Abstract
We conducted a serosurvey of landscapers to determine if they were at increased risk for exposure to Francisella tularensis and to determine risk factors for infection. In Martha’s Vineyard, Massachusetts, landscapers (n=132) were tested for anti–F. tularensis antibody and completed a questionnaire. For comparison, serum samples from three groups of nonlandscaper Martha’s Vineyard residents (n=103, 99, and 108) were tested. Twelve landscapers (9.1%) were seropositive, compared with one person total from the comparison groups (prevalence ratio 9.0; 95% confidence interval 1.2 to 68.1; p=0.02). Of landscapers who used a power blower, 15% were seropositive, compared to 2% who did not use a power blower (prevalence ratio 9.2; 95% confidence interval 1.2 to 69.0; p=0.02). Seropositive landscapers worked more hours per week mowing and weed-whacking and mowed more lawns per week than their seronegative counterparts. Health-care workers in tularemia-endemic areas should consider tularemia as a diagnosis for landscapers with a febrile illness.
Highlights
We conducted a serosurvey of landscapers to determine if they were at increased risk for exposure to Francisella tularensis and to determine risk factors for infection
The less common but more severe primary pneumonic form develops after inhalation of the bacteria; pneumonic tularemia can be difficult to diagnose because the respiratory signs and symptoms may be minimal or absent and, when present, are often nonspecific
All serum samples were tested at the Centers for Disease Control and Prevention (CDC) for anti–F. tularensis antibodies with a microagglutination assay [4]; titers of at least 1:128 were considered positive
Summary
We conducted a serosurvey of landscapers to determine if they were at increased risk for exposure to Francisella tularensis and to determine risk factors for infection. Twelve landscapers (9.1%) were seropositive, compared with one person total from the comparison groups (prevalence ratio 9.0; 95% confidence interval 1.2 to 68.1; p=0.02). The less common but more severe primary pneumonic form develops after inhalation of the bacteria; pneumonic tularemia can be difficult to diagnose because the respiratory signs and symptoms may be minimal or absent and, when present, are often nonspecific. The only two reported outbreaks of pneumonic tularemia in the United States occurred on Martha’s Vineyard in 1978 and 2000 [2,3]. A case-control study demonstrated that lawn mowing or brush-cutting were risk factors for pneumonic tularemia (adjusted odds ratio 6.7; 95% confidence interval [CI] 1.1 to 39.9). Tularemia transmission on Martha’s Vineyard continued in the summer of 2001; one case of ulceroglandular and three cases of primary pneumonic tularemia were identified. We conducted a serosurvey to determine the prevalence of antibodies to F. tularensis among landscapers and three comparison groups and to evaluate potential risk factors for exposure to F. tularensis among landscapers
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