Investigating an airborne tularemia outbreak, Germany

In November 2005, an outbreak of tularemia occurred among 39 participants in a hare hunt in Hesse, Germany. Previously reported tularemia outbreaks in Germany dated back to the 1950s. We conducted a retrospective cohort study among participants and investigated the environment to identify risk facto...

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Bibliographic Details
Published in:Emerging infectious diseases 2010-02, Vol.16 (2), p.238-243
Main Authors: Hauri, Anja M, Hofstetter, Iris, Seibold, Erik, Kaysser, Philip, Eckert, Juergen, Neubauer, Heinrich, Splettstoesser, Wolf D
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aerosols
Aged
airborne transmission
Animals
Child
Disease Outbreaks
Francisella tularensis
Francisella tularensis holarctica
Germany
Germany - epidemiology
hare hunting
Hares
Humans
Inhalation Exposure
Investigations
Male
Medical research
Medicine, Experimental
Middle Aged
Odds Ratio
Polymerase Chain Reaction
Retrospective Studies
Serologic Tests
Tularemia
Tularemia - epidemiology
Tularemia - transmission
Young Adult
zoonoses
Zoonoses - transmission
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Summary:In November 2005, an outbreak of tularemia occurred among 39 participants in a hare hunt in Hesse, Germany. Previously reported tularemia outbreaks in Germany dated back to the 1950s. We conducted a retrospective cohort study among participants and investigated the environment to identify risk factors for infection. Ten participants had serologic evidence of acute Francisella tularensis infection; 1 other participant died before laboratory confirmation was obtained. Presence within 5 meters of the place where disemboweled hares were rinsed with a water hose was the risk factor most strongly associated with infection (risk ratio 22.1; 95% confidence interval 13.2-154.3). Swabs taken at the game chamber and water samples were PCR negative for F. tularensis. Eleven of 14 hare parts showed low-level concentrations of F. tularensis, compatible with cross-contamination. More than half of case-patients may have acquired infection through inhalation of aerosolized droplets containing F. tularensis generated during rinsing of infected hares.
ISSN:1080-6040
1080-6059
DOI:10.3201/eid1602.081727