The status of tularemia in Europe in a one-health context: a review

Abstract

The bacterium Francisella tularensis causes the vector-borne zoonotic disease tularemia, and may infect a wide range of hosts including invertebrates, mammals and birds. Transmission to humans occurs through contact with infected animals or contaminated environments, or through arthropod vectors. Tularemia has a broad geographical distribution, and there is evidence which suggests local emergence or re-emergence of this disease in Europe. This review was developed to provide an update on the geographical distribution of F. tularensis in humans, wildlife, domestic animals and vector species, to identify potential public health hazards, and to characterize the epidemiology of tularemia in Europe. Information was collated on cases in humans, domestic animals and wildlife, and on reports of detection of the bacterium in arthropod vectors, from 38 European countries for the period 1992-2012. Multiple international databases on human and animal health were consulted, as well as published reports in the literature. Tularemia is a disease of complex epidemiology that is challenging to understand and therefore to control. Many aspects of this disease remain poorly understood. Better understanding is needed of the epidemiological role of animal hosts, potential vectors, mechanisms of maintenance in the different ecosystems, and routes of transmission of the disease.

Keywords: Animal pathogens; infectious disease; vectors; veterinary epidemiology and bacteriology; zoonoses.

Fig. 1.

Number of cases of tularemia by country and by year reported to the European Centre for Disease Prevention and Control (ECDC) and WHO databases between 1992 and 2012. Each country is represented by a different colour. Data for this figure come from Austria, Bosnia & Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Finland, France, Germany, Hungary, Italy, Latvia, Lithuania, Norway, Poland, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland and Turkey, but not all countries reported for the entire period.

Fig. 2.

Number of cases of tularemia by month recorded in the European Centre for Disease Prevention and Control (ECDC) database, 2008 to 2012 (n = 4388), with a 12-month moving average. Data for this figure come from Austria, Belgium, Cyprus, the Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Norway, Poland, Romania, Slovakia, Slovenia, Spain, Sweden and the UK.

Fig. 3.

Reported presence of tularemia in different host types across Europe 1992–2012, (a) presence in animals (reported in OIE database and literature), (b) presence in vectors (reported in literature), (c) presence in humans [reported in European Centre for Disease Prevention and Control (ECDC) and WHO-CISID databases for all countries except Switzerland and Turkey for which literature reports were used], and (d) type of human reporting at national level.

Fig. 4.

Number of cases of tularemia by month recorded in the European Centre for Disease Prevention and Control (ECDC) database (n = 5715), 2007 to 2012. Data for this figure has been reported by Austria, Belgium, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Norway, Poland, Romania, Slovakia, Slovenia, Spain, Sweden and the UK.