1. TULAREMIA IN A GROUP OF FALCONERS
Veronica A. Fialkowski, MPH, Kimberly Signs, DVM, Mary Grace Stobierski, DVM, MPH
Michigan Department of Community Health
THE CASES PUBLIC HEALTH IMPACTTULAREMIA
Exposure? We don’t know, but…
5 out of the 5 falconers participated in the
jackrabbit hunting and skinning of the captured
rabbits, only 2/5 got sick. Although this route of
transmission is possible and plausible, other
sources of infection should be examined.
2 out of 5 falconers handled a road kill rabbit
found on the side of the road. The 2 falconers
were those who became sick. The road kill
rabbit had no apparent organ lesions. Improper
use of gloves could have resulted in infection
through contamination of fresh cuts.
The two ill falconers who handled the road kill
rabbit also fed the road kill rabbit to their
hawks. This is another potential route of
transmission—through the falcon. The falcon’s
talons could have been contaminated and
scratches to unprotected skin could have
resulted in infection.
50 pounds of rabbit meat that was brought back
by the hunters was destroyed as a
precautionary measure.
Recommendations
Simple measures for hunters:
Rubber gloves and eye protection should be
used when handling wild animals.
Avoid handling or consuming any sick or road
kill animals.
Always thoroughly cook rabbit meat.
Use protective clothing and insect repellants
and check for ticks frequently.
Case No. 1
26 year old male, previously healthy.
Presented to ER with periorbital swelling, fever,
chills, body aches, nausea, and headache.
Diagnosed with conjunctivitis.
Two days later returned to ER with worsened
symptoms.
Patient shared information about a recent
rabbit hunting trip to Kansas.
Blood sample, ocular swab, and lymph node
aspirate were collected and antibiotic
treatment was started.
Ocular swab culture positive for Gram negative
coccobacilli.
Culture confirmed as Francisella tularensis
by PCR at MDCH Bureau of Labs.
Case No. 2
60 year old female with history of COPD.
Presented to ER with fever and right axillary
lymphadenopathy.
Patient suspected tularemia because friend
(case No. 1) was diagnosed day prior; both were
on the same hunting trip.
Patient complained of scratches on her right
arm from her falcons.
Treatment for tularemia was started.
The Group of Falconers
The hunting trip involved a group of falconers
that traveled to Dodge City, Kansas (October 18-
25, 2014 ) to go rabbit hunting. Two local health
departments interviewed the other falconers for
symptoms and potential exposures (Figure 1).
Kansas Incidence: 0.97 per 100,000
U.S. Incidence: 0.06 per 100,000
Tularemia, also known as Rabbit Fever, is a rare, but
serious infection caused by the bacterium Francisella
tularensis.
One of the most infectious pathogenic bacteria
known.
Figure 2. Reported tularemia cases – US, 2004-2013
Falcon
Hunter
Jackrabbit
Exposure?
Road kill
Rabbit
Exposure?
Wore Gloves
While Animal
Handling?
Fed
Jackrabbit
to Hawk?
1 Yes No Yes No
2 Yes No Yes No
3 Yes No Yes No
4 Yes Yes Yes Yes
5 Yes Yes Yes & No Yes
Figure 1. Exposure questionnaire for each hunter. Hunter
4 and 5 (highlighted in orange) are the diagnosed cases
of tularemia.
 As few as 10 organisms can cause disease.
Few cases of tularemia are reported in the U.S.
annually.
On average, there are 139 cases per year in the U.S.
(data from 2004 to 2013 cases).
Cases are rarely seen in Michigan.
It is a potentially fatal disease.
The incubation period is 3-5 days (range 1-21days).
Category A biological warfare agent.
References
 American Veterinary Medical Association. (2015). Hunters and disease risk. Retrieved
from https://www.avma.org/public/Health/Pages/Hunters-and-disease-risks.aspx
 Centers for Disease Control and Prevention. (2011). Tularemia. Retrieved
from http://www.cdc.gov/tularemia/
 J Infect Dis. (2011) 204 (1): 6-8.doi: 10.1093/infdis/jir224
 P. I. Padeshki, I. N. Ivanov, B. Popov And T. V. Kantardjiev (2010). The role of birds in
dissemination of Francisella tularensis: first direct molecular evidence for bird-to-human
transmission. Epidemiology and Infection, 138, pp 376-379.
doi:10.1017/S0950268809990513.
There are many routes of exposure (i.e. inhalation,
ingestion) and potential sources of infection
(Figure 3).
Tularemia has been identified in the following
animals: rabbits, squirrels, muskrats, beavers, prairie
dogs, cats, bobcats, deer and sheep.
 Rabbits are the most common source of
tularemia in the United States.
1 dot placed randomly within county of residence
for each reported case
Falconry is the hunting of wild quarry in its
natural state and habitat by means of a trained
bird of prey.
Little is known about birds and tularemia,
however there are studies which show some
birds may be more susceptible to infection, while
others are resistant but still may be infectious.
F. tularensis organisms can get under the talons
of the falcon during hunting or feeding which
may infect a human if scratched by the bird.
Figure 3. Routes of transmission of tularemia.
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Acknowledgements
Jackson County Health Department: Leslie Robbins, RN
Oakland County Health Department: Richard Renas, MPH; Ann Hocking, RN
This study/report was supported in part by an appointment to the Applied Epidemiology
Fellowship Program administered by the Council of State and Territorial Epidemiologists
(CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative
Agreement Number 1U38OT000143-02