Tularemia Seroprevalence in Humans in the Region of the Hittite-Arzawa War (Inner Aegean Region), Where the First Biological Weapon Was Used 3300 Years Ago

Abstract

Background: According to Egyptian records, tularemia emerged in the Canaan region, where it was first identified and spread to Anatolia over the Euphrates. It was used as an active biological weapon for the first time in the Hittite-Arzawa War in 1320-1318 BC. This study aimed to investigate the seroprevalence of tularemia in the Inner Aegean Region, which is thought to be the regions where this war was fought 3300 years ago. Methods: Tularemia seropositivity in humans was investigated in 27 villages/neighborhoods in 3 districts in each of Manisa, Kutahya, and Usak provinces. Before the study, the participants were informed about the disease via posters, and their blood samples were taken following filling out the questionnaire. Sera were separated from the blood on the same day and stored in a suitable environment until the tests were performed. Microagglutination tests were performed using in-house tularemia antigen and V plate for serological experiments. Rose-Bengal test was also performed on seropositive sera. Results: Of the total 410 people, 226 (55·12%) were male. The mean age of the volunteers was 43·72. Among the age groups of those who volunteered to participate in the study, the most participation was 61 years and over. The most participation was from Kutahya province. According to the results of the tularemia microagglutination test, seropositivity was detected in 6 cases. It was determined that all of the seropositive volunteers were in Kutahya. When the tularemia antibody titers were examined, seropositivity was determined at 1/20-1/160 titers. No positivity was detected in the Rose-Bengal test for cross-reaction. Interpretation: Kutahya has been identified as a risky region in terms of tularemia in the Inner Aegean Region. In order to use the resources in the country economically, first of all, the risk areas in terms of tularemia should be determined by serological studies in all regions. In order to increase awareness about the disease, physicians and filiation teams should be trained in risky areas. Surveillance studies should be conducted to identify and monitor possible sources in areas identified as risky. Funding Information: Trakya University Scientific Research Projects Commission Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was carried out with the approval of the Trakya University Scientific Research Ethics Committee dated 13/04/2020 and numbered TUTF-BAEK 2019/381 and the support of the Trakya University Scientific Research Projects Commission (TUBAP) project numbered 2020/121.