9. METHODS OF CONTROL

A. Preventive measures:

1) Educate the public to avoid bites of ticks, flies and mosquitoes and to avoid drinking, bathing, swimming or working in untreated water where infection prevails among wild animals.

2) Use impervious gloves when skinning or handling animals, especially rabbits. Cook the meat of wild rabbits and rodents thoroughly.

3) Prohibit interstate or interarea shipment of infected animals or their carcasses.

4) Live attenuated vaccines applied intradermally by scarification are used extensively in the former Soviet Union, and to a limited extent for occupational risk groups in the USA. Such an investigational live attenuated vaccine for laboratory personnel working with the organism is no longer available in the USA.

5) Wear face masks, gowns and impervious gloves and negative pressure microbiological cabinets when working with cultures of F. tularensis.

B. Control of patient, contacts and the immediate environment.

1) Report to local health authority: In selected endemic areas (USA); in many countries, not a reportable disease, Class 3B (see Communicable Disease Reporting).

2) Isolation: Drainage and secretion precautions for open lesions.

3) Concurrent disinfection: Of discharges from ulcers, lymph nodes or conjunctival sacs.

4) Quarantine: None.

5) Immunization of contacts: Not indicated.

6) Investigation of contacts and source of infection: Important in each case, with search for the origin of infection.

7) Specific treatment: Streptomycin or gentamicin given for 7-14 days is the drug of choice; the tetracyclines and chioramphenicol are bacteriostatic and effective when continued for no less than 14 days; relapses are reported to occur more often than with streptomycin. Moreover, fully virulent streptomycin resistant organisms have been described. Aspiration, incision and drainage, or biopsy of an inflamed lymph node can spread the infection and must be covered with prompt and specific antibiotics.

C Epidemic measures: 

Search for sources of infection related to arthropods, animal hosts, water, soil and crops. Control measures as indicated in 9A, above.

D. Disaster implications: None.

E. International measures: None.

F. Bioterrorism measures:

Tularemia is considered to be a potential biowarfare/bioterrorist agent, particularly if used as an aerosol threat. As is true of plague, cases acquired by inhalation would present as primary pneumonia. Such cases require prompt identification and specific treatment to prevent a fatal outcome. All diagnosed cases of pneumonia due to F. tularensis, especially any cluster of eases should be reported immediately to the local FBI and health department for appropriate investigations.