title: Ecoepidemiology of tularemia in the southcentral United States.
abstract: We combined county-based data for tularemia incidence from 1990 to 2003 for a nine-state region (Arkansas, Illinois, Indiana, Kansas, Kentucky, Missouri, Nebraska, Oklahoma, and Tennessee) in the southcentral United States with Geographic Information System (GIS)-based environmental data to determine associations between coverage by different habitats (especially dry forest representing suitable tick habitat) and tularemia incidence. High-risk counties (> 1 case per 100,000 person-years) clustered in Arkansas-Missouri and far eastern Oklahoma and Kansas. County tularemia incidence was positively associated with coverage by dry forested habitat suitable for vector ticks for Oklahoma-Kansas-Nebraska and Arkansas-Missouri but not for Illinois-Indiana-Kentucky-Tennessee. A multivariate logistic regression model predicting presence of areas with risk of tularemia based on GIS-derived environmental data was developed for the Arkansas-Missouri tularemia focus. The study shows the potential for research on tularemia ecoepidemiology and highlights the need for further modeling efforts based on acarologic data and more fine-scale point or zip code/census tract epidemiologic data.
authors.affiliation: Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado 80522, USA. dyn2@cdc.gov
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Eisen
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mead
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Meyer
authors.forename: Liza E
authors.initials: LE
authors.lastname: Pfaff
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Bradley
authors.forename: Lars
authors.initials: L
authors.lastname: Eisen
mesh_terms: D000907:Antibodies, Bacterial / Q000032:analysis; D000942:Antigens, Bacterial / Q000032:analysis; D002487:Centers for Disease Control and Prevention, U.S.; D003710:Demography; D005604:Francisella tularensis / Q000276:immunology; D006801:Humans; D015994:Incidence; D012044:Regression Analysis; D015203:Reproducibility of Results; D014406:Tularemia / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial