Pogosta disease (PD), an epidemic rash-arthritis occurring in late summer is caused by Sindbis virus (SINV) and is transmitted to humans by mosquitoes. Altogether 2183 PD cases were serologically confirmed 1981-96 in Finland, with an annual incidence of 2.7/100000 (18 in the most endemic area of Northern Karelia). The annual average was 136 (varying from 1 to 1282) with epidemics occurring in August-September with a 7-year interval. Studies on 6320 patients with suspected rubella (1973-89) revealed 107 PD cases. The depth of snow cover and the temperature in May-July seemed to predict the number of cases. The morbidity was highest in 45- to 65-year-old females and lowest in children. Subclinical SINV infections were 17 times more common than the clinical ones. The SINV-antibody prevalence in fertile-age females was 0.6% in 1992; the estimated seroprevalence in Finland is about 2%. Among game animals the tetraonids (black grouse and capercaillie) had the highest seroprevalence (65%) in the epidemic year of 1981.

This study presents data on 33,000 serum samples studied from July 1989 to June 1996 in Finland, with 6,701 serologically confirmed Puumala virus (PUU) infections. In addition, a PUU serosurvey of 8,000 sera from Finland is presented. On average, 957 PUU infections were detected annually, resulting in an incidence of 19/100,000; mortality was less than 0.1%. The infection was most common in the district of Ita-Savo with an incidence of 90/100,000. The seasonal peak was in November-December; however, the urban population had its incidence peak in August. Local epidemics mirrored bank vole densities, with 3-4-y cycles. Males contracted the disease at a mean age of 40 y, females at 44 y (male:female ratio 2:1). The disease was relatively rare in children and elderly people. The nationwide PUU antibody prevalence for women entering Finnish maternity clinics was 3%, suggesting 5% for the total population. The highest prevalences (7% for young women) were encountered in eastern Finland. In the district with the highest clinical alert, approximately 30% of all PUU infections were estimated to lead to clinical disease with serological confirmation.

The epidemiology of Pogosta disease is changing and practitioners should be better aware of it. Pogosta virus infection may lead to chronic musculoskeletal discomfort and arthritis.

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