West Virginia Department of Health and Human Resources Tularemia: Information for Public Health Officials

Bacteria

Unique Epidemiological Characteristics

• Natural reservoir in West Virginia – squirrels, voles, rats, mice, rabbits, hares
• A newly-reported case should by investigated urgently considering:
  • contact with animals,
  • aerosol exposure from contaminated hay/grass,
  • (BT)
• Incubation: 1-14 days
• No person-to-person transmission
• Mortality: 30-60% without treatment (pneumonic or systemic disease) – emergency
• Environmentally hardy in moist, cold environments
• Prophylaxis: effective only if initiated within 24 hours of exposure (ciprofloxacin or doxycycline)
• Treatment: effective if begun early with Streptomycin, gentamicin > ciprofloxacin, doxycycline

Laboratory Confirmation

• Initial screening by hospital laboratories; confirmation by OLS

Employee Health Considerations:

• Exposed employees should be started on antibiotics id they can be identified within 24 hours of exposure; if identified after 24 hours, they should be placed under surveillance and begun on treatment if symptoms develop
• Employees doing environmental investigation should have personal protective equipment and training if exposure is likely / possible
• Standard precautions

Lifesaving interventions – in order:

1. Recognition / reporting / case-finding + early appropriate therapy
2. Collect and analyze risk information to identify source AND
   • identify the exposed population to be placed under surveillance

Training considerations

• Physicians: recognition / reporting / treatment
• ICPs: reporting, active surveillance procedures
• Labs: screening tests and procedure for referral of specimens to OLS.
• Local health departments, regional epidemiologists: Investigation / NPS issues
• IDEP / DSDC / BPH: investigation / communication / prioritization of control measure