Risk factors for pneumonic and ulceroglandular tularaemia in Finland: a population-based case-control study

Epidemiol Infect. 2014 Oct;142(10):2207-16. doi: 10.1017/S0950268813002999. Epub 2013 Dec 2.

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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Agriculture
  • Animals
  • Bayes Theorem
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Culicidae
  • Diptera
  • Epidemics*
  • Female
  • Finland / epidemiology
  • Humans
  • Infant
  • Insect Bites and Stings / epidemiology
  • Logistic Models
  • Lymphatic Diseases / epidemiology*
  • Lymphatic Diseases / etiology
  • Male
  • Middle Aged
  • Odds Ratio
  • Pneumonia / epidemiology*
  • Pneumonia / etiology
  • Risk Factors
  • Skin Ulcer / epidemiology*
  • Skin Ulcer / etiology
  • Tularemia / complications
  • Tularemia / epidemiology*
  • Young Adult