title: Survey and case-control study during epidemics of Puumala virus infection.
abstract: In Baden-Wuerttemberg, a federal state in south-west Germany, a large outbreak of 1089 laboratory-confirmed human Puumala virus (PUUV) infections occurred in 2007. We conducted a survey to describe the disease burden and a case-control study to identify risk factors for acquiring PUUV. Case-patients were interviewed about clinical outcome and both case-patients and randomly recruited controls were interviewed about exposure. We calculated matched odds ratios (mOR) using a conditional logistic regression model. Multivariable analysis of 191 matched case-control pairs showed that case-patients were more likely than controls to have seen small rodents/their droppings (mOR 1.9, 95% CI 1.2-3.0), cleaned utility rooms (mOR 1.8, 95% CI 1.0-3.4) and visited forest shelters (mOR 3.9, 95% CI 1.1-14.3). Two thirds of case-patients required hospitalization. During PUUV epidemics rodent control measures and use of protective equipment should be considered in utility rooms and shelters.
authors.affiliation: Baden-Wuerttemberg State Health Office, District Government Stuttgart, Germany.
authors.forename: C H
authors.initials: CH
authors.lastname: Winter
authors.forename: S O
authors.initials: SO
authors.lastname: Brockmann
authors.forename: I
authors.initials: I
authors.lastname: Piechotowski
authors.forename: K
authors.initials: K
authors.lastname: Alpers
authors.forename: M
authors.initials: M
authors.lastname: an der Heiden
authors.forename: J
authors.initials: J
authors.lastname: Koch
authors.forename: K
authors.initials: K
authors.lastname: Stark
authors.forename: G
authors.initials: G
authors.lastname: Pfaff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D005858:Germany / Q000453:epidemiology; D006480:Hemorrhagic Fever with Renal Syndrome / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029262:Puumala virus / Q000302:isolation & purification*; D012307:Risk Factors; D055815:Young Adult