Page 139 - JSOM Summer 2018

antibody response was used as an indicator of previous in- were from various regions throughout the country, with 17%
fection. The primary objective of this study was to determine originating in Imereti in the west-central portion of the coun-
serologic evidence of exposure to 14 arthropod-borne and try (Figure 1; Table 1).
zoonotic infections prior to military recruitment and to deter-
mine the epidemiological risk factors associated with patho- FIGURE 1 Map of Georgia showing an outline of each 10
gen exposure. administrative division (region). (Adapted from d-maps.com. )

Materials and Methods

Study Site
The Military Hospital of the Ministry of Defense of Georgia
was chosen as the study site. This hospital is the primary treat-
ment center for the Georgian military and where all recruits
intending to serve in the Georgian Army undergo their pre-
recruitment medical assessment. Individuals were invited to
participate in the study at the time of this assessment. Enrolled
volunteers were required to be at least 18 years of age at the
time of enrollment and to agree to participate in this study by
signing an informed consent document.
TABLE 1 Demographic Characteristics of Volunteers in This
Data Collection Seroprevalence Study of Military Personnel, October 2014–
A questionnaire about previous illnesses and exposures to risk February 2016
factors was completed for each volunteer and 10mL of blood Characteristic No. (%) a
was collected for study purposes. All blood samples were col- Age, mean (SD), years 31.2 (7)
lected in anticoagulant-free tubes and stored at −20°C until Median 30
processing. Commercial enzyme-linked immunosorbent assays
(ELISAs) and immunofluorescence assays were used to evalu- Sex
ate each sample for antibody response to the pathogens under Male 978 (98)
study. 6,7 Female 18 (1.8)
Missing data 1 (0.1)
Pathogens Evaluated Regional distribution
Samples were tested serologically for antibody response to the Tbilisi 226 (23)
following pathogens: Bacillus anthracis, Brucella spp, Crimean Imereti 168 (17)
Congo hemorrhagic fever virus, Coxiella burnetii, Francisella Kvemo Kartli 109 (11)
tularensis, hantavirus, Rickettsia spp, tick-borne encephalitis Shida Karti 227 (23)
virus, Bartonella spp, Borrelia spp, Ehrlichia spp, Leptospira Kakheti 54 (5)
spp, S typhi, and WNV. C burnetii and B burgdorferi were
tested for at the Military Hospital; the rest of the assays were Samegrelo-Zemo Svaneti 97 (10)
performed by technologists at the National Center for Disease Ajara 44 (4)
Control and Public Health of Georgia. Other 72 (7)
Ethnicity
Statistical Analyses Georgian 983 (99)
Data were entered into an Epi Info database (Centers for Dis- Other 14 (1)
™
ease Control and Prevention, https://www.cdc.gov). Epi Info, Education
version 7, and SPSS, version 24 (IBM, https://www.ibm.com), Middle school 22 (3)
were used for data analysis. Odds ratios along with 95% con- High school 640 (64)
fidence intervals were calculated to estimate associations be-
tween risk factors and study outcomes by univariate logistic >High school 331 (33)
regression analysis. 8 SD, standard deviation.
Unless otherwise indicated.
a
Results ELISA-Based Seroprevalence
Table 2 lists seroprevalence rates of recorded in this study. The
Enrollment Demographics highest rate of seroprevalence was for S Typhi (23%).
From October 2014 to February 2016, a total of 1,000 re-
cruits were enrolled in this study. Most of the enrollees (98%) The lowest rates of seroprevalence were for C burnetii and
were male; the median age was 30 years (range, 18–52 years). WNV (0.6% and 0.8%, respectively). Approximately 1%
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Vector exposure was widespread, with 89% of the enrollees of the participants were seropositive for B burgdorferi, the
self-reporting being bitten by mosquitoes, 35% reporting ro- causative agent of Lyme disease, and about 4% were seropos-
dents in their houses, 8% reporting being bitten by fleas, 4% itive for either the spotted fever or the typhus group of the
reporting being bitten by ticks, and 1% reporting exposure Rickettsia spp. There was a seropositivity rate of 2.8% for
3
to lice. The largest number of enrollees were from the Shida- Leptospira spp and 5.7% for Bartonella spp; these organisms
Kartli region in central Georgia. The lowest number of en- are re-emerging bacterial pathogens that can result in severe
10
rollees came from the Racha Lechkhumi and Kvemo Svaneti life-threatening infections if left untreated. 3,11 Of the samples
region of northwestern Georgia, and the rest of the enrollees that were positive for agents that have been characterized as

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