Tularemia outbreak associated with outdoor exposure along the western side of Utah Lake, Utah, 2007

Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Reports (Impact Factor: 1.55). 11/2010; 125(6):870-6. DOI: 10.2307/41434853
Source: PubMed


In 2007, a localized outbreak of tularemia occurred among visitors to a lodge on the western side of Utah Lake, Utah. We assessed risk factors for disease and attempted to identify undiagnosed clinically compatible illnesses.
We conducted a retrospective cohort study by recruiting all people who had visited the lodge on the western side of Utah Lake from June 3 to July 28, 2007. A self-administered questionnaire was distributed to a sub-cohort of people who were part of an organized group that had at least one tularemia patient. Questions assessed risk and protective factors and disease symptoms.
During the outbreak period, 14 cases of tularemia were reported from five of Utah's 12 health districts. The weekly attack rate ranged from 0 to 2.1/100 lodge visitors from June 3 to July 28. Illness onset dates ranged from June 15 to July 8. The median delay between onset of symptoms and laboratory test for tularemia was 14 days (range: 7-34 days). Cohort study respondents who reported deer-fly bites while at the lodge (adjusted risk ratio [ARR] = 7.2, 95% confidence interval [CI] 2.4, 22.0) and who reported having worn a hat (ARR = 5.6, 95% CI 1.3, 24.6) were more likely to become ill.
This was Utah's second documented deer-fly-associated human tularemia outbreak. People participating in outdoor activities in endemic areas should be aware of disease risks and take precautions. Educational campaigns can aid in earlier disease recognition, reporting, and, consequently, outbreak detection.

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Available from: Renee Calanan, May 26, 2015
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    ABSTRACT: Tularemia is a bacterial zoonotic infection. The disease is endemic in most parts of the world, has been reported through the northern hemisphere between 30 and 71° N latitude. F. tularensis causes infection in a wide range of vertebrates (rodents, lagomorphs) and invertebrates (ticks, mosquitoes and other arthropods). Humans can acquire this infection through several routes including; a bite from an infected tick, deerfly or mosquito, contact with an infected animal or its dead body. It can also be spread to human by drinking contaminated water or breathing contaminated dirt or aerosol. Clinical manifestation of this disease varies depending on the biotype, inoculum and port of entry. Infection is potentially life threatening, but can effectively be treated with antibiotics. Travelers visiting rural and agricultural areas in endemic countries may be at greater risk. Appropriate clothing and use of insect repellants is essential to prevent tick borne illness. Travelers also should be aware of food and waterborne disease; avoid consuming potentially contaminated water and uncooked meat. Physicians should be aware of any clinical presentation of tularemia in the patients returning from endemic areas.
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