All about the Rise of Rare "Rabbit Fever" Infections in the US !

A very recent report from the U.S. Centers for Disease Control and Prevention (CDC) highlights a notable rise in tularemia, also known as "rabbit fever," within the US over the last decade. The report also reveals concerning new transmission methods: mowing over nests of infected animals can aerosolize the bacteria, which can unknowingly expose it to the person operating the mower to the infection.

This particular mode of transmission was first identified in 2000 at a Massachusetts vineyard, where an outbreak lasted for six months, leading to 15 confirmed cases and one death. In the same way, some of the cases reported in Colorado during 2014-2015 were related to lawn mowing.

Tularemia is a bacterial infection caused by Francisella tularensis, which humans can contract through various means, which includes bites from infected ticks and deer flies, or direct contact with infected animals such as rabbits, hares, and rodents, which are particularly vulnerable to the disease, as reported by the Science Alert. The CDC monitors this bacterium very discreetly, as it is classified as a Tier 1 Select Agent by the U.S. government due to its high potential for bioterrorism. Moreover, tularemia can be fatal without proper treatment when transmitted in a natural way.

"The case fatality rate of tularemia is typically below 2%, though it can be higher depending on the clinical presentation and bacterial strain," noted the CDC report authors for their reference. Although tularemia is relatively rare, with only 2,462 reported cases across 47 states between 2011 and 2022, it still occurs with an approximate rate of one case per 200,000 people. The CDC estimates that around 1.35M cases of Salmonella occur annually. The number of tularemia cases during this period was 56% higher than in 2001-2010, partly due to improved case identification. Since 2017, the CDC has included some cases where Francisella tularensis was detected via polymerase chain reaction (PCR) in the "probable case" count. Earlier, probable cases were only counted if symptoms and molecular markers of the bacteria were present.

To confirm a tularemia diagnosis, a bacterial sample must be taken from the patient’s body, or there must be a major change in antibody levels in blood tests. Between the years 2011 and 2022, there were 984 confirmed cases and 1,475 probable cases, with the latter accounting for 60% of the total. This marks a big change from earlier periods. The CDC noted down, "Increased reporting of probable cases might reflect an actual rise in human infections, improved detection methods, or both." Variations in laboratory testing methods over many years may have also influenced the data.

This disease disproportionately affects certain groups, with incidence rates among Native Americans and Alaska Natives being about 5 times higher than those of White individuals. The authors of the report have highly suggested that factors such as the geographic concentration of Native American reservations in central states and cultural or occupational activities increasing exposure to infected wildlife or arthropods could contribute to this disparity.

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