Tularemia outbreak investigation in Kosovo: case control and environmental studies.
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.
Reintjes
Ralf
R
Institute of Public Health North Rhine-Westphalia, Muenster, Germany. ReintjesR@hotmail.com
Dedushaj
Isuf
I
Gjini
Ardiana
A
Jorgensen
Tine Rikke
TR
Cotter
Benvon
B
Lieftucht
Alfons
A
D'Ancona
Fortunato
F
Dennis
David T
DT
Kosoy
Michael A
MA
Mulliqi-Osmani
Gjyle
G
Grunow
Roland
R
Kalaveshi
Ariana
A
Gashi
Luljeta
L
Humolli
Isme
I
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