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Notifiable Diseases
Tularemia
Epidemiological data
Data for 2008
From January 1 to December 31, 2008, 108 cases of tularemia were reported to the Departmental Directorates of Health and Social Affairs and forwarded to the Institute for Public Health Surveillance (VS).
Among them, 12 were associated with 2 episodes of clustered cases and 96 cases were sporadic. There is a doubling of the number of sporadic cases from 2007 and 4 times more sporadic than the annual period 2003-2006.
Description of the 96 sporadic cases
Among the 96 patients, 62 were men, the ratio H / F was 1.8. The cases were aged 15 to 95 years (mean 50 years). All resided in France in 38 counties (Figure 1), except one case in Germany but resident diagnosed during a stay in Franche-Comte.
Figure 1 - Distribution by county of residence of cases of tularemia reported in France in 2008
The dates of onset of cases reported in 1st half of 2008 ranged from August 20, 2007 to May 15, 2008 (Figure 2).
Figure 2 - Distribution of cases of tularemia reported in France in 2008 when early signs
From a clinical perspective, 50 patients had a glandular form of tularemia and 24 cases a form ulcerative node. Ten patients with typhoid form, 7 patients with pneumonic form, 3 cases a form oropharyngeal, 2 cases a form oculo-glandular.
Forty-seven were hospitalized. For 2 patients, tularemia has evolved into a meningo-encephalitis, 4 patients developed an abscess from their lymphadenopathy and 1 patient presented a labyrinthitis. One patient died of tularemia.
A strain of Francisella tularensis was isolated in 9 patients and a positive PCR obtained for 19 patients. A positive serology was obtained for 71 patients. The strains isolated were from blood cultures (n = 5), conjunctival swab (n = 1), skin ulcer (n = 1), nodal puncture (n = 1) and CSF (n = 1) . The PCR positive were obtained from punctures or lymph node biopsies in 17 patients, a sample of whole blood for 3 patients, a serum for 2 patients and a punctured lung nodule for 1 patient.
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Forty-eight patients had manipulated hares and most patients reported contact with vertebrate animals possibly vectors of tularemia (Table 1). Seventeen patients reported a tick bite.
Table 1 - Exposure to animal cases of tularemia diagnosed in France in 2008
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<table border="1" bordercolor="#bacfe3" cellpadding="2" cellspacing="0"> <tbody><tr bgcolor="#bacfe3"> <td colspan="3" style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top"> Tableau 1 - Exposition aux animaux des cas de tular?mie diagnostiqu?s en France en 2008</td> </tr> <tr> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="137">
Fifteen patients were engaged in occupations exposing them directly to animals can transmit tularemia, tick-or to create an environment conducive to the presence of rodents: 9 farmers, professionals, 2 timber, 2 bakers, 1 carpenter, 1 professional Vine . Two patients were working in a laboratory contamination was probably professional.
Thirty five patients practiced various outdoor recreation known as risk factors (eg gardening). For 2 patients, found only exposure to risk was possibly carrying out development works in a house neglected and for 2 others, the practice of jogging in the forest.
For 10 patients, the examination did not reveal exposure to risk. All lived in rural areas in isolated homes.
For 5 of them, the diagnosis was established by bacterial isolation, PCR for 4 and 1 by serology. Among these 10 persons, 3 showed significant comorbidities favor the occurrence of infections and their diagnosis is based on bacterial isolation.
In 2007 and 2008, an increase in the number of reported cases of tularemia were recorded (Figure 3). No changes to the system of monitoring or advocacy can not explain the increase in the number of registered cases. Following the peak observed during the winter 2007/2008, the number of reported cases has declined to return to previous levels. This increase remains unexplained to this day.
Figure 3 - Distribution of cases of tularemia reported in France from 2003 to 2008 by date of onset of symptoms and date of declaration
Description of 12 cases grouped
During the first half of 2008, two episodes of clustered cases were reported.
The first episode involved 5 people infected in late 2007 by air on a hike in Spain in Castilla y Leon. At the same time, a large epidemic has been described by Spanish health authorities, whose origin was the proliferation of rodents near cereal crops just before harvest: http://www.eurosurveillance.org/ViewArticle. aspx? PublicationType = W & Volume = 12 & Issue = 45 & OrderNumber = 1
The second episode occurred in Languedoc Roussillon, involved 7 people, 5 of which were hospitalized at the Hospital of Millau. Six of 7 cases belonged to the same family, the 7th person was a friend of the family. Six lived in Aveyron and in the Pyrenees-Orientales. The 7 cases had fever and pharyngitis sudden onset of very painful and bulky lymphadenopathy, bilateral cluster, involving the neck and retro-pharyngeal. One case presented a swelling of the tongue. The diagnosis of tularemia was raised from admission to hospital and was confirmed by the National Reference Center of tularemia. The only exposure common to all cases is a meal that included a hare prepared with a recipe that does not allow the destruction of Francisella. Eight people attended the dinner, 7 who ate the hare was infected.
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Data for 2007
Du 1er janvier au 31 d?cembre 2007, 47 cas de tular?mie ont ?t? d?clar?s aux DDASS et transmis ? l?InVS.
Among these 47 patients, 18 (38%) were female and 29 (61%) men, the ratio H / F was 1.5. The cases were aged 2 to 88 years (mean 48.6 years, median 50 years). They resided in 28 counties (Figure 1).
Figure 1: Distribution by county of residence of cases of tularemia reported in France in 2007
The dates of onset of reported cases in 2007 ranged from 1 November 2006 to December 13, 2007 (Figure 2). The number of cases has significantly increased during the second half of 2007, no common origin identified.
Figure 2: Distribution of cases of tularemia reported in France in 2007 when the early signs
From a clinical perspective, 28 cases (60%) had a glandular form of tularemia, 12 cases (25%) ulcerative form node, 2 cases a form typhoid, 2 cases oropharyngeal form, 1 in a form pleuropulmonary, one case a liver granuloma and 1 patient had encephalitis.
The diagnosis was made by sero-agglutination test for 38 cases (80%) by polymerase chain reaction for 7 cases (15%) and isolation of a Francisella in a blood culture for 3 patients (6%).
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Twenty three patients (48%) had manipulated hares, wild boar 1 case, 2 cases of rabbits, rodents 4 and 2 patients had been scratched by a cat. Eight patients (17%) reported a tick bite.
During the year 2007, an increase in the number of reported cases has been registered, with a doubling of the number of cases compared to previous years. This increase predominantly in the second half
No outbreaks of clustered cases, and no common source has yet been identified. This increase remains unexplained to this day.
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2006 Data
From January 1 to December 31, 2006, 24 mandatory reporting of tularemia are received at the Institute for Public Health Surveillance (VS).
Among these 24 patients, the ratio H / F was 1.4. The cases were aged 23 to 68 years (mean 45 years) and residing in 20 counties (Figure 1). A significant proportion of cases (25%) is found in the great West as in previous years, but the majority of cases have been reported this year in Rhone-Alpes (30%). Compared to previous years, the number of reported cases in the great West is less than 50%. In contrast, the number of reported cases in Maharashtra has been multiplied by 3 compared to 2005.
Figure 1 - Distribution by county of residence of cases of tularemia reported in France in 2006
The dates of onset of reported cases in 2006 ranged from 1 October 2005 to November 11, 2006 (Figure 2). The distribution of dates of onset of symptoms is consistent throughout the year unlike in previous years.
Figure 2 - Distribution by month of onset of tularemia cases reported in 2006
Twelve cases (50%) had a glandular form of tularemia, 5 cases (21%) ulcerative form node, 3 cases (13%) as an oro-pharyngeal, 3 cases (13%) form typhoid and one case (4%) presented a form of ocular tularemia. Nearly half the cases were hospitalized (46%). The evolution of the disease was considered positive when the statement in 15 patients (63%), "ongoing" for 9 patients (37%).
The diagnosis was made by one or more techniques for each case: 11 patients (46%) were positive agglutination and 11 immuno-flurorescence indirect positive (46%), 4 were diagnosed by PCR (16%) and 2 patients (8%) the diagnosis was established by isolation of a strain of Francisella tularensis. The strain was isolated from an abscess of a finger for a case and the other from a swab of the ocular conjunctiva.
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Six cases (25%) had manipulated hares, 2 cases (8%) rodents, 4 (16%) rabbits. Seven patients (30%) reported a tick bite within the 15 days preceding the onset of symptoms. Ten cases (42%) regularly practiced gardening and 11 (46%) of outdoor recreation. All cases had one or more risk exposures in the 15 days preceding the symptoms.
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2005 data
The data presented here are based on mandatory reporting sheets received between January 1 and December 31, 2005. During this period, 23 cases of tularemia were reported.
Among these 23 patients, the ratio H / F was 2.3. The cases were aged 20 to 86 years (median 48 years and average 53 years) and residing in 16 departments. More than half of the cases resided in the great West (Deux-S?vres Sarthe and Indre-et-Loire), but more cases were reported in Rhone-Alpes region compared to previous years (which is consistent with Results of surveillance conducted on wildlife by ONCFS, showing a high prevalence among rabbits tested in Rhone-Alpes, Vaissaire J. Tularemia, a zoonotic disease monitoring. Bulletin des GTV 2001 :235-8 ).
Figure 1 - Geographical distribution by county of residence of cases of tularemia reported in France in 2005
The dates of onset of reported cases in 2005 ranged from July 22, 2004 to November 16, 2005 (Figure 2). Their reporting dates ranged from January 12, 2005 to December 29, 2005.
Figure 2 - Monthly distribution of dates of onset of tularemia cases reported in France in 2005
Fourteen cases (63.3%) had a glandular form of tularemia, and 7 (30%) form ulcerative glandular and 2 form typhoid (9.1%). Ten patients were hospitalized (45.5%). The evolution of the disease was considered positive when the declaration for 18 patients (78.3%), "ongoing" for 4 patients (18.2%) and one patient had a complication of infection (abscess and lymph node fistulization of the abscess).
The diagnosis was obtained by isolating a strain of Francisella tularensis in two patients (9.1%). In one case, isolation was obtained from the removal of a skin lesion and in both cases from a blood culture. The diagnosis was established by sero-agglutination test for 15 cases (65.2%) by IIF for 6 cases (27.3%), PCR for 5 cases (22.7%).
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Eleven cases (47.8%) had manipulated hares, 1 case (4.5%) wild boars, 2 cases (9%) of ruminants, 1 case (8%) rabbits, 1 case (4.5%) a dog and 3 cases (13.6%) poultry and one case had been bitten by a bat (4.5%). Four patients (18.2%) reported a tick bite within the 15 days preceding the onset of symptoms. Nine cases (39.1%) practiced regular gardening and 14 (63.3%) of outdoor recreation.
All cases had one or more risk exposures in the 15 days preceding the symptoms.
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2004 data
All reported cases of tularemia are subject to further questioning about their disease and risk factors using a standardized questionnaire. This investigation aims to confirm the diagnosis, to identify other cases related to cases reported to identify exposures that can cause infection and elements suggestive malevolence.
During the year, 21 cases of tularemia were reported. All were investigated.
Among these 21 cases, the ratio H / F was 2.5. The cases were aged 27 to 85 years (median and average 54 years) and residing in 11 counties (Figure 1). A third lived in Deux-Sevres.
Figure 1 - Department of Residence cases of tularemia cases reported in France in 2004
Les dates de d?but des sympt?mes des cas d?clar?s en 2004 s??chelonnaient du 14 octobre 2003 au 18 novembre 2004 (figure 2).
Figure 2 - Month of the early symptoms of tularemia cases reported in France in 2004
The most common symptoms were fever (95%) and the presence of lymph node (s) (90%). Lymph nodes involved axillary lymph nodes in most cases (67%) and tended to the abscess in 6 cases (29%). The frequency of symptoms presented by the case is presented in Table 1.
Table 1 - Frequency of symptoms presented by cases of tularemia cases reported in France in 2004
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Sixteen of the 21 cases (76%) were carriers of a skin wound occurred in the 15 days preceding the symptoms. The conditions of occurrence of the injury, location, description, and its evolution have found that this plague was probably the entrance of the germ for the 16 patients.
Twelve cases (57%) had a glandular form of tularemia, 5 (24%) ulcerative form node, 3 cases (14%) form typhoid and one case (5%) oropharyngeal form. Twelve cases were hospitalized, the outcome was favorable in all cases.
The median time between symptom onset and diagnosis was 33 days (min 1 day, max 136 days).
The diagnosis was obtained by sero-agglutination test for 17 cases (81%) by PCR for 4 cases (19%) and isolation of the germ to a single case (5%).
Eleven cases (52%) received treatment with doxycycline, 5 cases (23%) received a quinolone, and 2 cases (10%) of amoxicillin. In 4 cases (19%), surgical treatment of lymph node abscess was necessary.
The median time between diagnosis and reporting of cases to Ddass was 16 days (2 to 146 days). The median time between diagnosis and receipt of alert to InVS was 29 days (3 to 147 days).
Risk exposures were collected for 25 cases during the 15 days preceding the onset of symptoms. Nine cases (43%) had occupations that may expose them to tularemia: 1 vegetable, 4 farmers, 2 laborers, 1 landscape and 1 laboratory technician. Nineteen cases (90%) lived or had lived in rural areas. Eight cases (38%) had manipulated hares, wild boars 3 cases, 3 cases of deer, rabbits, 6 cases. Among them, 8 cases (38%) were butchered at least one animal from the hunt. Six cases reported a tick bite within the 15 days preceding the onset of symptoms.
Eighteen cases (86%) practiced regular gardening.
All cases had one or more risk exposures in the 15 days preceding the symptoms.
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Data mid 2002-2003
Tularemia is historically known in France as a disease of hunters and their wives whose contamination is most often result in direct contact with the carcass of a hare. Mandatory reporting (OD) of tularemia existed until 1986 and was restored in October 2002, due to the possible use of the bacterium causing the disease as an agent of bioterrorism. All reports are subject to further questioning about their disease and risk factors using a standardized questionnaire. This investigation aims to confirm the diagnosis, to identify other cases related to cases reported to identify exposures that can cause infection and elements suggestive malevolence. The data presented here cover the period from 1 October 2002, start date of the "new" DO tularemia, to December 31, 2003.
During this period, 33 cases of tularemia were reported. Among them, 5 were excluded for not meeting the case definition. Twenty-five cases have been investigated.
Among these 25 cases, the ratio H / F was 1.5. The cases were aged 27 to 74 years (median 48 years) and residing in 18 counties (Figure 1).
Figure 1 - Department of Residence cases of tularemia cases reported in France between 1 October 2002 and December 31, 2003
The dates of onset of cases ranged from August 31, 2002 to November 15, 2003 (Figure 2).
Figure 2 - Month of the early symptoms of tularemia cases reported in France between 1 October 2002 and December 31, 2003
The most common symptoms were the presence of lymph node (s) (96% of cases) and fever (92%). Lymph nodes involved axillary lymph nodes and / or groin for most cases (16/25) and have evolved into the abscess in 6 cases (24%). The frequency of symptoms presented by the case is presented in Table 1.
Table 1 - Frequency of symptoms presented by cases of tularemia cases reported in France between 1 October 2002 and December 31, 2003
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Seventeen of the 25 cases (68%) were carriers of a skin wound occurred in the 15 days preceding the symptoms. For 12 cases (48%), conditions of occurrence of the injury, location, description, and its evolution have found that this plague was probably the entrance of the germ.
Sixteen cases (64%) had a glandular form of tularemia, 5 (20%) ulcerative form node, two (8%) as an eye-node, one case (4%) septicemic form and one case (4 %) a pneumonic form. Twelve cases were hospitalized, the outcome was favorable in all cases.
The median time between symptom onset and diagnosis was 22 days (min 1 day, max 52 days).
The diagnosis was obtained by sero-agglutination test for 22 cases (88%) by PCR for 4 cases (16%) and isolation of the germ to a single case (4%).
Seventeen cases (68%) received treatment with doxycycline, 6 cases (24%) received a quinolone, 4 cases (16%) of amoxicillin, 3 cases (12%) an aminoglycoside, 3 cases (12%) a beta-lactam (other than amoxicillin), 3 cases (12%) a macrolide. In seven cases (28%), surgical treatment of the lymph node was needed.
The median time between diagnosis and reporting of cases to Ddass was 26.5 days (4 to 188 days). The median time between diagnosis and receipt of alert to InVS was 42 days (4 to 190 days).
Risk exposures were collected for 25 cases during the 15 days preceding the onset of symptoms. Five cases (20%) had occupations that may expose them to tularemia, a nursery, two farmers, a gamekeeper and a seller of farm machinery. Twenty-one cases (84%) lived or had lived in rural areas. Fourteen cases (60%) had manipulated hares, wild boars 5 cases, 4 cases of deer, 2 cases of rabbits. Among them, 16 cases (64%) were butchered at least one animal from the hunt. Four cases reported a tick bite within the 15 days preceding the onset of symptoms.
Fourteen cases (60%) regularly practiced gardening, 3 had a filling done and a case was made earthworks.
Twenty-four cases had one or more risk exposures in the 15 days preceding the symptoms. In one case, no exposure to risk has been found during the 15 days preceding the symptoms. In this case, the extension of the interrogation to a longer period showed a history of febrile syndrome with lymphadenopathy occurred several months ago and has not led to a consultation. Exposures to risk have been found in the two weeks preceding the earlier episode. The diagnosis of this case was based solely on PCR.
Institut de Veille Sanitaire
Posted online July 15, 2004
Updated September 9, 2009 CONTACTS
Notifiable Diseases
Tularemia
Epidemiological data
Data for 2008
From January 1 to December 31, 2008, 108 cases of tularemia were reported to the Departmental Directorates of Health and Social Affairs and forwarded to the Institute for Public Health Surveillance (VS).
Among them, 12 were associated with 2 episodes of clustered cases and 96 cases were sporadic. There is a doubling of the number of sporadic cases from 2007 and 4 times more sporadic than the annual period 2003-2006.
Description of the 96 sporadic cases
Among the 96 patients, 62 were men, the ratio H / F was 1.8. The cases were aged 15 to 95 years (mean 50 years). All resided in France in 38 counties (Figure 1), except one case in Germany but resident diagnosed during a stay in Franche-Comte.
Figure 1 - Distribution by county of residence of cases of tularemia reported in France in 2008
The dates of onset of cases reported in 1st half of 2008 ranged from August 20, 2007 to May 15, 2008 (Figure 2).
Figure 2 - Distribution of cases of tularemia reported in France in 2008 when early signs
From a clinical perspective, 50 patients had a glandular form of tularemia and 24 cases a form ulcerative node. Ten patients with typhoid form, 7 patients with pneumonic form, 3 cases a form oropharyngeal, 2 cases a form oculo-glandular.
Forty-seven were hospitalized. For 2 patients, tularemia has evolved into a meningo-encephalitis, 4 patients developed an abscess from their lymphadenopathy and 1 patient presented a labyrinthitis. One patient died of tularemia.
A strain of Francisella tularensis was isolated in 9 patients and a positive PCR obtained for 19 patients. A positive serology was obtained for 71 patients. The strains isolated were from blood cultures (n = 5), conjunctival swab (n = 1), skin ulcer (n = 1), nodal puncture (n = 1) and CSF (n = 1) . The PCR positive were obtained from punctures or lymph node biopsies in 17 patients, a sample of whole blood for 3 patients, a serum for 2 patients and a punctured lung nodule for 1 patient.
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Forty-eight patients had manipulated hares and most patients reported contact with vertebrate animals possibly vectors of tularemia (Table 1). Seventeen patients reported a tick bite.
Table 1 - Exposure to animal cases of tularemia diagnosed in France in 2008
<title>HTML clipboard</title><meta name="GENERATOR" content="Microsoft FrontPage 5.0"><meta name="ProgId" content="FrontPage.Editor.Document">
<table border="1" bordercolor="#bacfe3" cellpadding="2" cellspacing="0"> <tbody><tr bgcolor="#bacfe3"> <td colspan="3" style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top"> Tableau 1 - Exposition aux animaux des cas de tular?mie diagnostiqu?s en France en 2008</td> </tr> <tr> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="137">
Type d?exposition
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="201"> Esp?ces animales
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="138"> Nombre de patientsexpos?s
</td> </tr> <tr> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="137"> Gibier
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="201"> Li?vres
Sangliers
Chevreuils
Gibiers ? poil non pr?cis?
Gibiers ? plume
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="138"> 48
7
8
3
4
</td> </tr> <tr> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="137"> Animaux d??levage
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="201"> Bovins
Lapins
Ovins-caprins
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="138"> 2
9
4
</td> </tr> <tr> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="137"> Animaux de
compagnie ou loisir
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="201"> Chiens
Chats
Chevaux
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="138"> 10
4
1
</td> </tr> <tr> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="137"> Animaux sauvages
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="201"> Rongeurs (contact accidentel)
</td> <td style="font-family: Arial,Helvetica; font-size: 9pt;" valign="top" width="138"> 10
</td> </tr> </tbody></table> Fifteen patients were engaged in occupations exposing them directly to animals can transmit tularemia, tick-or to create an environment conducive to the presence of rodents: 9 farmers, professionals, 2 timber, 2 bakers, 1 carpenter, 1 professional Vine . Two patients were working in a laboratory contamination was probably professional.
Thirty five patients practiced various outdoor recreation known as risk factors (eg gardening). For 2 patients, found only exposure to risk was possibly carrying out development works in a house neglected and for 2 others, the practice of jogging in the forest.
For 10 patients, the examination did not reveal exposure to risk. All lived in rural areas in isolated homes.
For 5 of them, the diagnosis was established by bacterial isolation, PCR for 4 and 1 by serology. Among these 10 persons, 3 showed significant comorbidities favor the occurrence of infections and their diagnosis is based on bacterial isolation.
In 2007 and 2008, an increase in the number of reported cases of tularemia were recorded (Figure 3). No changes to the system of monitoring or advocacy can not explain the increase in the number of registered cases. Following the peak observed during the winter 2007/2008, the number of reported cases has declined to return to previous levels. This increase remains unexplained to this day.
Figure 3 - Distribution of cases of tularemia reported in France from 2003 to 2008 by date of onset of symptoms and date of declaration
Description of 12 cases grouped
During the first half of 2008, two episodes of clustered cases were reported.
The first episode involved 5 people infected in late 2007 by air on a hike in Spain in Castilla y Leon. At the same time, a large epidemic has been described by Spanish health authorities, whose origin was the proliferation of rodents near cereal crops just before harvest: http://www.eurosurveillance.org/ViewArticle. aspx? PublicationType = W & Volume = 12 & Issue = 45 & OrderNumber = 1
The second episode occurred in Languedoc Roussillon, involved 7 people, 5 of which were hospitalized at the Hospital of Millau. Six of 7 cases belonged to the same family, the 7th person was a friend of the family. Six lived in Aveyron and in the Pyrenees-Orientales. The 7 cases had fever and pharyngitis sudden onset of very painful and bulky lymphadenopathy, bilateral cluster, involving the neck and retro-pharyngeal. One case presented a swelling of the tongue. The diagnosis of tularemia was raised from admission to hospital and was confirmed by the National Reference Center of tularemia. The only exposure common to all cases is a meal that included a hare prepared with a recipe that does not allow the destruction of Francisella. Eight people attended the dinner, 7 who ate the hare was infected.
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Data for 2007
Du 1er janvier au 31 d?cembre 2007, 47 cas de tular?mie ont ?t? d?clar?s aux DDASS et transmis ? l?InVS.
Among these 47 patients, 18 (38%) were female and 29 (61%) men, the ratio H / F was 1.5. The cases were aged 2 to 88 years (mean 48.6 years, median 50 years). They resided in 28 counties (Figure 1).
Figure 1: Distribution by county of residence of cases of tularemia reported in France in 2007
The dates of onset of reported cases in 2007 ranged from 1 November 2006 to December 13, 2007 (Figure 2). The number of cases has significantly increased during the second half of 2007, no common origin identified.
Figure 2: Distribution of cases of tularemia reported in France in 2007 when the early signs
From a clinical perspective, 28 cases (60%) had a glandular form of tularemia, 12 cases (25%) ulcerative form node, 2 cases a form typhoid, 2 cases oropharyngeal form, 1 in a form pleuropulmonary, one case a liver granuloma and 1 patient had encephalitis.
The diagnosis was made by sero-agglutination test for 38 cases (80%) by polymerase chain reaction for 7 cases (15%) and isolation of a Francisella in a blood culture for 3 patients (6%).
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Twenty three patients (48%) had manipulated hares, wild boar 1 case, 2 cases of rabbits, rodents 4 and 2 patients had been scratched by a cat. Eight patients (17%) reported a tick bite.
During the year 2007, an increase in the number of reported cases has been registered, with a doubling of the number of cases compared to previous years. This increase predominantly in the second half
No outbreaks of clustered cases, and no common source has yet been identified. This increase remains unexplained to this day.
TOP OF PAGE
2006 Data
From January 1 to December 31, 2006, 24 mandatory reporting of tularemia are received at the Institute for Public Health Surveillance (VS).
Among these 24 patients, the ratio H / F was 1.4. The cases were aged 23 to 68 years (mean 45 years) and residing in 20 counties (Figure 1). A significant proportion of cases (25%) is found in the great West as in previous years, but the majority of cases have been reported this year in Rhone-Alpes (30%). Compared to previous years, the number of reported cases in the great West is less than 50%. In contrast, the number of reported cases in Maharashtra has been multiplied by 3 compared to 2005.
Figure 1 - Distribution by county of residence of cases of tularemia reported in France in 2006
The dates of onset of reported cases in 2006 ranged from 1 October 2005 to November 11, 2006 (Figure 2). The distribution of dates of onset of symptoms is consistent throughout the year unlike in previous years.
Figure 2 - Distribution by month of onset of tularemia cases reported in 2006
Twelve cases (50%) had a glandular form of tularemia, 5 cases (21%) ulcerative form node, 3 cases (13%) as an oro-pharyngeal, 3 cases (13%) form typhoid and one case (4%) presented a form of ocular tularemia. Nearly half the cases were hospitalized (46%). The evolution of the disease was considered positive when the statement in 15 patients (63%), "ongoing" for 9 patients (37%).
The diagnosis was made by one or more techniques for each case: 11 patients (46%) were positive agglutination and 11 immuno-flurorescence indirect positive (46%), 4 were diagnosed by PCR (16%) and 2 patients (8%) the diagnosis was established by isolation of a strain of Francisella tularensis. The strain was isolated from an abscess of a finger for a case and the other from a swab of the ocular conjunctiva.
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Six cases (25%) had manipulated hares, 2 cases (8%) rodents, 4 (16%) rabbits. Seven patients (30%) reported a tick bite within the 15 days preceding the onset of symptoms. Ten cases (42%) regularly practiced gardening and 11 (46%) of outdoor recreation. All cases had one or more risk exposures in the 15 days preceding the symptoms.
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2005 data
The data presented here are based on mandatory reporting sheets received between January 1 and December 31, 2005. During this period, 23 cases of tularemia were reported.
Among these 23 patients, the ratio H / F was 2.3. The cases were aged 20 to 86 years (median 48 years and average 53 years) and residing in 16 departments. More than half of the cases resided in the great West (Deux-S?vres Sarthe and Indre-et-Loire), but more cases were reported in Rhone-Alpes region compared to previous years (which is consistent with Results of surveillance conducted on wildlife by ONCFS, showing a high prevalence among rabbits tested in Rhone-Alpes, Vaissaire J. Tularemia, a zoonotic disease monitoring. Bulletin des GTV 2001 :235-8 ).
Figure 1 - Geographical distribution by county of residence of cases of tularemia reported in France in 2005
The dates of onset of reported cases in 2005 ranged from July 22, 2004 to November 16, 2005 (Figure 2). Their reporting dates ranged from January 12, 2005 to December 29, 2005.
Figure 2 - Monthly distribution of dates of onset of tularemia cases reported in France in 2005
Fourteen cases (63.3%) had a glandular form of tularemia, and 7 (30%) form ulcerative glandular and 2 form typhoid (9.1%). Ten patients were hospitalized (45.5%). The evolution of the disease was considered positive when the declaration for 18 patients (78.3%), "ongoing" for 4 patients (18.2%) and one patient had a complication of infection (abscess and lymph node fistulization of the abscess).
The diagnosis was obtained by isolating a strain of Francisella tularensis in two patients (9.1%). In one case, isolation was obtained from the removal of a skin lesion and in both cases from a blood culture. The diagnosis was established by sero-agglutination test for 15 cases (65.2%) by IIF for 6 cases (27.3%), PCR for 5 cases (22.7%).
Risk exposures collected on the form DO affect the 15 days preceding the onset of symptoms. Eleven cases (47.8%) had manipulated hares, 1 case (4.5%) wild boars, 2 cases (9%) of ruminants, 1 case (8%) rabbits, 1 case (4.5%) a dog and 3 cases (13.6%) poultry and one case had been bitten by a bat (4.5%). Four patients (18.2%) reported a tick bite within the 15 days preceding the onset of symptoms. Nine cases (39.1%) practiced regular gardening and 14 (63.3%) of outdoor recreation.
All cases had one or more risk exposures in the 15 days preceding the symptoms.
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2004 data
All reported cases of tularemia are subject to further questioning about their disease and risk factors using a standardized questionnaire. This investigation aims to confirm the diagnosis, to identify other cases related to cases reported to identify exposures that can cause infection and elements suggestive malevolence.
During the year, 21 cases of tularemia were reported. All were investigated.
Among these 21 cases, the ratio H / F was 2.5. The cases were aged 27 to 85 years (median and average 54 years) and residing in 11 counties (Figure 1). A third lived in Deux-Sevres.
Figure 1 - Department of Residence cases of tularemia cases reported in France in 2004
Les dates de d?but des sympt?mes des cas d?clar?s en 2004 s??chelonnaient du 14 octobre 2003 au 18 novembre 2004 (figure 2).
Figure 2 - Month of the early symptoms of tularemia cases reported in France in 2004
The most common symptoms were fever (95%) and the presence of lymph node (s) (90%). Lymph nodes involved axillary lymph nodes in most cases (67%) and tended to the abscess in 6 cases (29%). The frequency of symptoms presented by the case is presented in Table 1.
Table 1 - Frequency of symptoms presented by cases of tularemia cases reported in France in 2004
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Sixteen of the 21 cases (76%) were carriers of a skin wound occurred in the 15 days preceding the symptoms. The conditions of occurrence of the injury, location, description, and its evolution have found that this plague was probably the entrance of the germ for the 16 patients.
Twelve cases (57%) had a glandular form of tularemia, 5 (24%) ulcerative form node, 3 cases (14%) form typhoid and one case (5%) oropharyngeal form. Twelve cases were hospitalized, the outcome was favorable in all cases.
The median time between symptom onset and diagnosis was 33 days (min 1 day, max 136 days).
The diagnosis was obtained by sero-agglutination test for 17 cases (81%) by PCR for 4 cases (19%) and isolation of the germ to a single case (5%).
Eleven cases (52%) received treatment with doxycycline, 5 cases (23%) received a quinolone, and 2 cases (10%) of amoxicillin. In 4 cases (19%), surgical treatment of lymph node abscess was necessary.
The median time between diagnosis and reporting of cases to Ddass was 16 days (2 to 146 days). The median time between diagnosis and receipt of alert to InVS was 29 days (3 to 147 days).
Risk exposures were collected for 25 cases during the 15 days preceding the onset of symptoms. Nine cases (43%) had occupations that may expose them to tularemia: 1 vegetable, 4 farmers, 2 laborers, 1 landscape and 1 laboratory technician. Nineteen cases (90%) lived or had lived in rural areas. Eight cases (38%) had manipulated hares, wild boars 3 cases, 3 cases of deer, rabbits, 6 cases. Among them, 8 cases (38%) were butchered at least one animal from the hunt. Six cases reported a tick bite within the 15 days preceding the onset of symptoms.
Eighteen cases (86%) practiced regular gardening.
All cases had one or more risk exposures in the 15 days preceding the symptoms.
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Data mid 2002-2003
Tularemia is historically known in France as a disease of hunters and their wives whose contamination is most often result in direct contact with the carcass of a hare. Mandatory reporting (OD) of tularemia existed until 1986 and was restored in October 2002, due to the possible use of the bacterium causing the disease as an agent of bioterrorism. All reports are subject to further questioning about their disease and risk factors using a standardized questionnaire. This investigation aims to confirm the diagnosis, to identify other cases related to cases reported to identify exposures that can cause infection and elements suggestive malevolence. The data presented here cover the period from 1 October 2002, start date of the "new" DO tularemia, to December 31, 2003.
During this period, 33 cases of tularemia were reported. Among them, 5 were excluded for not meeting the case definition. Twenty-five cases have been investigated.
Among these 25 cases, the ratio H / F was 1.5. The cases were aged 27 to 74 years (median 48 years) and residing in 18 counties (Figure 1).
Figure 1 - Department of Residence cases of tularemia cases reported in France between 1 October 2002 and December 31, 2003
The dates of onset of cases ranged from August 31, 2002 to November 15, 2003 (Figure 2).
Figure 2 - Month of the early symptoms of tularemia cases reported in France between 1 October 2002 and December 31, 2003
The most common symptoms were the presence of lymph node (s) (96% of cases) and fever (92%). Lymph nodes involved axillary lymph nodes and / or groin for most cases (16/25) and have evolved into the abscess in 6 cases (24%). The frequency of symptoms presented by the case is presented in Table 1.
Table 1 - Frequency of symptoms presented by cases of tularemia cases reported in France between 1 October 2002 and December 31, 2003
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Seventeen of the 25 cases (68%) were carriers of a skin wound occurred in the 15 days preceding the symptoms. For 12 cases (48%), conditions of occurrence of the injury, location, description, and its evolution have found that this plague was probably the entrance of the germ.
Sixteen cases (64%) had a glandular form of tularemia, 5 (20%) ulcerative form node, two (8%) as an eye-node, one case (4%) septicemic form and one case (4 %) a pneumonic form. Twelve cases were hospitalized, the outcome was favorable in all cases.
The median time between symptom onset and diagnosis was 22 days (min 1 day, max 52 days).
The diagnosis was obtained by sero-agglutination test for 22 cases (88%) by PCR for 4 cases (16%) and isolation of the germ to a single case (4%).
Seventeen cases (68%) received treatment with doxycycline, 6 cases (24%) received a quinolone, 4 cases (16%) of amoxicillin, 3 cases (12%) an aminoglycoside, 3 cases (12%) a beta-lactam (other than amoxicillin), 3 cases (12%) a macrolide. In seven cases (28%), surgical treatment of the lymph node was needed.
The median time between diagnosis and reporting of cases to Ddass was 26.5 days (4 to 188 days). The median time between diagnosis and receipt of alert to InVS was 42 days (4 to 190 days).
Risk exposures were collected for 25 cases during the 15 days preceding the onset of symptoms. Five cases (20%) had occupations that may expose them to tularemia, a nursery, two farmers, a gamekeeper and a seller of farm machinery. Twenty-one cases (84%) lived or had lived in rural areas. Fourteen cases (60%) had manipulated hares, wild boars 5 cases, 4 cases of deer, 2 cases of rabbits. Among them, 16 cases (64%) were butchered at least one animal from the hunt. Four cases reported a tick bite within the 15 days preceding the onset of symptoms.
Fourteen cases (60%) regularly practiced gardening, 3 had a filling done and a case was made earthworks.
Twenty-four cases had one or more risk exposures in the 15 days preceding the symptoms. In one case, no exposure to risk has been found during the 15 days preceding the symptoms. In this case, the extension of the interrogation to a longer period showed a history of febrile syndrome with lymphadenopathy occurred several months ago and has not led to a consultation. Exposures to risk have been found in the two weeks preceding the earlier episode. The diagnosis of this case was based solely on PCR.
Institut de Veille Sanitaire
Posted online July 15, 2004
Updated September 9, 2009 CONTACTS