Tularemia Outbreaks Research Articles

The great tularemia outbreak in Sivas: Evaluation of 205 cases

This study aimed to report a tularemia outbreak in Sivas and describe the epidemiological and diagnostic characteristics of the patients. Patients aged 18 and over followed up with a diagnosis of tularemia in Sivas Cumhuriyet University Hospital, Sivas Numune State Hospital, and Sivas State Hospital Infectious Diseases Outpatient Clinics and wards between November 2023 and May 2024 were evaluated. 205 adult patients with tularemia were included. The most common symptoms were sore throat (73.2 %, n=150), swelling in the neck (70.2 %, n = 144), and fatigue (55.1 %, n = 113). The most common form was oropharyngeal (82.4 %, n = 169) and glandular (14.6 %, n = 30). Lymphadenopathy was detected in 182 (88.8 %) patients, the most is cervical lymphadenopathy (60 %, n = 123). Lymph node drainage/excision was performed on 50 patients (24.3 %). There have been no deaths in this outbreak. This study presents patient data from the tularemia outbreak in Sivas.

Clinical features of tularemia in cats: a retrospective study from 2000 to 2021.

The objectives of this study were to describe the clinical features of cats diagnosed with tularemia, and to compare the clinical features of cats with and without tularemia and identify characteristics increasing the likelihood of a tularemia diagnosis. Diagnostic laboratory data and medical records were retrospectively reviewed of cats tested for tularemia between 2000 and 2021. Clinical features including signalment, presenting complaint(s), physical examination findings and clinicopathologic data were described for cats with tularemia diagnosed by culture and/or PCR. Clinical features were also compared between PCR+ vs PCR- cats and logistic regression was used to identify features that predicted PCR+ status. A total of 18 cats were diagnosed with tularemia. The affected cats had a mean age of 5.8 ± 4.9 years, with a slight male predominance. Most were domestic shorthair cats and had outdoor access. Common presenting complaints included lethargy and anorexia, while physical examination findings frequently revealed fever, peripheral lymphadenomegaly and oral ulcers. Laboratory findings varied, with notable abnormalities including neutrophilic inflammation observed on cytology and widespread acute systemic pathologic changes in necropsy results. Leukopenia and neutropenia were more common in PCR+ vs PCR- cats, and these factors were 7.4 times (confidence interval [CI] 1.2-62.3) and 10.0 times (CI 1.4-83.2) more likely to occur in PCR+ vs PCR- cats, respectively. There were no significant differences between the groups in other parameters including anemia, thrombocytopenia, band neutrophilia and hyperbilirubinemia. This study provides a more comprehensive description of tularemia in cats than has been available to date. In particular, leukopenia and neutropenia are significantly associated with tularemia-positive cats. These clinical features should be considered and raise suspicion for tularemia in cats. These findings may be valuable for the timely diagnosis, treatment and prevention of tularemia outbreaks in cats and humans.

Characterization of tularemia foci in the Republic of Kazakhstan from 2000 to 2020.

The wide distribution of tularemia in the territory of Kazakhstan is associated with landscape and geographical characteristics. This is explained by a combination of natural factors: the presence of certain types of rodents-reservoirs and sources, ectoparasites-carriers of the causative agent of tularemia. The study of the current spatial and temporal characterization of tularemia in Kazakhstan from 2000 to 2020 will determine the epidemiological status of tularemia and improve the monitoring system in Kazakhstan. In this work we demonstrated the results of a retrospective survey of natural foci of tularemia: analysis of vector, small mammal and human data. The spatial and temporal characteristics of tularemia from 2000 to 2020 in the territory of Kazakhstan were studied in comparison with historical data, including the description of tularemia outbreaks, the clinical picture, and the source of infection, transmission factors, and geographical coordinates of outbreak registration. Sampling was carried out by trapping rodents on snap traps and collecting ticks by rodent combing and by "flagging" methods. For the last 20 years, 85 human cases of tularemia have been reported. During the period from 2000 to 2020, more than 600 strains of F. tularensis were isolated from field rodents and ticks in the natural foci of tularemia. MLVA typing of F. tularensis strains isolated from natural foci of tularemia in Kazakhstan over the past 20 years. The results of retrospective monitoring indicate that currently active foci of tularemia include the Aktobe, West Kazakhstan, Almaty, East Kazakhstan, and Pavlodar regions. Low-activity natural foci are located in the territory of the Akmola, Karaganda, North Kazakhstan, Kostanay, Atyrau, Zhambyl, and Kyzylorda regions. There are no active natural foci of tularemia in the Mangystau and Turkestan regions. The widespread occurrence of tularemia in the country is associated with landscape and geographical features that contribute to the circulation of the pathogen in the natural focus. An analysis of natural foci of tularemia showed that it is necessary to continue monitoring studies of carriers and vectors for the presence of the causative agent of the F. tularensis, in order to prevent mass cases of human disease.

Considerations for prevention of and emergency response to tularemia outbreaks in Ukraine: vaccine involvement

Tularemia is a highly dangerous, febrile zoonotic bacterial infection, endemic to many regions of the Northern hemisphere including Eastern Europe. The current war in Ukraine raises the risk for both natural outbreaks of tularemia resulting from destroyed infrastructure, and potential use as a weapon of war or bioterrorism. There has been a substantial history of outbreaks in prior wars in the region, and tularemia has been previously weaponized and stockpiled as an offensive agent. There are current reports of “mouse fever”, where Russian soldiers are affected with a high fever associated with mice in the battlefield. While antibiotic countermeasures to naturally occurring forms of tularemia are available, these may not be appropriate for long-term risks on the battlefield and could contribute to antibiotic resistance. At this time, there are no FDA or EMA approved tularemia vaccines, which are an ideal alternative to antibiotic prophylaxis. Vaccines have advantages in not requiring diagnosis, are generally safe and effective, leading to long-lasting prophylaxis with little impact to the patient and little need for future medical intervention. The potential for engineered forms of the disease for deliberate use may limit the effectiveness of existing countermeasures. The sporadic nature of outbreaks, and likely outcomes following deliberate use raise a number of complexities in a potential emergency response. Means to optimize potential countermeasure assessment, including responsible and effective vaccine candidate testing are discussed.

Innovative Approaches for Ecological Monitoring Disease Outbreaks Carried by Horseflies (Diptera, Tabanidae): A Systematic Review

Background: The spread and adaptation of horseflies to new habitats, driven by global climate change, threatens not only animal health but also human well-being. Objective: This article addresses the significant health risks posed by horseflies, which are known carriers of multiple pathogens causing up to 25 different infectious, parasitic, and viral diseases, including anthrax, tularemia, leptospirosis, and anaplasmosis. Methodology: The study provided an overview based on an extensive literature review from 1929 to 2022, analyzing both Russian and English publications. Results: The 2011 tularemia outbreak in Norway, linked to lemming population surges, and the higher susceptibility among men in Slovakia's annual tularemia cases highlight the role of animal reservoirs and gender in disease transmission. Leptospirosis, prevalent globally except in cold regions, is influenced by climate events, with significant public health impacts observed in various regions, including Russia and the Philippines following natural disasters. Anaplasmosis, transmitted by insects and ticks and more prevalent in warmer months, remains under-researched, with its rising threat exemplified by the growing ixodes tick population in Belarus. Conclusion: In conclusion, understanding the epidemiology and sources of these diseases, along with recognizing the environmental and anthropogenic factors that influence their transmission, is vital. The study underscores the importance of ongoing surveillance, research, and preventive measures to mitigate the impact of these infectious diseases on public health. Bangladesh Journal of Infectious Diseases, December 2023;10(2):77-84

Multidrug Resistance of <i>F. tularensis</i> subsp. <i>holarctica</i>, Epizootiological and Epidemiological Analysis of the Situation on Tularemia in the Russian Federation in 2022 and Forecast for 2023

The review provides concise information on the innate ability of cells of the tularemia pathogen, Francisella tularensis subsp. Holarctica, to resist antimicrobials through a variety of mechanisms, leading to its multi-resistance. In total, taking into account new territories, 120 cases of human infection were registered in the Russian Federation in 2022. Epizootic manifestations of the infection of varying degrees of intensity were detected in 58 constituent entities. Against this background, sporadic cases of tularemia in humans were reported in 18 regions of the country. An outbreak of tularemia occurred in the Stavropol Territory; the disease of mild and moderate severity was found in 76 people. The increased incidence of tularemia persists in the Republic of Karelia with severe cases of the disease in the absence of immunoprophylaxis of this infection in the region. A total of 61 cultures of the tularemia pathogen F. tularensis subsp. holarctica, out of which 20 erythromycin-resistant strains were isolated in the Stavropol Territory. In addition, 8 cultures of F. tularensis subsp. mediasiatica from a silt sample and mites Dermacentor silvarum and Haemaphysalis concinna caught in the Republic of Altai were isolated. On the territory of the Russian Federation in 2022, 930 999 people were vaccinated and revaccinated against tularemia. Based on the analysis of the data obtained in 2022, epidemic complications in 2023 in the form of sporadic cases of the disease among the unvaccinated population are most likely to occur in the territories of the Central Federal District – in the Vladimir, Ryazan and Smolensk Regions; Northwestern Federal District – in the Arkhangelsk Region and the Republic of Karelia; Southern Federal District – in the Volgograd and Rostov Regions. The situation in the North Caucasian Federal District will remain tense in the Stavropol Territory; in the Volga Federal District – in the territories of the Saratov Region, as well as in the Kirov Region and the Republic of Mordovia; Ural Federal District – in Khanty-Mansi and Yamalo-Nenets Autonomous Districts; Siberian Federal District – in certain territories of Omsk, Kemerovo, Tomsk, Novosibirsk, Irkutsk Regions, Altai, Krasnoyarsk Territories; in the Far Eastern Federal District, the most intense epizootic activity of natural tularemia foci is in Primorsky Krai.

Muş İlinde Görülen Tularemi Olgularının Retrospektif Değerlendirilmesi: 2011-2022

Objective: Tularemia is a bacterial disease of humans, wild and domestic animals. Recently, an increase in human tularemia cases has been observed in many countries worldwide. This study aimed to calculate the incidence of tularemia cases in Muş, determine the seasonal distribution of cases, and describe the socio-demographic and clinical characteristics of tularemia cases detected over a twelve-year period. Methods: Data from 162 patients diagnosed clinically and serologically with tularemia and admitted to health facilities in Muş province between 2011 and 2022 were retrospectively analysed. Results: In our study, among 162 tularemia patients with F. tularensis microagglutination test titres of 1/160 and above, the ratio of male and female cases was equal (50%), and the mean age was 24.51 years. In the twelve-year evaluation, there were two major epidemics, and the most cases were seen in 2018 with 37 cases. Most cases were observed in winter (38.3%) and autumn (25.3%). Oropharyngeal tularemia was the most common form (64.2%) among the cases evaluated. Similar disease was found in 33.3% of patients living in the same neighbourhood as the patients, and no mortality was observed in any of the patients. Conclusion: As the oropharyngeal form is the most common, contact with contaminated water should be questioned, rodent and tick populations should be monitored and detailed epidemiological studies should be conducted. We believe that hygiene and sanitation measures are important with regard to tularemia outbreaks.

Vole outbreaks may induce a tularemia disease pit that prevents Iberian hare population recovery in NW Spain

Iberian hare populations have suffered severe declines during recent decades in Spain. Between 1970 and 1990s, a rapid increase in irrigation crop surface in NW Spain (Castilla-y-León region) was followed by a common vole massive range expansion and complete colonization of lowland irrigated agricultural landscapes from mountainous habitats. The subsequent large cyclic fluctuations in abundance of colonizing common voles have contributed to a periodic amplification of Francisellatularensis, the etiological agent that causes human tularemia outbreaks in the region. Tularemia is a fatal disease to lagomorphs, so we hypothesize that vole outbreaks would lead to disease spill over to Iberian hares, increasing prevalence of tularemia and declines among hare populations. Here we report on the possible effects that vole abundance fluctuations and concomitant tularemia outbreaks had on Iberian hare populations in NW Spain. We analysed hare hunting bag data for the region, which has been recurrently affected by vole outbreaks between 1996 and 2019. We also compiled data on F.tularensis prevalence in Iberian hares reported by the regional government between 2007 and 2016. Our results suggest that common vole outbreaks may limit the recovery of hare populations by amplifying and spreading tularemia in the environment. The recurrent rodent-driven outbreaks of tularemia in the region may result in a "disease pit" to Iberian hares: at low host densities, the rate of population growth in hares is lower than the rate at which disease-induced mortality increases with increased rodent host density, therefore, keeping hare populations on a low-density equilibrium. We highlight future research needs to clarify tularemia transmission pathways between voles and hares and confirm a disease pit process.

Tularemia above the Treeline: Climate and Rodent Abundance Influences Exposure of a Sentinel Species, the Arctic Fox (Vulpes lagopus), to Francisella tularensis

Tularemia is a zoonotic disease found throughout most of the northern hemisphere that may experience range expansion with warming temperatures. Rodents and lagomorphs are reservoirs for the disease, and outbreaks of tularemia often follow peaks in their abundance. As small mammals dominate the diet of arctic foxes (Vulpes lagopus), we determined whether they may serve as sentinels by identifying antibodies in live-captured and harvested foxes from northern Canada. Overall seroprevalence was 2% (CI95 1-2%) in 176 foxes harvested in 2018-2019 compared to 17% (CI95 12-22%) of 230 foxes captured live in 2011-2021. Prevalence was at an all-time high in 2018, following a peak in vole abundance in 2017. Antibodies were identified in fox pups born in 2018 and 2019, suggesting that F. tularensis was actively transmitted during the summers. High precipitation during the summer, increased snow cover and colder temperatures in May, and a higher abundance of voles were all associated with increased seroprevalence in live-captured foxes. Thus, exposure to F. tularensis is largely mediated through climate and rodent populations in the Canadian Arctic, and arctic foxes are useful sentinels for F. tularensis in northern ecosystems. Further studies should investigate whether infection impacts arctic fox survival and reproductive success in the circumpolar North.

An Uncommon Presentation of Pulmonary Tularemia: A Case Report and Literature Review

Francisella tularensis is a re-emerging organism causing more significant outbreaks of tularemia and fear of bioterrorism. It can be challenging to recognize tularemia due to its variable presentation, especially in low-incidence areas. Physicians must be mindful of this life-threatening infectious disease and consider it a differential diagnosis in patients with fever of unknown origin. We encountered a case of pulmonary tularemia with a unique presentation of severe headache and fever.

First Tularemia Outbreak in the Province of Muş: Evaluation of 50 Cases

First Tularemia Outbreak in the Province of Muş: Evaluation of 50 Cases

Epidemiological investigation of a tularaemia outbreak after a hare hunt in Bavaria, Germany, 2018.

In November 2018, a tularaemia outbreak occurred in Bavaria, Germany, among participants of a hare hunt and butchery employees handling the hares. We conducted an epidemiological outbreak investigation, including a retrospective cohort study among hunting participants, to identify likely transmission routes and activities associated with infection. Twelve of 41 participants were antibody-positive for Francisella (F.) tularensis (attack rate: 29%). Cases reported influenza-like symptoms (n=11), lymphadenopathy (n=1) and conjunctivitis (n=1). Infection only occurred in those hunting participants present while hares were processed, while risk of infection was highest when directly involved (RR=10.0; 95%CI: 2.6-392). F.tularensis was isolated from 1/4 hares. Only two individuals reported using some of the recommended personal protective equipment (PPE). Occurrence of mainly non-specific symptoms, likely due to early treatment, was not indicative of a specific transmission route. Transmissions via direct (skin/mucosa) contact and by inhalation of contaminated aerosols seem plausible. Promoting and increasing appropriate use of PPE among people processing hares is crucial to prevent future outbreaks.

Linking Zoonosis Emergence to Farmland Invasion by Fluctuating Herbivores: Common Vole Populations and Tularemia Outbreaks in NW Spain.

The expansion and intensification of agriculture are driving profound changes in ecosystems worldwide, favoring the (re)emergence of many human infectious diseases. Muroid rodents are a key host group for zoonotic infectious pathogens and frequently invade farming environments, promoting disease transmission and spillover. Understanding the role that fluctuating populations of farm dwelling rodents play in the epidemiology of zoonotic diseases is paramount to improve prevention schemes. Here, we review a decade of research on the colonization of farming environments in NW Spain by common voles (Microtus arvalis) and its public health impacts, specifically periodic tularemia outbreaks in humans. The spread of this colonizing rodent was analogous to an invasion process and was putatively triggered by the transformation and irrigation of agricultural habitats that created a novel terrestrial-aquatic interface. This irruptive rodent host is an effective amplifier for the Francisella tularensis bacterium during population outbreaks, and human tularemia episodes are tightly linked in time and space to periodic (cyclic) variations in vole abundance. Beyond the information accumulated to date, several key knowledge gaps about this pathogen-rodent epidemiological link remain unaddressed, namely (i) did colonizing vole introduce or amplified pre-existing F. tularensis? (ii) which features of the “Francisella—Microtus” relationship are crucial for the epidemiology of tularemia? (iii) how virulent and persistent F. tularensis infection is for voles under natural conditions? and (iv) where does the bacterium persist during inter-epizootics? Future research should focus on more integrated, community-based approaches in order to understand the details and dynamics of disease circulation in ecosystems colonized by highly fluctuating hosts.

In Vitro Antimicrobial Susceptibilities of Francisella tularensis subsp. holarctica Isolates from Tularemia Outbreaks That Occurred from the End of the 20th Century to the 2020s in Spain.

A collection of 177 Francisella tularensis subsp. holarctica clinical isolates (29 from humans and 148 from animals, mainly hares and voles) was gathered from diverse tularemia outbreaks in the Castilla y León region (northwestern Spain) that occurred from the end of the 20th century to the 2020s. Along with four F. tularensis subsp. holarctica reference strains, all of these clinical isolates were tested using a broth microdilution method to determine their susceptibility to 22 antimicrobial agents, including β-lactams, aminoglycosides and one member each of the tetracycline, glycylcycline, quinolone and sulphonamide classes. Many multi-resistance profiles were found among the tested isolates, but especially among those of human origin (all but two isolates showed resistance to at least 13 of 18 antimicrobial agents). Even so, all human isolates were susceptible to gentamicin and tobramycin, while more than 96% of animal isolates were susceptible to these two aminoglycosides. Ciprofloxacin showed activity against more than 92% of animal and human isolates. However, almost 21% of human isolates were resistant to tetracycline, and more than 65% were resistant to tigecycline. Finally, a quite similar activity to other F. tularensis subsp. holarctica isolates collected 20 years earlier in Spain was observed.

Tularemia Outbreaks in Spain from 2007 to 2020 in Humans and Domestic and Wild Animals.

In this study, tularemia outbreaks associated with humans and several domestic and wild animals (Iberian hares, wild rabbits, voles, mice, grey shrews, sheep, dogs, foxes, wolves, ticks, and river crayfish) are reported in Spain from 2007 to 2020. Special attention was paid to the outbreaks in humans in 2007–2009 and 2014–2015, when the most important waves occurred. Moreover, positive rates of tularemia in lagomorphs were detected in 2007–2010, followed by negative results in 2011–2013, before again returning to positive rates in 2014 and in 2017 and in 2019–2020. Lagomorphs role in spreading Francisella tularensis in the epidemiological chain could not be discarded. F. tularensis is described for the first time infecting the shrew Crocidura russula worldwide, and it is also reported for the first time infecting wild rabbits (Oryctolagus cuniculus) in Spain. Serological positives higher than 0.4% were seen for sheep only from 2007–2009 and again in 2019, while serological rates greater than 1% were revealed in dogs in 2007–2008 and in wild canids in 2016. F. tularensis were detected in ticks in 2009, 2014–2015, 2017, and 2019. Lastly, negative results were achieved for river crayfish and also in environmental water samples from 2007 to 2020.

An outbreak of tularemia in southwestern Turkey.

Tularemia has reemerged and spread throughout Turkey, and the number of cases has increased. In this study, we report on a waterborne outbreak of tularemia in the spring of 2013 in a region which was previously disease-free, and we investigated the reasons for the outbreak. The index case, a 17-year-old male, was diagnosed with oropharyngeal tularemia. An outbreak investigation was initiated after receiving information from other patients with similar symptoms from the same village along with Balkıca, Tavas, and Denizli. An epidemiological and environmental investigation was conducted. Tonsil swab specimens/lymph node aspirates collected from patients, and water samples collected from unchlorinated drinking water sources, were cultured. Additionally, a real-time polymerase chain reaction (RT-PCR) was performed on these samples. Serum samples from patients were analyzed for antibody response. A total of 7 patients were found in this outbreak investigation. The attack rate was found to be 1% among the people of the village and 25% among patients' family members. The drinking-water system was contaminated with F. tularensis during this outbreak. Lack of appropriate water infrastructure and sanitation was the primary reason for this tularemia outbreak in Turkey. Improving the water source infrastructure and sanitation should be the primary approach to preventing tularemia outbreaks.

The Important Role of Metal Ions for Survival of Francisella in Water within Amoeba Environment

Francisella tularensis is a gram-negative facultative intracellular bacterium that resists harsh environments. Several outbreaks of tularemia are linked to the consumption and contact with spring water. The number of F. tularensis in some waters is high, while in others, this bacterium does not survive. Except organic compounds, metals could be important for the survival of F. tularensis in water. Some Francisella strains showed the association with amoeba, which may act as the environmental reservoir. This study was aimed at following the role of metal ions and/or amoeba in the existence and replication of F. novicida in spring waters by growth kinetics, acquisition of metals, and ultrastructural analyses of bacteria. The bacteria showed a longer survival in water with higher initial concentrations of Mn and Zn. Although Mn and Zn were necessary for the survival of F. novicida, the results also showed that the bacterium does not grow in water with high levels of Zn. In contrast, high levels of Mn did not have such a negative effect on the survival of this bacterium in water. In addition, while F. novicida benefits presence of amoeba in spring water, the number of amoebae is decreasing in a coculture model with F. novicida.

Francisella tularensis human infections in a village of northwest Iran

BackgroundRecent seroepidemiological studies have suggested that tularemia could be an endemic bacterial zoonosis in Iran.MethodsFrom January 2016 to June 2018, disease cases characterized by fever, cervical lymphadenopathy and ocular involvement were reported in Youzband Village of Kaleybar County, in the East Azerbaijan Province, northwestern Iran. Diagnostic tests included Francisella tularensis serology (including tube agglutination test and ELISA), PCR, and culture.ResultsAmong 11 examined case-patients, the tularemia tube agglutination test was positive in ten and borderline in one. PCR detected the F. tularensisISFtu2 elements and fopA gene in one rodent and a spring water sample from the same geographic area.ConclusionsBased on the clinical manifestations of the disease suggesting an oropharyngeal form of tularemia, serology results in case patients, and F. tularensis detection in the local fauna and aquatic environment, the water supply of the village was the likely source of the tularemia outbreak. Intervention such as dredging and chlorination of the main water storage tank of the village and training of villagers and health care workers in preventive measures and treatment of the illness helped control the infection.

Comparison of tul4, fopA, 16S rRNA and RD1 gene regions of Francisella tularensis strains isolated from Sivas, Turkey

Tularemia is a zoonotic disease that can infect animals and people. It is known that tularemia outbreaks in Turkey is water-borne and causative agent F. tularensis subsp. holarctica. Eight F. tularensis were isolated from the water samples in tularemia outbreaks observed in Sivas during 2011-2013. In this study; tul4, fopA, RD1 and 16S rRNA gene regions of eight F. tularensis isolates were amplified by PCR method and investigated by sequencing method. Sequence analysis of the gene regions were compared with each other and the samples found in GenBank. All samples were found to be similar in terms of the partial sequence of the tul4 and fopA gene region. In terms of 16S rRNA gene region, Belkent2012 and Belkent2013 isolates and Çiçekoğlu and Döllük isolates were detected similar among themselves. Bahçeiçi and Karaören isolates were found similar at RD1 gene regions. In the sequence comparison of GenBank in terms of examined gene regions, 94-100% similarity was determined with F. tularensis subsp. holarctica LVS and F. tularensis subsp. holarctica PHIT-FT049. As a result of our study; the tul4 and fopA gene regions of eight F. tularensis subsp. holarctica isolates were found to have identical and different base sequence origins in 16S rRNA and RD1 gene regions in tularemia outbreaks in Sivas. In order to reveal the phylogeography of F. tularensis’ in Turkey, it is necessary to produce new isolates from epidemic regions and to investigate them with advanced molecular techniques.

Healthy ecosystems for human and animal health: Science diplomacy for responsible development in the Arctic

AbstractClimate warming is occurring most rapidly in the Arctic, which is both a sentinel and a driver of further global change. Ecosystems and human societies are already affected by warming. Permafrost thaws and species are on the move, bringing pathogens and vectors to virgin areas. During a five-year project, the CLINF – a Nordic Center of Excellence, funded by the Nordic Council of Ministers, has worked with the One Health concept, integrating environmental data with human and animal disease data in predictive models and creating maps of dynamic processes affecting the spread of infectious diseases. It is shown that tularemia outbreaks can be predicted even at a regional level with a manageable level of uncertainty. To decrease uncertainty, rapid development of new and harmonised technologies and databases is needed from currently highly heterogeneous data sources. A major source of uncertainty for the future of contaminants and infectious diseases in the Arctic, however, is associated with which paths the majority of the globe chooses to follow in the future. Diplomacy is one of the most powerful tools Arctic nations have to influence these choices of other nations, supported by Arctic science and One Health approaches that recognise the interconnection between people, animals, plants and their shared environment at the local, regional, national and global levels as essential for achieving a sustainable development for both the Arctic and the globe.