FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 345:1601-1606 November 29, 2001 Number 22 Next

	Full Text PDF Editorial by Hornick, R. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In the summer of 2000, an outbreak of primary pneumonic tularemia occurred on Martha's Vineyard, Massachusetts. The only previously reported outbreak of pneumonic tularemia in the United States also occurred on the island in 1978.

Methods We conducted a case–control study of adults with pneumonic tularemia and investigated the environment to identify risk factors for primary pneumonic tularemia. Patients with confirmed cases were residents of or visitors to Martha's Vineyard who had symptoms suggestive of primary pneumonic tularemia, were ill between May 15 and October 31, 2000, and had a positive laboratory test for tularemia. Controls were adults who had spent at least 15 days on Martha's Vineyard between May 15 and September 28, 2000.

Results We identified 15 patients with tularemia; 11 of these cases were primary pneumonic tularemia. Francisella tularensis type A was isolated from blood and lung tissue of the one man who died. Patients were more likely than controls to have used a lawn mower or brush cutter in the two weeks before the illness (odds ratio, 9.2; 95 percent confidence interval, 1.6 to 68.0) and during the summer (odds ratio, undefined; 95 percent confidence interval, 1.8 to ). Lawn mowing and brush cutting remained significant risk factors after adjustment for other potentially confounding variables. Only one patient reported being exposed to a rabbit while cutting brush. Of 40 trapped animals, 1 striped skunk and 1 Norway rat were seropositive for antibodies against F. tularensis.

Conclusions Study of this outbreak of primary pneumonic tularemia implicates lawn mowing and brush cutting as risk factors for this infection.

Source Information

From the Epidemic Intelligence Service (K.A.F., S.L.L.) and the National Center for Infectious Diseases (R.E.E., M.E.S., D.T.D., L.R.P., E.B.H.), Centers for Disease Control and Prevention, Fort Collins, Colo.; the Massachusetts Department of Public Health, Boston (B.T.M., M.M.); and the Martha's Vineyard Hospital, Oak Bluffs, Mass. (D.S.-E.).

Address reprint requests to Dr. Feldman at the Centers for Disease Control and Prevention, P.O. Box 2087, Rampart Rd., Fort Collins, CO 80522, or at kfeldman{at}cdc.gov.

Full Text of this Article