Human Cases of Tularemia in Armenia, 1996–2012

Abstract

A retrospective analysis was conducted of human cases and outbreaks of tularemia in the Republic of Armenia from 1996 to 2012 utilizing geographic information system software. A total of 266 human cases of tularemia were recorded in Armenia from 1996 to 2012, with yearly incidence ranging from 0 to 5.5 cases per 100,000 people. Cases predominantly affected the male population (62.8%), 11-20 year age group (37.2%), agricultural workers (49.6%), and persons residing in rural areas (93.6%). In 2003, a waterborne outbreak involving 158 cases occurred in Kotayk Marz, and in 2007, a foodborne outbreak with 17 cases occurred in Gegharkunik Marz, attributed to exposure of food products to contaminated hay. Geospatial analysis of all cases showed that the majority were associated with the steppe vegetation zone, elevations between 1,400 and 2,300 m, and the climate zone associated with dry, warm summers, and cold winters. Characterization of these environmental factors were used to develop a predictive risk model to improve surveillance and outbreak response for tularemia in Armenia.

Epidemiological survey of tularemia in Ilam Province, west of Iran

“…According to the high prevalence of tularemia in the neighboring countries of Iran, including Azerbaijan [18], Armenia [25] and Turkey [26], and the high tularemia seroprevalence we found in the present and in previous studies, there is a high potential for human infections with F. tularensis occurring in different parts throughout the country. Therefore, tularemia should be considered as a differential diagnosis in patients suffering from infectious diseases that have compatible clinical manifestations.…”

Tularemi Salgını ve Sonrası; Mevsimsel Değişikliklerin Etkisi

“…Rusya'da (Russian Arctic) ise 1955-2000 yılları arasında yıllık ortalama sıcaklığın 1.2ºC arttığı ve 2007 yılından itibaren Arkhangelsk Bölgesindeki tularemi prevalansının sıcaklık artışına bağlı olarak 100.000'de 2'ye ulaştığı bildirilmiştir 17 . Ermenistan'da 2003 yılındaki su kaynaklı ve 2007 yılındaki gıda kaynaklı tularemi salgınları incelendiğinde, salgınların görüldüğü bölgelerin rakımının 1400-2300 m olduğu, salgınların kuru ve ılıman yaz ayları ve soğuk kış ayları ile ilişkili olduğu bildirilmiştir 18 . Alaska'da son 60 yılda yıllık ortalama sıcaklığın 1.6ºC arttığı ve iklim değişikliğinin etkisi ile kene ve kemiricilerin dağılımı ve sayısal artışı ile tularemi olgularının artmasının beklendiği belirtilmiştir 19 .…”

Erythema Nodosum: An Unusual Clinical Manifestation of Oropharyngeal Tularemia

“…As oropharyngeal tularemia is usually contracted via contaminated food and drinking water, surety of hygienic food and clean drinking water is a must to avoid an outbreak [ 3 ]. The occurrence of two outbreaks in the past (2003 and 2007) in Armenia indicates the presence of environmental factors that can lead to an epidemic [ 4 ]. Detected cases should also be reported to the concerned public health authority.…”

“…The Republic of Armenia considers tularemia a public health priority, as the disease is endemic across >90% of the country. Since 2001, 262 cases of tularemia have been reported in Armenia: 182 (69%) cases of glandular form, 8 (3%) anginal-bubonic, and 75 (28%) oculoglandular form with farmers (49.6%), and rural population (93.6%) being the most affected ones [ 4 ]. Oropharyngeal tularemia is typically characterized by fever, sore throat, mouth ulcers, and cervical buboes, and rarely, cutaneous lesions and other skin conditions.…”