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TULAREMIA
Public Health Preparedness Program
What is Tuleramia?
Tularemia is a potentially serious illness that occurs naturally in the United States. It is
caused by the bacterium Francisella tularensis found in animals (especially rodents, rabbits,
and hares) and is highly infectious. In the United States, tularemia is usually caused by
being bitten by infected ticks or by handling infected animal tissue from sick or dead
animals.
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are five different forms of tularemia:
Ulceroglandular - skin ulcer at site of bite
Glandular - no ulcer at site of bite
Oculoglandular - bacteria enters through eye
Oropharyngeal - results from eating or drinking contaminated food or water
Pneumonic - breathing dusts or aerosols containing organism
Why are we Concerned About Tuleramia as a Bioweapon?
Francisella tularensis is very infectious. A small number (10-50 or so organisms) can cause
disease. Tularemia has long been considered a potential biological weapon because of its
extreme infectivity, ease of dissemination, and substantial capacity to cause illness and
death. If F. tularensis was used as a weapon, the bacteria would likely be made airborne for
exposure by inhalation. People who inhale an infectious aerosol would generally experience
severe respiratory illness, including life-threatening pneumonia and systemic infection, if
they are not treated. The bacteria that cause tularemia occur widely in nature and could be
isolated and grown in large quantity in a laboratory, although manufacturing an effective
aerosol weapon would require considerable sophistication.
Transmission: How does Someone Become Infected with Tularemia?
People can get tularemia many different ways, including being bitten by an infected tick,
deerfly or other insect, or by handling infected animal carcasses. The main concern for
public health is the transmission of the disease through ingestion of water from a
contaminated water supply and/or inhalation of contaminated dusts or aerosol, both of
which are conducive to potential bioterrorism attacks.
Tularemia is not contagious, meaning it is NOT spread from one person to another person.
People who have tularemia do not need to be isolated. People who have been exposed to
the tularemia bacteria should be treated as soon as possible. The disease can be fatal if it is
not treated with the right antibiotics.
What are the Signs and Symptoms of Tularemia?
The symptoms of tularemia vary depending on the type of exposure, and illness ranges
from mild to life-threatening. If the bacteria that cause tularemia are inhaled in the form of
dust or aerosol, it can cause an infection of the lungs (pneumonic). This is the most serious
form, and may be used during a bioterrorism attack. Symptoms of tularemia may include
sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, and
progressive weakness. If pneumonia develops, people can also experience chest pain,
bloody sputum, difficulty breathing, and even respiratory failure.
A biological attack may also lend itself to food or water contamination, resulting in the
oropharyngeal form. After ingesting contaminated food or water, symptoms of this form of
tularemia include sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the
neck.
F. tularensis can also infect humans through the skin or mucous membranes. When a
person contracts the disease through this means, they may have symptoms that include
swollen and painful lymph glands, or a skin ulcer.
How Soon do Infected People get Sick?
Symptoms usually appear 3 to 5 days after exposure to the bacteria, but can take as long
as 14 days.
How is Tularemia Treated?
Early treatment of tularemia with appropriate antibiotics is essential. Although tularemia
can be life-threatening, most infections can be treated successfully with antibiotics.
Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline, and
ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and
the medication used. Although symptoms may last for several weeks, most patients
completely recover. Antibiotics must be taken only under the direction of your health care
provider or local health department.
Can a Person Exposed to Tularemia Avoid Becoming Sick?
Yes. Antibiotics can prevent tularemia from developing in people who have been exposed
but have not developed symptoms. A vaccine for tularemia is under review by the Food and
Drug Administration, but is not currently available in the United States.
Would Enough Medication be Available in the Event of a Bioterrorism Attack?
Yes. National and state public health officials have large supplies of drugs needed in the
event of a bioterrorism attack. These supplies can be sent anywhere in the United States
within 12 hours.
What is the Washoe County Health District Doing to Prepare for a Tularemia Outbreak?
In the event of a weaponized tularemia attack or outbreak, the Washoe County Health
District will announce detailed instructions on how to obtain preventive medication through
a point of dispensing (POD) site. This information will be available through the media and
the Washoe County Health District website.
Source: www.cdc.gov