Tularemia is most common in the
Northern Hemisphere, including North America and parts of Europe and Asia. In Europe, tularemia is generally rare, though outbreaks with hundreds of cases occur every few years in neighboring
Finland and
Sweden. In Sweden over a period from 1984 to 2012 a total of 4,830 cases of tularemia occurred (most of the infections were acquired within the country). About 1.86 cases per 100,000 persons occur each year with higher rates in those between 55 and 70.
Outbreaks In the
14th century BC, a disease believed to probably be Tularemia spread throughout the
Hittite Empire, known as the
Hittite plague, and its use in repelling an invasion was the first use of
biological warfare recorded. From May to October 2000, an outbreak of tularemia in
Martha's Vineyard,
Massachusetts, resulted in one fatality, and brought the interest of the United States
Centers for Disease Control and Prevention (CDC) as a potential investigative ground for aerosolised
Francisella tularensis. For a time, Martha's Vineyard was identified as the only place in the world where documented cases of tularemia resulted from
lawn mowing. However, in May 2015 a resident of
Lafayette, Colorado, died from aerosolised
F. tularensis, which was also connected to lawn mowing, highlighting this new vector of risk. An outbreak of tularemia occurred in
Kosovo in 1999–2000. In 2004, three researchers at
Boston Medical Center, in Massachusetts, were accidentally infected with
F. tularensis, after apparently failing to follow safety procedures. In 2005, small amounts of
F. tularensis were detected in the
National Mall area of
Washington, D.C., the morning after an antiwar demonstration on September 24, 2005.
Biohazard sensors were triggered at six locations surrounding the Mall. While thousands of people were potentially exposed, no infections were reported. The detected bacteria likely originated from a natural source, not from a
bioterror attempt. In 2005, an outbreak occurred in
Germany amongst participants in a hare hunt. About 27 people came into contact with contaminated blood and meat after the hunt. Ten of the exposed, aged 11 to 73, developed tularemia. One of these died due to complications caused by chronic heart disease. Tularemia is
endemic in the
Gori region of the
Eurasian country of
Georgia. The last outbreak was in 2006. The disease is also endemic on the uninhabited
Pakri Islands off the northern coast of
Estonia. Used for bombing practice by
Soviet forces, chemical and bacteriological weapons may have been dropped on these islands. In July 2007, an outbreak was reported in the
Spanish autonomous region of
Castile and León and traced to the plague of
voles infesting the region. Another outbreak had taken place ten years before in the same area. In January 2011, researchers searching for
brucellosis among
feral pig populations in
Texas discovered widespread tularemia infection or evidence of past infection in feral hog populations of at least two Texas counties, even though tularemia is not normally associated with
pigs at all. Precautions were recommended for those who hunt, dress, or prepare feral hogs. Since feral hogs roam over large distances, concern exists that tularemia may spread or already be present in feral hogs over a wide geographic area. In November 2011, it was found in
Tasmania. Reports claimed it to be the first in the
Southern Hemisphere. However, the causative organism was documented to have been isolated from a foot wound in the
Northern Territory in 2003. In 2014, at least five cases of tularemia were reported in
Colorado and at least three more cases in early 2015, including one death as a result of lawn mowing, as noted above. In the summer of 2015, a popular hiking area just north of
Boulder was identified as a site of animal infection, and signs were posted to warn hikers. ==History==