Germany. ReintjesR@hotmail.com
authors.forename: Ralf
authors.initials: R
authors.lastname: Reintjes
authors.forename: Isuf
authors.initials: I
authors.lastname: Dedushaj
authors.forename: Ardiana
authors.initials: A
authors.lastname: Gjini
authors.forename: Tine Rikke
authors.initials: TR
authors.lastname: Jorgensen
authors.forename: Benvon
authors.initials: B
authors.lastname: Cotter
authors.forename: Alfons
authors.initials: A
authors.lastname: Lieftucht
authors.forename: Fortunato
authors.initials: F
authors.lastname: D'Ancona
authors.forename: David T
authors.initials: DT
authors.lastname: Dennis
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kosoy
authors.forename: Gjyle
authors.initials: G
authors.lastname: Mulliqi-Osmani
authors.forename: Roland
authors.initials: R
authors.lastname: Grunow
authors.forename: Ariana
authors.initials: A
authors.lastname: Kalaveshi
authors.forename: Luljeta
authors.initials: L
authors.lastname: Gashi
authors.forename: Isme
authors.initials: I
authors.lastname: Humolli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination / Q000032:analysis*; D005604:Francisella tularensis / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D006920:Hygiene; D007223:Infant; D008199:Lymphadenitis / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000453:epidemiology / Q000382:microbiology; D012307:Risk Factors; D012377:Rodentia; D016036:Seroepidemiologic Studies; D014406:Tularemia / Q000453:epidemiology* / Q000635:transmission; D014857:Warfare; D014871:Water Microbiology; D015022:Yugoslavia / Q000453:epidemiology