Tularemia.ppt

* Tularemia is endemic on Martha’s Vineyard, an island off the coast of Cape Cod, Massachusetts. It first occurred in the 1930s, after game clubs introduced cottontail rabbits from Arkansas and Missouri (endemic States). Shortly after the first cases of tularemia were reported. The only reported outbreaks of pneumonic tularemia in the U.S. occurred on Martha’s Vineyard in 1978 and 2000. In 1978, the cluster of cases involved seven persons who all lived together in a cottage. Epidemiological investigation attributed exposure to a wet dog which aerosolized F. tularensis when it shook itself inside of the cottage. In 2000, 15 cases were identified; 11 had pneumonic tularemia, two had the ulceroglandular form, and 2 experienced fever and malaise without localized signs. Epidemiologic investigation determined that landscaping (i.e., lawn mowing, brush cutting) was associated with infection. Investigation also suggested that F. tularensis was shed in animal (rodent) excrement and infected people after it was mechanically aerosolized and inhaled. * There are many known reservoirs -- at least 14 species of ticks, 6 species of flies, several mosquito species, over 100 wild mammal species, and 25 species of birds. Ticks and rabbits are the source for most human cases in the United States. A rodent-mosquito cycle has been described in Russia and Sweden. People can become infected by as few as 10 organisms via inoculation or inhalational route but require a larger dose (108) via ingestion. * Tularemia can be transmitted through arthropod bites, including Dermacentor andersonii, Dermacentor variabilis, Amblyomma americanum, and less commonly the deer fly, Chrysops discalis. Tick bites are the most common method of transmission to people. Transovarial transmission occurs in ticks, and they can be infective for life. Flies are a less common source of transmission and are only infective for 14 days. [Top photo: Dermacentor variabilis (American dog tick); Middle photo: Amblyomma