Department of Public Health and Clinical Medicine Epidemiology and Global Health
Department of Clinical Microbiology Infectious Diseases
Umeå University, 2016
Umeå University Medical Dissertations, New Series No 1840
Towards the Limits -
Climate Change Aspects of Life and Health in Northern Sweden
Studies of tularemia and regional experiences of changes in the environment
Maria Furberg
Akademisk avhandling
som med vederbörligt tillstånd av Rektor vid Umeå universitet för avläggande av medicine doktorsexamen framläggs till offentligt försvar i Sal A, 9 trappor, byggnad 1D, Norrlands Universitetssjukhus.
Fredagen den 18 november, kl. 09:00.
Avhandlingen kommer att försvaras på svenska.
Fakultetsopponent: Professor, Peter Friberg
Avdelningen för molekylär och klinisk medicin, Sahlgrenska Akademin, Göteborgs Universitet
Göteborg, Sverige.
Organization Document type Date of publication
Umeå University Doctoral thesis 26 October 2016
Dept. of Public Health and Clinical Medicine, Epidemiology and Global Health Dept. of Clinical Microbiology, Infectious Diseases
Author
Maria Furberg
Title
Towards the limits – Climate Change Aspects of Life and Health in Northern Sweden Studies of tularemia and regional experiences of changes in the environment
Abstract
Infectious diseases and Indigenous peoples with traditional lifestyles are considered particularly vulnerable to climate change effects and the Arctic regions are experiencing the most rapid climate changes in the world. Climate change experiences among Sami reindeer herders in northern Sweden were investigated through a qualitative interview study. The results were then combined with instrumental weather data in a mixed- methods design for further elaboration. All 4792 reported cases of tularemia in Sweden 1984–2012 were analyzed and correlated to ecological regions and presence of inland water using geographical mapping. A case-control outbreak investigation of risk factors was performed in Norrbotten and Västerbotten, together with a serological survey to estimate the burden of disease including unreported cases in the population in the same region.
Extensive changes to the climate were observed in the studies with warmer winters, shorter snow cover season and diminishing cold periods. These changes pose a threat to reindeer herding. Weather data supported the observations: a two-month shorter snow cover season was seen and winter temperatures increased significantly, most
pronounced in the lowest temperatures. During the same time period a near tenfold increase in national incidence of tularemia was observed in Sweden with a clear overrepresentation of cases in the north versus the south. The incidence was positively correlated with the presence of inland water and higher than expected in the alpine and boreal ecologic regions. A dose-response relationship to water and mosquito bites was identified in the risk factor analyses. The prevalence of tularemia antibodies was 2.9%
corresponding to a 16 times higher number of cases than reported, indicating that the reported numbers represent only a minute fraction of the true tularemia occurrence.
Keywords
Climate change, public health, Indigenous peoples, Sami, reindeer herding, resilience, tularemia, mixed-methods, infectious diseases, seroprevalence, ELISA, outbreak investigation, risk factor, ecology, Francisella tularensis.
Language ISBN ISSN Number of pages
English 978-91-7601-552-0 0346-6612 50 + 4 papers
