Tularemia -- United States, 1990 – 2000. CDC, MMWR, 51(09):182-84, March 8, 2002. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5109a1.htm
Emergency preparedness and response: key facts about tularemia, CDC: http://www.bt.cdc.gov/agent/tularemia/facts.asp
Infectious disease control manual, Ohio Department of Health: https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/infectious-disease-control-manual/infectious-disease-control-manual
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Zoonosis: a disease that can be acquired by humans from an animal source.
As few as 10 organisms can cause serious, potentially fatal disease.
Waterborne outbreaks of tularensis occurred in Europe during the 1930s and '40s.
The highest number of reported cases were in Missouri, Arkansas, Oklahoma, South Dakota and Montana.
Laboratory workers are at particular risk for tularemia infection due to potential exposure to aerosols and open culture plates and the potential for needle injuries.
There was an airborne epidemic in Sweden in 1966 and 1967 due to exposure to contaminated aerosols while farming.
NOTE: Since there is no know cases of person-to-person transmission, confirmed cases of tularemia do NOT require isolation. Isolation is an appropriate precaution until there is laboratory confirmation of the disease.
Japanese germ warfare units studied the organism in the 1930s and '40s. In the 1950s, the U.S. developed weapons that would disseminate F. tularensis aerosols. In the 1970s, development of biological weapons was terminated in the U.S. and stockpiles were destroyed.
The incubation period for the disease is one to 14 days.
A WHO expert estimated that an aerosol of 50 kg of F tularensis over a metropolitan area of five million persons would result in 250,000 serious illnesses and 19,000 deaths. One estimate of the economic impact was $5.4 billion dollars per 100,00 exposed individuals.
Note: Tularemia has a number of forms, which differ based on the virulence of the organism, the dose and the site of the innoculum. The disease may present with ocular symptoms, skin lesions, lymphadenitis and GI symptoms.
Untreated pneumonic and systemic forms of the disease have reported mortality rates of 30 to 60 percent.
The organism will not be successfully isolated using routine laboratory procedures.
Laboratory workers are at high risk of infection and Biosafety Level 3 precautions must be used.
Research indicates that the vaccine is only partially protective against inhalation infection. Vaccine is not recommended for post-exposure protection.
Information on BSL precautions can be found on the following site: http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s2.htm
Details on environmental decontamination and infection control can be found at the following site: http://jama.ama-assn.org/cgi/content/full/285/21/2763