Approximately 200 cases of tularemia in humans are reported annually in the United States, mostly in persons living in the south-central and western states. Tularemia is an occupational risk for farmers, foresters, and veterinarians, and is listed by the US Centers for Disease Control and Prevention (CDC) as one of the six category A, or high-priority, biological warfare agents. Nearly all cases of tularemia occur in rural areas and are associated with the bites of infected ticks, mosquitoes, and biting flies or with the handling of infected rodents, rabbits, or hares. Less commonly, tularemia can be contracted through ingestion of contaminated food or water or by inhalation. Release of the bacteria in a aerosolized form is the most likely method to be used in bioterrorism.
Tularemia is extremely infectious. Relatively few bacteria are required to cause the disease, which is why it is an attractive weapon for use in bioterrorism.
There are currently no specific OSHA standards or directives for tularemia.
This section highlights OSHA standards, preambles to
final rules (background to final rules), and directives (instructions for
compliance officers) generally applicable to emergency
response activities associated with a bioterrorist attack and the use of
personal protective equipment (PPE). Refer to OSHA's
Preparedness and Response and
Protective Equipment (PPE) Safety and Health Topics Pages for additional
Note: Twenty-five states, Puerto Rico and the Virgin Islands have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.
General Industry (29
Preambles to Final Rules
Tularemia, also known as "rabbit fever" or
"deer fly fever," is caused by the Francisella
tularensis bacterium. As few as 10 of these organisms can cause the
disease. Humans become infected through a variety of environmental exposures.
Exposure may lead to a severe and sometimes fatal illness. The following
references aid in recognizing disease characteristics and hazards associated
Centers for Disease Control and Prevention (CDC). Offers fact sheets and overviews,
information about infection control, laboratory testing, and surveillance
Outbreak in Prairie Dogs in Texas. Centers for Disease Control and Prevention (CDC), (2002, August 6). Covers the investigation by officials from the CDC and the Texas Department of Health of an outbreak of tularemia in wild prairie dogs at a commercial facility in Texas that distributes the animals in the United States and other countries.
- United States, 1990-2000. Centers for Disease Control and Prevention
(CDC) Morbidity and Mortality Weekly Report (MMWR) 51(09):182-4, (2002,
March 8). Covers reported cases of
tularemia occurring in the United States from 1990-2000. Also provides background
information on tularemia including symptoms and diagnosis.
- Tularemia. Center for Infectious Disease Research and Policy (CIDRAP). Provides links the latest news and information available about
Current, comprehensive information on pathogenesis, microbiology,
epidemiology, diagnosis, treatment, and prophylaxis. Provides an overview
of tularemia and includes agent information, clinical symptoms,
pathogenesis, microbiology, and epidemiology.
MedlinePlus Health Information. Includes
illustrations, definitions, disease causes, incidence, and risk factors.
- Hornick, R. "Tularemia
Revisited." New England Journal of Medicine
345(2001, November 29): 1637-1639. Covers basic information about tularemia
and presents a review of recent outbreaks in the United States.
Description of Tularemia. University of California Los Angeles (UCLA), Department of Epidemiology, School of Public Health. Provides a description of tularemia, including its occurrence and mode of transmission.
Bioterrorist Threat Evaluation
On September 11, 2001, following the terrorist incidents
in New York City and Washington, DC, the Centers for Disease Control and
Prevention (CDC) recommended heightened surveillance for any unusual disease
occurrence or increased numbers of illnesses that might be associated with
intentional release of a biological agent.
Tularemia, in aerosol form, is considered a possible bioterrorism agent.
Although it is not easy to disseminate, it takes only a small amount of inhaled
bacterium to cause infection. The following references provide information about
evaluating the threat of tularemia as a biological weapon.
"Consensus Statement: Tularemia as a Biological Weapon"." Abstracted
from Dennis, D., et al. Journal of the American Medical Association (JAMA)
285.21(2001, June 6): 2763-2773. Contains information about the history
of tularemia and its use in biological warfare, as well as its epidemiology,
microbiology, pathogenesis, diagnosis, vaccination, and treatment. Also
discusses infection control and decontamination procedures. Links to full
Tularemia presents as a systemic febrile illness and
diagnosis may be made by culture of body fluid or serologic tests. Tularemia is
easily treatable with antibiotics as long as victims receive treatment quickly.
If a patient is not treated, the fatality rate can exceed 30 percent.
Isolation is not recommended for tularemia patients because it is not
transmitted from person to person.
It is a United States Public Health Service requirement that all suspected tularemia cases
be reported to
state and local health departments and the diagnosis confirmed by the Centers for
Disease Control and Prevention (CDC).
- Tärnvik A, and Chu, MC. "New Approaches to diagnosis and therapy of Tularemia."
Annals of the New York Academy of Science 1105(2007, June):
378-404. Concludes that the clinical handling of tularemia is currently
facilitated by new achievements in molecular diagnostics and, at least with
regard to type B tularemia, by the introduction of quinolones for therapy.
- Tularemia: New York City Department of Health and Mental Hygiene. Provides information on epidemiology, diagnosis, and treatment.
- Evans M.E., and A.M. Friedlander. "Tularemia." Textbook of Military Medicine: Medical Aspects of
Chemical and Biological Warfare [127 KB PDF, 10 pages].(1997). Provides a
thorough medical description of the disease including epidemiology,
pathogenesis, symptoms, diagnosis, and treatment.
- Clinical Pathway: Pneumonic Tularemia [237 KB PDF, 3 pages]. University of
Minnesota (UM), Center
for Infectious Disease Research and Policy (CIDRAP), (2002). Provides step-by-step procedures for patient
evaluation and treatment.
Control and Prevention
Workers should avoid bites by ticks
and blood-feeding flies, and also avoid touching wild animal tissue. Cases of tularemia require prompt
identification and treatment to prevent fatalities. The following references
provide information about the control and prevention of tularemia exposure.
- Tularemia [225 KB PDF, 2 pages]. US Army Center for Health Promotion
and Preventive Medicine (USACHPPM), (2006, April). Includes a list of precautions that reduce the risk of becoming
infected with tularemia.
Description of Tularemia, Methods of Control. University of California Los Angeles (UCLA), Department of Epidemiology, School of Public Health, (2000). Describes various measures that can prevent and control the transmission of tularemia.
- Tularemia. Washington State Department of
Current, comprehensive information on pathogenesis, microbiology,
epidemiology, diagnosis, treatment, and prophylaxis. Center for Infectious Disease Research and Policy (CIDRAP) and Infectious Diseases Society of America. Provides an overview of tularemia and includes the following sections relative to control and prevention:
Personal Protective Equipment (PPE). OSHA Safety and Health Topics Page.
Related Safety and Health Topics Pages
Report an Emergency. Centers for Disease Control and Prevention (CDC). Provides a list of health department websites and
emergency notification procedures for use by health officials and healthcare
Tularaemia. World Health Organization
(WHO), Global Alert and Response (GAR). Lists outbreaks reported to WHO
from 2000 to 2002.
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