Tularemia is caused by the bacterium Francisella tularensis and can be transmitted by ticks; biting flies; handling tissues of infected animals; contaminated water, soil, and vegetation; and by inhalation of aerosols. The normal reservoirs are a variety of small mammals such as rabbits, hares, squirrels, voles, mice, and rats. As few as 10 organisms are thought to be capable of establishing an infection. Tularemia can infect the skin, mucous membranes, gastrointestinal tract, lungs, or disseminate throughout the body. It is not transmissible from person to person. Because the bacteria can be infectious via aerosol, it is classified as a Category A potential bioterrorism agent.
Indiana did not have any reported tularemia cases in 2003. Figure 1 shows the number of reported tularemia cases in Indiana for the five-year period 1999-2003. Cases reported in 1999-2003 have been related to hunters skinning rabbits and, in one case, preparing a pheasant for cooking. At least one case was thought to have resulted from a tick bite. The occurrence of cases by time of year (Figure 2) suggests exposure to infected ticks or exposure to animals during hunting season. The female to male sex ratio is 1:10. This sex ratio most likely reflects the probable routes of infection: outdoor activities with exposure to ticks, or hunting rabbits or other small mammals.
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