Headlines - Ten Years of Tularemia Surveillance in Humans in France

Tularemia has been a reportable disease since 2002 under the Nuclear, Radiological, Biological, and Chemical (NRBC) Risk Prevention Plan, as Francisella tularensis is a bacterium that could be used in bioterrorism. A report from the French Institute for Public Health Surveillance (InVS) on the results of 10 years of surveillance has just been published. From October 1, 2002, to December 31, 2012, 433 cases of tularemia were reported (including 130 confirmed cases and 303 probable cases). The median age was 49 years, and the male-to-female ratio was 1.83. The majority of cases occurred in the fall (31%) and winter (28%). Two deaths were reported, but this number may be underestimated because no follow-up of patients is conducted after notification. The most common clinical forms were lymphadenic (n=200; 46%) and ulcer-lymph node (n=113; 26%). Two risk exposures were identified: recreational activities involving exposure to dust aerosols that could affect the general population (n=217; 50%), and handling of hares, a precise and specific exposure (n=179; 41%). Tick bites were reported in nearly 1 in 5 cases (19% of patients). Ten clusters of cases and an outbreak during the winter of 2007–08 (direct exposure to hares) were detected; this highlights the ability of this surveillance system to detect such events and its utility within the framework of the CBRN risk prevention plan.The Bourgogne and Franche-Comté regions have the same average annual incidence, ranging from 1.1 to 1.5 per million inhabitants.