Tularemia in Kosovo
In April and May, 2000, an epidemiologist and ecologist from CDC joined a WHO-led investigation of an outbreak of tularemia among displaced persons returning to damaged homes and farms in rural Kosovo. The illness, which affected 500 to 1,000 people, was characterized by fever, severe sore throat, enlarged lymph nodes in the neck, and abscess formation.

The people who fled from Kosovo in March 1999 had left behind unharvested crops and homes with unprotected stocks of food. Over the following months, the local populations of field mice and domestic rats increased exponentially. Returning refugees became ill after ingesting food and water contaminated with rodent excrement and carcasses containing the bacteria Francisella tularensis. The epidemic was halted by instituting simple sanitation measures.

Louseborne Relapsing Fever in the Sudan
In April, 1999, epidemiologists from CDC assisted WHO in investigating an apparent outbreak of hemorrhagic fever in southern Sudan among seminomadic tribes displaced by famine, civil war, and intertribal strife. The causative agent proved to be the spirochete Borrelia recurrentis, which is transmitted by body lice. The outbreak affected about 20,000 people and caused about 2,000 deaths before the diagnosis was established and disease control measures were implemented.