Tularemia

What is tularemia?

Tularemia is a disease caused by a bacterium, Francisella tularensis, that infects both animals and people. Although infection occurs among many wild and domestic animals, the rabbit is most often involved in disease outbreaks. Tularemia is relatively rare in New York City. Since 2004, there have been two tularemia cases reported from Staten Island. One person became ill and was diagnosed with tularemia after a family dog killed a wild rabbit and brought the carcass home. In 2007, a Staten Island child was infected shortly after two tick bites.   

Who gets tularemia?

Hunters, hikers, or other people who spend a great deal of time outdoors and who may come in contact with wild animals and their carcasses or who may be bitten by infected ticks are at greater risk for exposure to this organism.

How is tularemia spread?

The common sources of exposure include inoculation of the skin or mucous membranes with blood or tissue while handling infected animals or meat from infected animals; being bitten by infected ticks or biting flies; and handling or eating insufficiently cooked rabbit meat. Less common means of spread include drinking contaminated water, inhaling dust from contaminated soil, or handling contaminated pelts or paws of animals. Human-to-human transmission does not occur.

What are the symptoms of tularemia?

The symptoms of tularemia depend on whether the bacteria enter through the skin, gastrointestinal tract, lungs, or eyes. Tularemia usually is recognized by the presence of a skin ulcer at the location where the bacteria entered the skin and swollen lymph nodes (glands). Swallowing the organism in food or water may produce a throat infection, abdominal pain, diarrhea, and vomiting. Inhalation of the organism may produce a pneumonia-like illness. If the organism infects the eyes, it can cause painful swelling of the lids, red eyes, and visual pain.

How is tularemia diagnosed?

Tularemia can be diagnosed by culturing the bacteria from blood, sputum, or wounds; however, it can be difficult to grow. It also can be diagnosed with antibody testing.

How soon after infection do symptoms appear?

Symptoms can appear within 1 to 14 days, with most occurring within 3 to 5 days.

What is the treatment for tularemia?

Certain antibiotics, such as streptomycin, gentamicin, doxycycline and ciprofloxacin are effective in treating tularemia.

Does past infection with tularemia make a person immune?

Most persons who have been infected with this organism will become immune to re-infection; however, re-infection has been occasionally reported in laboratory workers.

How can tularemia be prevented?

Rubber gloves, masks, and eye protection should be used when skinning or handling animal carcasses (especially rabbits). Wild rabbit and rodent meat should be cooked thoroughly before eating. Wells and other waters contaminated with dead animal carcasses should not be used. Insect repellants and long clothing should be used when walking through areas known to contain F. tularenis-infected deer flies and ticks.

Is tularemia a potential bioterrorist threat?

Tularemia has been weaponized in state-sponsored bioweapons programs and could, theoretically, be released as a bioterrorist agent.

What has New York City done to address the threat of tularemia?

Many federal, State, and City agencies-including the New York City Department of Health and Mental Hygiene (DOHMH)-have been working together for several years to prepare for the detection and response to a bioterrorist event in New York City. In cooperation with other emergency response agencies, DOHMH has established a comprehensive surveillance system to improve our ability to detect and respond to the release of a biological agent.

As part of this plan, the DOHMH continuously looks for any indication of bioterrorism in the City. DOHMH regularly asks all health-care providers in New York City to be alert for any unusual disease clusters, and to immediately report such occurrences to us. Additionally, several surveillance systems are in place to quickly detect an increase in unusual illnesses, including monitoring of 911-ambulance calls and emergency department visits. The response plan includes coordinating with OEM and other City, State, and federal agencies; alerting hospitals and the medical care community; communicating with the public; and ensuring that appropriate medical care and prevention services are provided.

Last updated July 2008