title: Risk factors for pneumonic and ulceroglandular tularaemia in Finland: a population-based case-control study.
abstract: Few population-based data are available on factors associated with pneumonic and ulceroglandular type B tularaemia. We conducted a case-control study during a large epidemic in 2000. Laboratory-confirmed case patients were identified through active surveillance and matched control subjects (age, sex, residency) from the national population information system. Data were collected using a self-administered questionnaire. A conditional logistic regression model addressing missing data with Bayesian full-likelihood modelling included 227 case patients and 415 control subjects; reported mosquito bites [adjusted odds ratio (aOR) 9·2, 95% confidence interval (CI) 4·4-22, population-attributable risk (PAR) 82%] and farming activities (aOR 4·3, 95% CI 2·5-7·2, PAR 32%) were independently associated with ulceroglandular tularaemia, whereas exposure to hay dust (aOR 6·6, 95% CI 1·9-25·4, PAR 48%) was associated with pneumonic tularaemia. Although the bulk of tularaemia type B disease burden is attributable to mosquito bites, risk factors for ulceroglandular and pneumonic forms of tularaemia are different, enabling targeting of prevention efforts accordingly.
authors.affiliation: Department of Veterinary Biosciences, Faculty of Veterinary Medicine,University of Helsinki,Helsinki,Finland.
authors.forename: H
authors.initials: H
authors.lastname: Rossow
authors.affiliation: Department of Infectious Disease Surveillance and Control,National Institute for Health and Welfare (THL),Helsinki,Finland.
authors.forename: J
authors.initials: J
authors.lastname: Ollgren
authors.affiliation: Department of Infectious Disease Surveillance and Control,National Institute for Health and Welfare (THL),Helsinki,Finland.
authors.forename: P
authors.initials: P
authors.lastname: Klemets
authors.affiliation: Occupational Healthcare Services, Terveystalo Oulu, Oulu,Finland.
authors.forename: I
authors.initials: I
authors.lastname: Pietarinen
authors.affiliation: Etelä-Pohjanmaa Central Hospital, Seinäjoki,Finland.
authors.forename: J
authors.initials: J
authors.lastname: Saikku
authors.affiliation: Department of Infectious Disease Surveillance and Control,National Institute for Health and Welfare (THL),Helsinki,Finland.
authors.forename: E
authors.initials: E
authors.lastname: Pekkanen
authors.affiliation: Centre for Biothreat Preparedness, CB Defence and Environmental Health Centre,Finnish Defence Forces,Helsinki,Finland.
authors.forename: S
authors.initials: S
authors.lastname: Nikkari
authors.affiliation: Oulu University Hospital,Oulu,Finland.
authors.forename: H
authors.initials: H
authors.lastname: Syrjälä
authors.affiliation: Department of Infectious Disease Surveillance and Control,National Institute for Health and Welfare (THL),Helsinki,Finland.
authors.forename: M
authors.initials: M
authors.lastname: Kuusi
authors.affiliation: Department of Infectious Disease Surveillance and Control,National Institute for Health and Welfare (THL),Helsinki,Finland.
authors.forename: J P
authors.initials: JP
authors.lastname: Nuorti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000383:Agriculture; D000818:Animals; D001499:Bayes Theorem; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D009033:Culicidae; D004175:Diptera; D058872:Epidemics; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007299:Insect Bites and Stings / Q000453:epidemiology; D016015:Logistic Models; D008206:Lymphatic Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012883:Skin Ulcer / Q000453:epidemiology* / Q000209:etiology; D014406:Tularemia / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult