A small outbreak of tularemia in a rural area

Abstract

To assess clinically and epidemiologically an outbreak of tularemia detected in a small village in Tokat Province in Turkey. Materials and methods: Recorded clinical and laboratory data of 15 serologically confirmed patients, who either presented to hospital or were diagnosed during family medicine visits to the village during the outbreak, were assessed. Forms including a questionnaire about the symptomatology and previously given treatments were filled out by the patients. In addition, the entire village was investigated to establish the origin of the outbreak. Results: Ages of the 15 individuals (9 females) ranged between 10 and 75, and the mean was 34.2 ± 12.4. Thirteen patients matched the oropharyngeal type and 2 the oculoglandular type. The field investigation of the village revealed that open-air drinking water sources were not sufficiently chlorinated, and the villagers used to consume natural spring water. The outbreak was controlled via chlorination, with advice to the people to use clean water sources and limit natural spring water consumption. Conclusion: Tularemia has become an emerging infection particularly due to the increase in water- and food-based outbreaks in recent years. The crucial step in its diagnosis is the clinical suspicion of tularemia since it is still an underestimated disease in Turkey. Therefore, clinicians should be informed about where the entity is common. It is suggested that safe drinking water sources should be provided by the authorities, and open-air natural spring water sources should be avoided for the control of outbreaks.