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Public Health Emergency Network


Tularemia

What is a tularemia?
Tularemia is a disease caused by a bacterium, Francisella tularensis, which infects both animals and people. Although infection occurs among many wild and domestic animals, rabbits are 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. In 2008, a Brooklyn man was infected when camping overnight in a wetland area. A Manhattan woman was probably infected in 2009 when visiting Europe.

What are the different types of tularemia?
Pneumonic tularemia (lung) occurs when tularemia bacteria are inhaled into the lungs. Flu-like illness, with fever, headache, muscle aches and joint pain is followed by dry cough, chest pain and breathing discomfort.

Ulceroglandular tularemia (skin and lymph node) occurs when tularemia bacteria s enters the skin through cuts and abrasions from handling an infected animal carcass without gloves. It also occurs if an infected tick or biting flies attaches and feeds on human blood. Fever, chills and muscle aches are usually followed by a painful skin ulcer and tender lymph nodes in the neck, armpit or groin, depending on where the bacteria entered the skin.

Glandular tularemia (lymph node) occurs when tularemia bacteria F. enter the skin but a skin ulcer is not found. Except for this detail, symptoms are the same as with ulceroglandular tularemia.

Pharyngeal tularemia (throat) occurs when tularemia bacteria are swallowed in contaminated food or beverage, resulting in a serious throat infection. Typical symptoms include fever, chills, severe sore throat and enlarged and tender lymph nodes in the neck.

Oculoglandular tularemia (eye and lymph node) is a painful eye infection that can occur if tularemia bacteria are rubbed into an eye. Symptoms include fever, chills, painful yellow bumps on the surface of the eyes and the inside surface of the eyelids, pus draining from the eyes, swelling around the eyes and enlarged and tender lymph nodes in the neck and on the head.

Typhoidal tularemia (like typhoid fever) occurs when tularemia bacteria spread through the bloodstream. The illness can appear similar to typhoid fever. If not treated with antibiotics, it can be very severe, even fatal. Flu-like illness, with fever, headache, and muscle aches and joint pain is followed by extreme weakness, inability to get out of bed, vomiting, diarrhea and dehydration.

What are the symptoms of tularemia?
Symptoms can appear within one to 14 days, with most occurring within three to five days. They 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 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.

Who gets tularemia?
Hunters, hikers and r others 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 or biting flies.

How is tularemia spread?
F. tularensis organisms can enter to skin or the thin tissue layers of the mouth, throat, nose and eyes if one comes into contact with an infected animal’s blood, meat or carcass, or if eating or drinking contaminated food or drink. Penetration through the skin also can occur following bites of infected ticks or biting flies. The bacteria can be inhaled if the organism becomes airborne in certain outdoor environments, such as near estuaries and coastlines. Human to human transmission of F. tularensis infections does not occur.

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.

What is the treatment for tularemia?
A number of antibiotics can be used to treat tularemia.

Is there a tularemia vaccine, and how can I get it?
Currently, there are no tularemia vaccines approved for use in the U.S.

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 in areas known to contain F. tularenis-infected deer flies and ticks. Laboratory workers need to take special precautions to avoid being exposed to this organism when working with specimens from patients suspected of having tularemia.

What has New York City done to address the threat of tularemia?
Bioterrorism is an intentional use of a biological agent to cause illness and terrorists may use the bacterium Francisell Tularensis for this purpose. 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, the Health Department has established systems to improve detection and response to public health emergencies caused by the intentional release of a biological agent, including tularemia.

How Will I Cope?
A tularemia outbreak in NYC can be very stressful, especially if it is large scale event. It can disrupt your everyday life and make you and those around you feel less safe. You may experience fear and uncertainty. Learning about stress and strategies to manage it can help you cope.

Prepare Today, Cope Better Tomorrow - Stress during Disasters provides basic information and practical advice on dealing with the stress and anxiety caused by disasters. It is available in seven languages.
If there is a tularemia in the city and you feel overwhelmed and unable to cope, or if you are concerned about someone else, you can find help by calling 1-800 LIFENET. LIFENET is a free, confidential helpline for New York City residents, available 24/7, with trained staff ready to take your calls and offer advice: 1-800-LifeNet 1-800-543-3638 (English), 1-877-Ayudese 1-877-298-3373 (Spanish), 1-877-990-8585 (Chinese), 1-212-982-5284 (TTY).

Where can I get more information?
For more information about tularemia, visit:

Centers for Disease Control and Prevention (CDC)