Cause: Bacterium Francisella tularensis.

Illness and treatment: Symptoms reflect the route of transmission and can include fever, malaise, swollen lymph nodes, skin ulcers, eye infection, sore throat, abdominal pain, diarrhea and pneumonia; any infection can cause sepsis. Treatment is with antibiotics.

Sources: The reservoir is wild mammals (especially rabbits, hares, voles, squirrels, muskrats, beavers). Infection can occur through direct contact with an infected animal, bite from an arthropod (e.g., tick, deerfly), ingestion of contaminated raw meat or water, or inhalation, including during outdoor work or with improper handling of cultures in laboratories.

Prevention: Wear gloves if skinning wild game and keep hands or gloves away from the eyes. Drink only treated water when in wilderness areas. In endemic areas avoid tick and insect bites.

Recent Washington trends: Each year there are one to 10 reports. Exposures include insect and animal bites, contaminated water, exposure to wild rabbits or rodents, and inhalation while farming or landscaping with power tools. In 2004-2005 a statewide serosurvey of over 370 outdoor pet cats and dogs found 0.6% positive overall but 4.5% positive in southwest counties.

Purpose of Reporting and Surveillance

  • To assist in diagnosis.
  • When the source is a risk for only a few individuals (e.g., animal exposure), to inform those individuals how they can reduce their risk of exposure.
  • To educate potentially exposed persons, including laboratory personnel, about signs and symptoms of disease, thereby facilitating early diagnosis.
  • To determine the endemicity and epidemiology of the disease in Washington state.
  • To raise the index of suspicion of a possible bioterrorism event if no natural exposure source is identified.

Legal Reporting Requirements

  • Health care providers: immediately notifiable to local health jurisdiction
  • Health care facilities: immediately notifiable to local health jurisdiction
  • Laboratories: Francisella tularensis immediately notifiable to local health jurisdiction; specimen submission required - culture or other appropriate clinical material (2 business days)
  • Veterinarians: Suspected human cases immediately notifiable to the local health jurisdiction; animal cases notifiable to Washington State Department of Agriculture (see: https://app.leg.wa.gov/wac/default.aspx?cite=16-70)
  • Local health jurisdictions: suspected and confirmed cases are immediately notifiable to the Washington State Department of Health (DOH) Communicable Disease Epidemiology (CDE) (1-877-539-4344). If bioterrorism is suspected, case must be immediately reported to DOH: 1-877-539-4344