Skip to main content Accessibility help

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

  • G. HESTVIK (a1) (a2), E. WARNS-PETIT (a3), L. A. SMITH (a4), N. J. FOX (a4), H. UHLHORN (a1), M. ARTOIS (a5), D. HANNANT (a6), M. R. HUTCHINGS (a4), R. MATTSSON (a1), L. YON (a6) and D. GAVIER-WIDEN (a1) (a2)...


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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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


Corresponding author

* Author for correspondence: Ms. G. Hestvik, Department of Pathology and Wildlife Diseases, National Veterinary Institute, SE-751 89, Uppsala, Sweden. (Email:


Hide All
1. Olsufjev, NG. Tularemia. In: Pavlovsky, YN, ed. Human Diseases with Natural Foci. Moscow: Foreign Languages Publishing House, 1963, pp. 219281.
2. Friend, M. Tularemia. US Geological Survey, Circular 1297. Reston. 2006, pp. 1–61, 63–67.
3. Keim, P, Johansson, A, Wagner, DM. Molecular epidemiology, evolution, and ecology of Francisella. Annals of the New York Academy of Sciences 2007; 1105: 3066.
4. Morner, T. The ecology of tularaemia. Revue Scientifique et Technique de l'Office International des Epizooties 1992; 11: 11231130.
5. Tarnvik, A, Priebe, HS, Grunow, R. Tularaemia in Europe: an epidemiological overview. Scandinavian Journal of Infectious Diseases 2004; 36: 350355.
6. Splettstoesser, WD, et al. Tularemia in Germany: the tip of the iceberg? Epidemiology and Infection 2009; 137: 736743.
7. Hoflechner-Poltl, A, et al. Prevalence of tularaemia and brucellosis in European brown hares (Lepus europaeus) and red foxes (Vulpes vulpes) in Austria. Tierarztliche Umschau 2000; 55: 264268.
8. Muller, W, et al. Detection of Francisella tularensis subsp holarctica in a European brown hare (Lepus europaeus) in Thuringia, Germany. Veterinary Microbiology 2007; 123: 225229.
9. Hofer, E, et al. Isolation of Francisella tularensis and Brucella suis from red foxes (Vulpes vulpes). Tierärztliche Umschau 2010; 65: 229232.
10. Kuehn, A, et al. Tularaemia seroprevalence of captured and wild animals in Germany: the fox (Vulpes vulpes) as a biological indicator. Epidemiology and Infection 2013; 141: 833840.
11. Diaz de Tuesta, AM, et al. Tularemia outbreak in the province of Cuenca associated with crab handling [in Spanish]. Revista Clinica Espanola 2001; 201: 385389.
12. Balci, E, et al. Tularemia outbreaks in Kayseri, Turkey: an evaluation of the effect of climate change and climate variability on tularemia outbreaks. Journal of Infection and Public Health 2013; 7: 125132.
13. Grunow, R, et al. Surveillance of tularaemia in Kosovo, 2001 to 2010. Eurosurveillance 2012; 17.
14. Commission of the European Communities. Decision No. 2119/98/EC of the European Parliament and of the Council, consolidated version 20120927 ( Accessed 7 May 2014.
15. ECDC. Database of the European Centre for Disease Prevention and Control (ECDC) ( Accessed 7 May 2014.
16. World Health Organization Centralized Information System for Infectious Diseases. WHO-CISID database ( Accessed 7 Mai 2014.
17. European Commission. Eurostat population data ( Accessed 7 Mai 2014.
18. Leblebicioglu, H, et al. Outbreak of tularemia: a case-control study and environmental investigation in Turkey. International Journal of Infectious Diseases 2008; 12: 265269.
19. Wicki, R, et al. Swiss Army survey in Switzerland to determine the prevalence of Francisella tularensis, members of the Ehrlichia phagocytophila genogroup, Borrelia burgdorferi sensu lato, and tick-borne encephalitis virus in ticks. European Journal of Clinical Microbiology & Infectious Diseases 2000; 19: 427432.
20. Council of the European Communities. Council Directive 82/894/EEC on the notification of animal diseases within the Community amended and consolidated version 20130101 ( Accessed 7 Mai 2014.
21. World Organization for Animal Health, OIE ( Accessed 3 April 2014.
22. World Animal Health Information Database. Handistatus II ( Accessed 10 March 2014.
23. World Animal Health Information Database (WAHID). ( Accessed 10 March 2014.
24. Global Administrative Areas ( Accessed 26 November 2013.
25. Akalin, H, Helvaci, S, Gedikoglu, S. Re-emergence of tularemia in Turkey. International Journal of Infectious Diseases 2009; 13: 547551.
26. Tarnvik, A (ed.). WHO Guidelines on Tularemia: Epidemic and Pandemic Alert and Responses. Geneva: WHO Press, 2007, pp. 1115.
27. Ekdahl, K, Twisselmann, B. Epidemics of tularaemia in Sweden and Finland. Eurosurveillance 2001; 5: 1825.
28. Kuusi, M, Klemets, P, Nuorti, P. Outbreak of tularaemia in Finland. Eurosurveilllance 2000; 4: 1547.
29 Mailles, A, et al. Unexpected increase of human and animal tularemia cases during winter 2007/2008 in France: emergence or short-lasting episode? Medecine et Maladies Infectieuses 2010; 40: 279284.
30. Splettstoesser, WD, Seibold, E. Re-emerging of tularemia in Germany: real increase in incidence or consequence of a raised awareness in public health and diagnostic microbiology? International Journal of Medical Microbiology 2009; 299: 105.
31. Reintjes, R, et al. Tularemia outbreak investigation in Kosovo: case control and environmental studies. Emerging Infectious Diseases 2002; 8: 6973.
32. Lyko, C, Chuard, C. Tularemia, an emerging disease in Switzerland [in French]. Revue Médical Suisse 2013; 9: 18161818, 1820.
33. Morner, T, et al. Infections with Francisella tularensis biovar palaearctica in hares (Lepus timidus, Lepus europaeus) from Sweden. Journal of Wildlife Diseases 1988; 24: 422433.
34. Gyuranecz, M, et al. Factors Influencing emergence of tularemia, Hungary, 1984–2010. Emerging Infectious Diseases 2012; 18: 13791381.
35. Gyuranecz, M, et al. Tularemia of European brown hare (Lepus europaeus): a pathological, histopathological, and immunohistochemical study. Veterinary Pathology 2010; 47: 958963.
36. Vikoren, T, Handeland, K, Djonne, B. Several cases of tularemia diagnosed in hares in southern Norway. Norsk Veterinaertidskrift 2008: 120.
37. Vikoren, T, Djonne, B. Tularaemia (harepest) found in a hare in Akerhus. Norsk Veterinartidsskrift 2008; 120: 388.
38. Josefsen, TD, et al. Tularaemia in Finnmark. Norsk Veterinartidsskrift 2012; 124: 173174.
39. Decors, A, et al. Outbreak of tularaemia in brown hares (Lepus europaeus) in France, January to March 2011. Eurosurveillance 2011; 16: 35.
40. Gyuranecz, M, et al. Investigation of the ecology of Francisella tularensis during an inter-epizootic period. Vector-Borne and Zoonotic Diseases 2011; 11: 10311035.
41. Kaysser, P, et al. Re-emergence of tularemia in Germany: presence of Francisella tularensis in different rodent species in endemic areas. BMC Infectious Diseases 2008; 8.
42. Ryser-Degiorgis, MP, et al. Epizootiologic investigations of selected infectious disease agents in free-ranging Eurasian lynx from Sweden. Journal of Wildlife Diseases 2005; 41: 5866.
43. Berdal, BP, et al. Field investigations of tularemia in Norway. FEMS Immunology and Medical Microbiology 1996; 13: 191195.
44. Morner, T, Sandstrom, G, Mattsson, R. Comparison of serum and lung extracts for surveys of wild animals for antibodies to Francisella tularensis biovar palaearctica . Journal of Wildlife Diseases 1988; 24: 1014.
45. Morner, T, Sandstedt, K. A serologic survey of antibodies against Francisella tularensis in some Swedish mammals. Nordisk Veterinaer Medicin 1983; 35: 8285.
46. Hauri, AM, et al. Investigating an airborne tularemia outbreak, Germany. Emerging Infectious Diseases 2010; 16: 238243.
47. Runge, M, et al. Prevalence of Francisella tularensis in brown hare (Lepus europaeus) populations in Lower Saxony, Germany. European Journal of Wildlife Research 2011; 57: 10851089.
48. Lamarque, F, Barrat, J, Moutou, F. Principal diagnoses for determining causes of mortality in the European brown hare (Lepus europaeus) found dead in France between 1986 and 1994. Gibier Faune Sauvage 1996; 13: 5372.
49. Haerer, G, et al. Causes of mortality, zoonoses and reproductive performance in European brown hare in Switzerland. Schweizer Archiv fur Tierheilkunde 2001; 143: 193201.
50. Broman, T, et al. Molecular detection of persistent Francisella tularensis subspecies holarctica in natural waters. International Journal of Microbiology 2011. doi:10.1155/2011/851946. 10 pp.
51. de Carvalho, IL, et al. Borrelia garinii and Francisella tularensis subsp. holarctica detected in migratory shorebirds in Portugal. European Journal of Wildlife Research 2012; 58: 857861.
52. Jellison, WL. Tularemia geographical distribution of deerfly fever and the biting fly, chrysops-discalis Williston. Public Health Reports 1950; 65: 13211329.
53. Gurycova, D, et al. Prevalence of ticks infected with Francisella tularensis in natural foci of tularemia in western Slovakia. European Journal of Epidemiology 1995; 11: 469474.
54. Hubalek, Z, Halouzka, J. Mosquitoes (Diptera: Culicidae), in contrast to ticks (Acari: Ixodidae), do not carry Francisella tularensis in a natural focus of tularemia in the Czech Republic. Journal of Medical Entomology 1997; 34: 660663.
55. Hubalek, Z, Sixl, W, Halouzka, JI. Francisella tularensis in Dermacentor reticulatus ticks from the Czech Republic and Austria. Wiener Klinische Wochenschrift 1998; 110: 909910.
56. Svensson, K, et al. Landscape epidemiology of tularemia outbreaks in Sweden. Emerging Infectious Diseases 2009; 15: 19371947.
57. Toledo, A, et al. Tick-borne zoonotic bacteria in ticks collected from central Spain. American Journal of Tropical Medicine and Hygiene 2009; 81: 6774.
58. de Carvalho, IL, et al. Francisella-like endosymbiont in Dermacentor reticulatus collected in Portugal. Vector-Borne and Zoonotic Diseases 2011; 11: 185188.
59. Reis, C, et al. Questing ticks in suburban forest are infected by at least six tick-borne pathogens. Vector-Borne and Zoonotic Diseases 2011; 11: 907916.
60. Gehringer, H, et al. Presence of an emerging subclone of Francisella tularensis holarctica in Ixodes ricinus ticks from south-western Germany. Ticks and Tick-Borne Diseases 2013; 4: 93100.
61. Lundstrom, JO, et al. Transstadial transmission of Francisella tularensis holarctica in mosquitoes, Sweden. Emerging Infectious Diseases 2011; 17: 794799.
62. Gurycova, D. First isolation of Francisella tularensis subsp. tularensis in Europe. European Journal of Epidemiology 1998; 14: 797802.
63. Reif, KE, et al. Dermacentor andersoni transmission of Francisella tularensis subsp. novicida reflects bacterial colonization, dissemination, and replication coordinated with tick feeding. Infection and Immunity 2011; 79: 49414946.
64. Petrov, VG. Experimental study of Dermacentor marginatus sulz. and Rhipicephalus rossicus Jak. et K. Jak. ticks as vectors of tularemia. Journal of Parasitology 1960; 46: 877884.
65. Petersen, JM, Mead, PS, Schriefer, ME. Francisella tularensis: an arthropod-borne pathogen. Veterinary Research 2009; 40.
66. Michelet, L, et al. Discriminating Francisella tularensis and Francisella-like endosymbionts in Dermacentor reticulatus ticks: evaluation of current molecular techniques. Veterinary Microbiology 2013; 163: 399403.
67. Abd, H, et al. Survival and growth of Francisella tularensis in Acanthamoeba castellanii. Applied and Environmental Microbiology 2003; 69: 600606.
68. Thelaus, J, et al. Francisella tularensis subspecies holarctica occurs in Swedish mosquitoes, persists through the developmental stages of laboratory-infected mosquitoes and is transmissible during blood feeding. Microbial Ecology 2014; 67: 96107.
69. Triebenbach, AN, et al. Detection of Francisella tularensis in Alaskan mosquitoes (Diptera: Culicidae) and assessment of a laboratory model for transmission. Journal of Medical Entomology 2010; 47: 639648.
70. Gyuranecz, M, et al. Susceptibility of the common hamster (Cricetus cricetus) to Francisella tularensis and its effect on the epizootiology of tularemia in an area where both are endemic. Journal of Wildlife Diseases 2010; 46: 13161320.
71. Borg, K, et al. On tularemia in varying hare (Lepus timidus L.) Nordisk Veterinaer Medicin 1969; 21: 95.
72. Bystrom, M, et al. Tularemia in Denmark: identification of a Francisella tularensis subsp. holarctica strain by real-time PCR and high-resolution typing by multiple-locus variable-number tandem repeat analysis. Journal of Clinical Microbiology 2005; 43: 53555358.
73. Gurycova, D, et al. Importance of surveillance of tularemia natural foci in the known endemic area of Central Europe, 1991–1997. Wiener Klinische Wochenschrift 2001; 113: 433438.
74. Vyrostekova, V, et al. Prevalence of coinfection with Francisella tularensis in reservoir animals of Borrelia burgdorferi sensu lato. Wiener Klinische Wochenschrift 2002; 114: 482488.
75. Anda, P, et al. Waterborne outbreak of tularemia associated with crayfish fishing. Emerging Infectious Diseases 2001; 7: 575582.
76. Allue, M, et al. Tularaemia outbreak in Castilla y Leon, Spain, 2007: an update. Eurosurveillance 2008; 13.
77. Eliasson, H, et al. The 2000 tularemia outbreak: a case-control study of risk factors in disease-endemic and emergent areas, Sweden. Emerging Infectious Diseases 2002; 8: 956960.
78. Buyuk, F, et al. Investigation of Francisella tularensis antibodies in dogs in Kars and Ankara Region. Turk Hijyen ve Deneysel Biyoloji Dergisi 2012; 69: 8388.
79. Guercan, S. Francisella tularensis and tularemia in Turkey. Mikrobiyoloji Bulteni 2007; 41: 621636.
80. Rodon, P, et al. Tularemia acquired from a cat-scratch. Medecine et Maladies Infectieuses 1998; 28: 223224.
81. Yaqub, S, Bjørnholt, JV, Enger, AE. Tularemia from a cat bite. Tidsskrift for den norske Laegeforening 2004; 124: 31973198.
82. Senol, M, et al. Tularemia: a case transmitted from a sheep. Cutis 1999; 63: 4951.
83. Haydon, DT, et al. Identifying reservoirs of infection: a conceptual and practical challenge. Emerging Infectious Diseases 2002; 8: 14681473.
84. Bell, JF, Stewart, SJ. Chronic shedding tularemia nephritis in rodents: possible relation to occurrence of Francisella tularensis in lotic waters. Journal of Wildlife Diseases 1975; 11: 421430.
85. Munnich, D, Lakatos, M. Clinical. epidemiological and therapeutic experience with human tularemia – role of hamster hunters. Infection 1979; 7: 6163.
86. Christova, I, Gladnishka, T. Prevalence of infection with Francisella tularensis, Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum in rodents from an endemic focus of tularemia in Bulgaria. Annals of Agricultural and Environmental Medicine 2005; 12: 149152.
87. Berdal, BP, et al. Field detection of Francisella tularensis. Scandinavian Journal of Infectious Diseases 2000; 32: 287291.
88. Larssen, KW, et al. Outbreak of tularaemia in central Norway, January to March 2011. Eurosurveillance 2011; 16: 24.
89. Hubalek, Z, et al. Serological survey of the wild boar (Sus scrofa) for tularaemia and brucellosis in South Moravia, Czech Republic. Veterinarni Medicina 2002; 47: 6066.
90. Al, Dahouk S, et al. Seroprevalence of brucellosis, tularemia, and yersiniosis in wild boars (Sus scrofa) from North-Eastern Germany. Journal of Veterinary Medicine, Series B: Infectious Diseases and Veterinary Public Health 2005; 52: 444455.
91. Tarnvik, A, Sandstrom, G, Sjostedt, A. Epidemiological analysis of tularemia in Sweden 1931–1993. FEMS Immunology and Medical Microbiology 1996; 13: 201204.
92. Ryden, P, et al. Outbreaks of tularemia in a boreal forest region depends on mosquito prevalence. Journal of Infectious Diseases 2012; 205: 297304.
93. Akimana, C, Kwaik, YA. Francisella-arthropod vector interaction and its role in patho-adaptation to infect mammals. Frontiers in Microbiology 2011; 2: 3434.
94. Goethert, HK, Telford, SR III. Nonrandom Distribution of vector ticks (Dermacentor variabilis) infected by Francisella tularensis . PLoS Pathogens 2009; 5.
95. Goethert, HK, Saviet, B, Telford, SR III. Metapopulation structure for perpetuation of Francisella tularensis tularensis. BMC Microbiology 2009; 9.
96. Gurcan, S, et al. Tularemia re-emerging in European part of Turkey after 60 years. Japanese Journal of Infectious Diseases 2006; 59: 391393.
97. Vaissaire, PJ, et al. Tularemia: situation in france, issues and public health risk [in French]. Bulletin de l'Académie vétérinaire de France 2006; 159: 153160.
98. Christova, I, et al. Tularaemia outbreak in Bulgaria. Scandinavian Journal of Infectious Diseases 2004; 36: 785789.
99. Velinov, T, Kantardjiev, T, Kuzmanov, A. An outbreak of tularemia in Bulgaria – January, 1998–2000. Problems of Infectious and Parasitic Diseases 2001; 29: 13.
100. Komitova, R, et al. Tularemia in bulgaria 2003–2004. Journal of Infection in Developing Countries 2010; 4: 689694.
101. Kantardjiev, T, et al. Tularemia outbreak, Bulgaria, 1997–2005. Emerging Infectious Diseases 2006; 12: 678680.
102. Cerny, Z. Changes of the epidemiology and the clinical picture of tularemia in Southern Moravia (the Czech Republic) during the period 1936–1999. European Journal of Epidemiology 2001; 17: 637642.
103. Pazdiora, P, et al. Water-borne epidemic of tularaemia in Chlumcany. Epidemiologie, Mikrobiologie, Imunologie 2002; 51: 2325.
104. Jounio, U, Renko, M, Uhari, M. An outbreak of holarctica-type tularemia in pediatric patients. Pediatric Infectious Disease Journal 2010; 29: 160162.
105. Vaissaire, J, et al. Tularemia. The disease and its epidemiology in France [in French]. Médicine et Maladies Infectieuses 2005; 35: 273280.
106. Siret, V, et al. An outbreak of airborne tularaemia in France, August 2004. Eurosurveillance 2006; 11: 5860.
107. Mahy, S, et al. Emergence of tularemia in France: paradigm of the Burgundy region. International Journal Infectious Diseases 2011; 15: e882883.
108. Maurin, M, et al. Human tularemia in France, 2006–2010. Clinical Infectious Diseases 2011; 53: e133141.
109. Mailles, A, Vaillant, V. Review of 10 years of surveillance of tularemia in humans in France [in French]. Saint-Maurice: Institut de veille sanitaire, 2013.
110 Twisselmann, B. Tularaemia in Germany. Eurosurveillance 2000; 4: pii = 1597.
111. Hofstetter, I, et al. Tularaemia outbreak in hare hunters in the Darmstadt-Dieburg district, Germany. Eurosurveillance 2006; 11: E060119 060113.
112. Schatzle, W, Schwenk, R. Three cases of tularaemia in southern Baden-Wuerttemberg, Germany, November 2007. Eurosurveillance 2008; 13.
113. Boui, M, Errami, E. Tularaemia outbreak in Kosovo [in French]. Annals de Dermatologie et de Venereologie 2007; 134: 839842.
114. Sadiku, I, et al. An overview of familiar tularemia in Kosovo. European Journal of Internal Medicine 2011; 22: S83S84.
115. Who. Tularaemia in Kosovo. Eurosurveillance 2000; 4: 1616.
116. Hagen, IJ, Aandahl, E, Hasseltvedt, V. Five case histories of tularaemia infection in Oppland and Hedmark Counties, Norway. Eurosurveillance 2005; 10: E050317050314.
117. Brantsaeter, AB, et al. Tularaemia outbreak in northern Norway. Eurosurveillance 2007; 12: E070329070322.
118. Djordjevic-Spasic, M, et al. Oropharyngeal tularemia in father and son after consumption of under-cooked rabbit meat. Scandinavian Journal of Infectious Diseases 2011; 43: 977981.
119. Gurycova, D. Epidemiologic characteristics of tularemia in Slovakia. Bratislavské Lekárske Listy 2006; 107: 224.
120. De Mateo, S, Ruiz Coisin, C. Outbreak of tularaemia in Castilla y León, Spain. Eurosurveillance 1998; 2: 1268.
121. Bellido-Casado, J, et al. Report on five cases of tularaemic pneumonia in a tularaemia outbreak in Spain. European Journal of Clinical and Microbiology Infectious Diseases; 19: 218220.
122. Bachiller Luque, P, et al. Preliminary report of an epidemic tularemia outbreak in Valladolid [in Spanish]. Revista Clinica Espanola 1998; 198: 789793.
123. Andres Puertas, C, et al. Epidemic outbreak of tularemia in Palencia [in Spanish]. Revista Clinica Espanola 1999; 199: 711715.
124. Aldea-Mansilla, C, et al. Tularemia: a decade in the province of Soria (Spain) [in Spanish]. Enfermedades Infecciosas y Microbiologia Clinica 2010; 28: 2126.
125. Gonzalez Quijada, S, et al. Tularemia: study of 27 patients in Spanish]. Medicina Clinica 2002; 119: 455457.
126. Perez-Castrillon, JL, et al. Tularemia epidemic in northwestern Spain: clinical description and therapeutic response. Clinical Infectious Diseases 2001; 33: 573576.
127. Eliasson, H, Back, E. Tularaemia in an emergent area in Sweden: an analysis of 234 cases in five years. Scandinavian Journal of Infectious Diseases 2007; 39: 880889.
128. Payne, L, et al. Endemic tularemia, Sweden, 2003. Emerging Infectious Diseases 2005; 11: 14401442.
129. Wik, O. Large tularaemia outbreak in Varmland, central Sweden, 2006. Eurosurveillance 2006; 11: E060921 060921.
130. Penttinen, P, Giesecke, J. Outbreak of tularaemia in Sweden, July-August 2003. Eurosurveillance 2003; 7: 2276.
131. Helvaci, S, et al. Tularemia in Bursa, Turkey: 205 cases in ten years. European Journal of Epidemiology 2000; 16: 271276.
132. Sencan, I, et al. An outbreak of oropharyngeal tularemia with cervical adenopathy predominantly in the left side. Yonsei Medical Journal 2009; 50: 5054.
133. Gurcan, S, et al. An outbreak of tularemia in Western Black Sea region of Turkey. Yonsei Medical Journal 2004; 45: 1722.
134. Barut, S, Cetin, I. A tularemia outbreak in an extended family in Tokat Province, Turkey: observing the attack rate of tularemia. International Journal of Infectious Diseases 2009; 13: 745748.
135. Ozdemir, D, et al. Comparison of the 2000 and 2005 outbreaks of tularemia in the Duzce region of Turkey. Japanese Journal of Infectious Diseases 2007; 60: 5152.
136. Celebi, G, et al. Tularemia, a reemerging disease in northwest Turkey: epidemiological investigation and evaluation of treatment responses. Japanese Journal of Infectious Diseases 2006; 59: 229234.
137. Karadenizli, A, et al. Outbreak of tularaemia in Golcuk, Turkey in 2005: report of 5 cases and an overview of the literature from Turkey. Scandinavian Journal of Infectious Diseases 2005; 37: 712716.
138. Meric, M, et al. Tularaemia outbreaks in Sakarya, Turkey: case-control and environmental studies. Singapore Medical Journal 2010; 51: 655659.
139 Ulu Kilic, A, et al. Tularaemia outbreak in central Anatolia. Clinical Microbiology and Infection 2011; 17: S264.
140. Ozturk, B, et al. Tularaemia: Evaluation of the patients and antimicrobials. Clinical Microbiology and Infection 2012; 18: 581.
141. Engin, A, et al. The first tularemia outbreak in the sivas province: a review of 29 cases. Klimik Dergisi 2011; 24: 1723.
142. Winkelmayer, R, et al. Explorative study on the seroprevalence of Brucella, Francisella and Leptospira antibodies in the European hare (Lepus europaeus Pallas) of the Austrian-Czech border region. Wiener Tierarztliche Monatsschrift 2005; 92: 131135.
143. Hofer, E, et al. Detection of tularemia in European brown hares (Lepus europaeus) in Austria. Wiener Tierarztliche Monatsschrift 1997; 84: 301306.
144. Treml, F, et al. European brown hare as a potential source of zoonotic agents. Veterinarni Medicina 2007; 52: 451456.
145. Frolich, K, et al. Epizootiologic and ecologic investigations of European brown hares (Lepus europaeus) in selected populations from Schleswig-Holstein, Germany. Journal of Wildlife Diseases 2003; 39: 751761.
146. Korudgiyski, N, et al. Serological investigations on the distribution of Tularemia in animals in risk regions of Bulgaria. Zhivotnov'dni Nauki 2004; 41: 6364.
147. Gurcan, S, et al. Tularemia re-emerging in European part of Turkey after 60 years. Japanese Journal of Infectious Diseases 2006; 59: 391393.
148. Seyda, T. Serological and cultural studies on the prevalence of Francisella tularensis infection in sheep in the Kars area: preliminary report. Kafkas Universitesi Veteriner Fakultesi Dergisi 1996; 2: 4960.
149. Corrias, F, et al. Health evaluation in the native Garfagnina goat. Small Ruminant Research 2012; 104: 191194.
150. Barataud, D, et al. Grouped cases of tularaemia, Vendee, August 2004. Cas groupes de tularemie, Vendee, aout 2004. Bulletin Epidemiologique Hebdomadaire 2006: 117119.
151. Gurycova, D, Kopcok, M. Surveillance of Francisella tularensis infestation in dogs from Bratislava. Veterinarni Medicina 1992; 37: 169176.
152. Franke, J, et al. Coexistence of Pathogens in host-seeking and feeding ticks within a single natural habitat in central Germany. Applied and Environmental Microbiology 2010; 76: 68296836.
153. Hildebrandt, A, et al. Diversity and coexistence of tick-borne pathogens in central Germany. Journal of Medical Entomology 2011; 48: 651655.
154. Egyed, L, et al. Seasonal activity and tick-borne pathogen infection rates of Ixodes ricinus ticks in Hungary. Ticks and Tick-Borne Diseases 2012; 3: 9094.
155. Reye, AL, et al. Prevalence and seasonality of tick-borne pathogens in questing Ixodes ricinus ticks from Luxembourg. Applied and Environmental Microbiology 2010; 76: 29232931.
156. Milutinovic, M, et al. Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Francisella tularensis and their co-infections in host-seeking Ixodes ricinus ticks collected in Serbia. Experimental and Applied Acarology 2008; 45: 171183.
157. de Carvalho, IL, et al. Francisella tularensis, Portugal. Emerging Infectious Diseases 2000; 13: 666667.


Type Description Title
Supplementary materials

Hestvik Supplementary Material
Supplementary Material

 Word (14 KB)
14 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed