Tularemia has been listed as a notifiable disease since October 2002. The objective of mandatory reporting is to monitor trends in incidence, describe the clinical and epidemiological characteristics of cases, and detect any unusual occurrences early on, particularly clusters of cases or the emergence of a virulent strain used for malicious purposes. All cases must be reported promptly. We present the cases of tularemia reported in 2003 and 2004. For each reported case, a surveillance form and a questionnaire gathering clinical information and details on risk exposures during the 2 weeks preceding the onset of symptoms are completed. When clusters of cases are reported, an investigation is conducted to determine the source of the outbreak and, if necessary, to implement appropriate control measures. Twenty sporadic cases were reported in 2003 and 21 in 2004. Among these 41 patients, 25 (61%) presented with the lymphadenic form. Risk exposure was identified in 40 patients (98%), of whom 20 (49%) had butchered game, 8 had been bitten by a tick (20%), and 1 patient had been infected in a laboratory. The patients resided primarily in Poitou-Charentes and Alsace-Lorraine. Furthermore, in 2004, a cluster of 14 cases linked to a common airborne source occurred in Vendée. The description of tularemia cases from the first two years of the surveillance program helps identify the most affected geographic areas and the main modes of transmission. It thus helps guide recommendations for prevention and identify the populations for whom these preventive measures should be implemented. We also propose recommendations for case investigation and the improvement of surveillance tools. (R.A.)