Tularemia Revisited

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Abstract
Tularemia, which is caused by the gram-negative bacillus Francisella tularensis, is now a rare infection in the United States. The peak incidence was in 1939, when about 2300 cases were reported. The decline may be related to the fact that wild rabbits are no longer sold in markets and perhaps to an increased awareness among hunters of the risks posed by sick rabbits. In 2000, 142 infections were reported in the United States, including the 11 from the epidemic described by Feldman et al. in this issue of the Journal.1 Most of the cases now occur in Missouri, Arkansas, Oklahoma, and Kansas. Cottontail rabbits are a prime reservoir in many states, as are jack rabbits in states west of the Mississippi River. These rabbits are found primarily in the United States and to a lesser extent in Mexico and Central America. Tick bites appear to be the main mode of transmission to humans in the summer months, and exposure to rabbits is the chief mode of transmission in the fall and winter, the small-game–hunting season.

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