Rich Shannan N, Hinckley Alison F, Earley Austin, Petersen Jeannine M, Mead Paul S, Kugeler Kiersten J
MMWR Morb Mortal Wkly Rep. 2025 Jan 2;73(5152):1152-1156. doi: 10.15585/mmwr.mm735152a1.
Tularemia is a rare nationally notifiable zoonosis, caused by the tier-1 select agent Francisella tularensis, that has been reported from all U.S. states except Hawaii. Clinical manifestations typically include fever and localized symptoms that vary by route of infection. The case fatality rate of tularemia is typically <2% but can be higher depending on clinical manifestation and infecting strain. Tularemia is treatable with antibiotics. During 2011-2022, a total of 47 states reported 2,462 tularemia cases, but four central states (Arkansas, Kansas, Missouri, and Oklahoma) accounted for 50% of all reported cases. Incidence was highest among children aged 5-9 years (0.083 per 100,000 population) and adult males aged 65-84 years (range = 0.133-0.161). Incidence among American Indian or Alaska Native persons (0.260) was approximately five times that among White persons (0.057). The average annual incidence of tularemia in the United States during 2011-2022 (0.064) was 56% higher than that reported during 2001-2010 (0.041), largely resulting from increased reporting of probable cases. These findings might reflect an actual increase in human infection or improved case detection amid changes in commercially available laboratory tests during this period. Reducing tularemia incidence will require tailored prevention education; mitigating morbidity and mortality will require health care provider education, particularly among providers serving tribal populations, regarding early and accurate diagnosis and treatment.
兔热病是一种罕见的全国法定报告人畜共患病，由一级选择病原体土拉弗朗西斯菌引起，除夏威夷外，美国所有州均有病例报告。临床表现通常包括发热和因感染途径而异的局部症状。兔热病的病死率通常<2%，但根据临床表现和感染菌株的不同，病死率可能更高。兔热病可用抗生素治疗。在2011 - 2022年期间，共有47个州报告了2462例兔热病病例，但四个中部州（阿肯色州、堪萨斯州、密苏里州和俄克拉荷马州）占所有报告病例的50%。发病率在5 - 9岁儿童中最高（每10万人中0.083例），在65 - 84岁成年男性中也较高（范围为0.133 - 0.161）。美国印第安人或阿拉斯加原住民的发病率（0.260）约为白人发病率（0.057）的五倍。2011 - 2022年期间美国兔热病的年均发病率（0.064）比2001 - 2010年期间报告的发病率（0.041）高56%，这主要是由于可能病例报告的增加。这些发现可能反映了人类感染的实际增加，或者在此期间商用实验室检测方法变化导致病例检测得到改善。降低兔热病发病率需要针对性的预防教育；减轻发病率和死亡率则需要对医疗保健提供者进行教育，特别是为部落人口服务的提供者，使其了解早期准确的诊断和治疗方法。
