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The Division of Public Health is forwarding this Health Advisory from the Centers for Disease Control and Prevention. To contact DPH about this Health Advisory, call 1-888-295-5156. This number is answered during normal business hours, and during non-business hours for emergencies.
Distributed via Health Alert Network
September 30, 2005, 19:40 EDT (07:40 PM EDT)
CDC has become aware that from September 24th through September 25th environmental air monitors in SW Washington D.C., more specifically the Capitol Mall area, signaled the low level presence of Francisella tularensis, the bacterium that causes Tularemia, also known as "rabbit fever."
At this time, public health agencies have no reports of any related human or animal illnesses. This announcement is a precautionary measure to assure that clinicians are aware of the situation and are able to recognize, test and report any suspected cases to the appropriate medical and public health authorities.
This is a national alert because the Capitol Mall area is a highly-trafficked tourist destination, and on Saturday, September 24th, was the site of several very well attended outdoor events.
The clinical presentations most likely to occur after an aerosol exposure to F. tularensis are pneumonic, oculoglandular and oropharyngeal. The usual incubation period is 3-5 days, but in rare instances can be longer. The disease is not communicable from person to person and can be effectively treated with readily available antimicrobials.
Onset from Monday September 26th through October 5th of an acute febrile illness associated with at least one of the following:
which is not otherwise explained in a resident or visitor to the National Capitol Region on Saturday or Sunday, September 24-25.
Clinical specimens may include:
Microbiology laboratory personnel should be alerted when F. tularensis is clinically suspected, so that appropriate laboratory precautions can be taken.
F. tularensis is a fastidious, slow-growing organism that requires cysteine for growth.
F. tularensis may be cultured on the following:
Culture plates should be held for 5-7 days at 35-370C (C02 is acceptable) and checked for growth daily.
F. tularensis can be isolated from nutrient enriched specimens (tissues) on sheep blood agar (SBA), but the organism will usually fail to thrive with passage on SBA. Growth on CHAB provides for presumptive identification of F. tularensis as the organism shows characteristic growth on this media (green, opalescent, raised, shiny colonies at 24-48 hours).
Note: Specimens for recovery of live bacteria, should be collected before antibiotics are administered.
CDC does not recommend mass or targeted prophylaxis at this time because:
One antibiotic, appropriate for treatment for patient age, should be chosen from among the alternatives. Treatment with streptomycin, gentamicin, or ciprofloxacin should be continued for 10 days; treatment with doxycycline should be continued for 14-21 days. Persons beginning treatment with intramuscular (IM) or intravenous (IV) doxycycline, ciprofloxacin can switch to oral antibiotic administration when clinically indicated.
†Not a U.S. Food and Drug Administration-approved use.
‡Ciprofloxacin dosage should not exceed 1 g/d in children.