[Hemorrhagic fever with renal syndrome in Bosnia and Herzegovina--history review till 1990].Acta Med Croatica. 2005; 59(4):303-6.AM
The first data on a disease that was clinically similar to hemorrhagic fever with renal syndrome (HFRS) in Bosnia and Herzegovina, date from 1952. Fifteen years later, an outbreak in the territory of Bosanska Krajina, turned to a great HFRS outbreak in the Sarajevo area. The outbreak was considered as the largest HFRS outbreak in Eastern Europe ever described. After that time, HFRS occurred mostly sporadically, or as small epidemics in 1970, 1975 and 1986. A new large epidemic was registered in 1989, again mostly affecting the population of the Sarajevo area. According to different data sources, 452 HFRS patients, 26 of them with lethal outcome, were recorded in Bosnia and Herzegovina. In addition, HFRS was recorded in 11 soldiers who were on military service in the territory of Bosnia and Herzegovina. According to the results of several field studies, it appears justifiable to assume that the true prevalence of the disease was higher than diagnosed and reported. The reason was probably our failure to recognize HFRS due to the variable clinical manifestation and significantly greater frequency of mild or atypical forms than of the typical form of the disease. This is supported by the fact that inapparent infections were proven in approximately 5% of the examined healthy persons living close to the focal areas. The disease and inapparent infection were mostly observed in the groups of active population. The infections were most common in rural regions among foresters and farmers. Appodemus flavicollis was the main reservoir of hantaviruses in Bosnia and Herzegovina till 1990, and transmission was mainly by aerosol in the conditions of fresh contamination of the environment with excretions and secretions of small mammals. The intensity of the epidemic process is directly correlated with the intensity of the epizootic process as well as with the extent of human population exposure.