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    Bäckman, Stina Näslund, Jonas Forsman, Mats and Thelaus, Johanna 2015. Transmission of tularemia from a water source by transstadial maintenance in a mosquito vector. Scientific Reports, Vol. 5, p. 7793.

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    Afset, J Larssen, K Bergh, K Lärkeryd, A Sjödin, A Johansson, A and Forsman, M 2015. Phylogeographical pattern of Francisella tularensis in a nationwide outbreak of tularaemia in Norway, 2011. Eurosurveillance, Vol. 20, Issue. 19, p. 21125.

    Rossow, H Ollgren, J Hytönen, J Rissanen, H Huitu, O Henttonen, H Kuusi, M and Vapalahti, O 2015. Incidence and seroprevalence of tularaemia in Finland, 1995 to 2013: regional epidemics with cyclic pattern. Eurosurveillance, Vol. 20, Issue. 33, p. 21209.


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

  • H. ROSSOW (a1) (a2), J. OLLGREN (a3), P. KLEMETS (a3), I. PIETARINEN (a4), J. SAIKKU (a5), E. PEKKANEN (a3), S. NIKKARI (a2), H. SYRJÄLÄ (a6), M. KUUSI (a3) and J. P. NUORTI (a3) (a7)
  • DOI:
  • Published online: 02 December 2013

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.

Corresponding author
*Author for correspondence: Professor J. Pekka Nuorti, Department of Epidemiology, School of Health Sciences, FIN-33014, University of Tampere, Finland. (Email:
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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