title: Seroprevalence of tularemia in rural Azerbaijan.
abstract: A representative, two-stage probability sampling design was used to select 40 villages in northern Azerbaijan with populations of <500 people to screen for evidence of prior infection with Francisella tularensis. Informed consent was provided, and samples were obtained from 796 volunteers and tested for the presence of immunoglobulin G antibodies using enzyme-linked immunosorbent assay. F. tularensis seropositivity was prevalent (15.5% of volunteers), but there was minimal reporting of signs and symptoms consistent with clinical tularemia, suggesting that mild or asymptomatic infection commonly occurs. Frequently seeing rodents around the home was a risk factor for seropositivity (POR = 1.6, p = 0.03), controlling for age and gender. Geospatial analysis identified associations between village-level tularemia prevalence and suitable tick habitats, annual rainfall, precipitation in the driest quarter, and altitude. This study contributes to the growing understanding of the geographic distribution of tularemia and provides further information on the climatic and landscape conditions that increased the potential for exposure to this pathogen. The potential occurrence of asymptomatic or mild F. tularensis infection warrants further study.
authors.affiliation: Walter Reed Army Institute of Research, Silver Spring, Maryland 20009, USA. dvclark@gmail.com
authors.forename: Danielle V
authors.initials: DV
authors.lastname: Clark
authors.forename: Afrail
authors.initials: A
authors.lastname: Ismailov
authors.forename: Esmiralda
authors.initials: E
authors.lastname: Seyidova
authors.forename: Ayten
authors.initials: A
authors.lastname: Hajiyeva
authors.forename: Sevinj
authors.initials: S
authors.lastname: Bakhishova
authors.forename: Huseyn
authors.initials: H
authors.lastname: Hajiyev
authors.forename: Tahir
authors.initials: T
authors.lastname: Nuriyev
authors.forename: Saleh
authors.initials: S
authors.lastname: Piraliyev
authors.forename: Sadigulla
authors.initials: S
authors.lastname: Bagirov
authors.forename: Afag
authors.initials: A
authors.lastname: Aslanova
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Debes
authors.forename: Maqsud
authors.initials: M
authors.lastname: Qasimov
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hepburn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood*; D001096:Arachnid Vectors / Q000382:microbiology*; D058070:Asymptomatic Diseases; D001382:Azerbaijan / Q000453:epidemiology; D002980:Climate; D005260:Female; D005604:Francisella tularensis / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012377:Rodentia; D012424:Rural Population; D016036:Seroepidemiologic Studies; D013987:Ticks / Q000382:microbiology*; D014406:Tularemia / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G