{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:13:13Z","timestamp":1783660393916,"version":"3.55.0"},"reference-count":58,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vector-Borne and Zoonotic Diseases"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The largest documented outbreak of hemorrhagic fever with renal syndrome occurred in Primorje-Gorski Kotar County, Croatia, in 2021, marking the first-time cases of hantavirus infection recorded outside of the known endemic region in the north of the county.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To identify the factors contributing to the spread of the outbreak and to compare risk factors for acquiring hantavirus infection in the endemic and newly affected regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>\n                      A total of 189 cases were confirmed by positive Puumala IgM\/IgG antibodies (93.6%), and 13 probable cases were identified by clinical and epidemiological data (6.4%) using a structured questionnaire. Of the 179 cases with available clinical data, 59 (33.0%) were hospitalized. Three cases received hemodialysis, and no deaths were reported. Among 170 cases with information on exposures, 66 (38.8%) reported occupational risk. Cases in the northern part of county were more likely to have been infected in early spring (OR 27.1, 95% CI 2.93\u2013250.7), to report seeing a rodent (OR 6.5; 95%CI 2.3\u201318.4), and to know someone with hemorrhagic fever with renal syndrome (HFRS) (OR 3.0; 95%CI 1.2\u20138.0) than cases from the southern part of the county. Data from Croatian Forests Ltd. suggested that an unusually good production of beech seeds in 2020 may have contributed to an increased rodent population in 2021. However, average temperature, rainfall, and humidity data from 2021 did not illustrate a significant difference from previous years (Kruskal\u2013Wallis\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.837,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.999,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.108).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The 2021 HFRS outbreak was likely fueled by an abundant rodent population and virus transmission in rodent hosts. Human activity, environmental factors, and the ensuing animal\u2013human interactions have spread hantavirus infection from Croatia\u2019s mountainous region to a previously nonendemic coastal area with a Mediterranean climate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/vbz.2024.0032","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T05:04:25Z","timestamp":1720674265000},"page":"773-783","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Spread of Puumala Hantavirus to New Areas in a Large Croatian Outbreak of Hemorrhagic Fever with Renal Syndrome, 2021"],"prefix":"10.1177","volume":"24","author":[{"given":"Morana","family":"Tomljenovic","sequence":"first","affiliation":[{"name":"Department of Social Medicine and Epidemiology, Faculty of Medicine University of Rijeka, Rijeka, Croatia, Faculty of Medicine, Rijeka, Croatia."},{"name":"Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danijela","family":"Lakoseljac","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia."},{"name":"Department of Public Health, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucija","family":"Knezevic","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Batista","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Vilibic-Cavlek","sequence":"additional","affiliation":[{"name":"Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia."},{"name":"School of Medicine, University of Zagreb, Zagreb, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernad","family":"Kaic","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Croatian Institute of Public Health, Zagreb, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hansen","sequence":"additional","affiliation":[{"name":"Office of the Chief Science Officer, Office of the President, Public Health Agency of Canada, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oktavija \u0110akovic","family":"Rode","sequence":"additional","affiliation":[{"name":"Department of Virology, University Hospital for Infectious Diseases \u201cDr. Fran Mihaljevi\u0107\u201d, Zagreb, Croatia."},{"name":"School of Dental Medicine, University of Zagreb, Zagreb, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12291"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s007050050654"},{"key":"e_1_3_5_4_1","doi-asserted-by":"publisher","DOI":"10.3129\/8\/sl.140.9-10.2"},{"issue":"9","key":"e_1_3_5_5_1","first-page":"320","article-title":"Hemorrhagic fever with renal syndrome in Croatia: Incidence of infection in human and wild animal reservoirs","volume":"113","author":"Bor\u010di\u0107 B","year":"1991","unstructured":"Bor\u010di\u0107 B, , Turkovi\u0107 B, , Aleraj B, et al. 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