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


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


Related Links

CDC - Tularemia Page