Tularemia epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Tularemia has long been a silent disease plaguing the worldwide community. However, it is difficult to quantify the total worldwide incidence since tularemia is rarely reported. North America and Eurasia are commonly referred to as endemic areas. The majority of cases in the United States have been reported in the South-central and Western states. Seasonal distribution of tularemia infection shows a higher incidence between June and September. A higher incidence has also been reported in children under the age of 10 years.

Epidemiology and Demographics

Incidence

• Worldwide incidence of naturally occurring tularemia is unknown.
• It is likely that the disease is greatly under-recognized and under-reported.
• In the U.S., reported cases have dropped sharply from several thousand/year prior to 1950 to fewer than 200/year in the 1990s.
• Between 1985 and 1992, 1409 cases and 20 deaths were reported in the U.S., a case fatality rate of 1.4%.
• Release in a densely populated area would be expected to result in an abrupt onset of large numbers of acute, nonspecific febrile illness beginning 3–5 days later (incubation range 1–14 days), with pleuropneumonitis developing in a significant proportion of cases during the ensuing days and weeks. .

Geographic distribution of Tularemia

Endemic Areas

• Tularemia occurs throughout much of North America and Eurasia.
• In the U.S., human cases have been reported from every state except Hawaii.
• The majority of cases have been reported in South-central and Western states.

Tularemia cases have been reported throughout the United States, with the exception of Hawaii. The majority of cases have been reported in the South-central United States, followed by the Pacific Northwest and Massachusetts.

Seasonality

• Most U.S. cases occur June–September, when arthropod-borne transmission is most common.
• Cases in winter most commonly occur among hunters and trappers who handle infected animal carcasses.

Age and Gender

• The high incidence of tularemia among males and among children aged <10 years might be associated with increased opportunity for exposure to infected ticks or animals, less use of personal protective measures against tick bites, or diagnostic or reporting bias.
• The high incidence among American Indians/Alaska Natives might be associated with their increased risk for exposure; outbreaks of tularemia have been reported on reservations in Montana and South Dakota, where a high prevalence of tularemia infection was found in ticks and dogs.

Most common among males and children.