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. 2002 Jan;8(1):69-73.
doi: 10.3201/eid0801.010131.

Tularemia outbreak investigation in Kosovo: case control and environmental studies

Ralf Reintjes  1 , Isuf Dedushaj, Ardiana Gjini, Tine Rikke Jorgensen, Benvon Cotter, Alfons Lieftucht, Fortunato D'Ancona, David T Dennis, Michael A Kosoy, Gjyle Mulliqi-Osmani, Roland Grunow, Ariana Kalaveshi, Luljeta Gashi, Isme Humolli
Affiliations

Tularemia outbreak investigation in Kosovo: case control and environmental studies

Ralf Reintjes et al. Emerg Infect Dis. 2002 Jan.

Abstract

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.

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Figures

Figure 1
Figure 1
Girl with ulcerating lymphadenitis colli due to tularemia, Kosovo, April 2000.
Figure 2
Figure 2
Total number of confirmed tularemia cases in Kosovo by municipality, July 1999-May 2000. Unshaded areas are Serb minority municipalities from which no data were available.
Figure 3
Figure 3
Epidemic curve of laboratory-confirmed tularemia cases (n = 247) in Kosovo, by month of onset of symptoms, October 1999- May 2000.
See this image and copyright information in PMC

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