title: Re-emergence of tularemia in Germany: presence of Francisella tularensis in different rodent species in endemic areas.
abstract: BACKGROUND
  Tularemia re-emerged in Germany starting in 2004 (with 39 human cases from 2004 to 2007) after over 40 years of only sporadic human infections. The reasons for this rise in case numbers are unknown as is the possible reservoir of the etiologic agent Francisella (F.) tularensis. No systematic study on the reservoir situation of F. tularensis has been published for Germany so far.
  
  
  METHODS
  We investigated three areas six to ten months after the initial tularemia outbreaks for the presence of F. tularensis among small mammals, ticks/fleas and water. The investigations consisted of animal live-trapping, serologic testing, screening by real-time-PCR and cultivation.
  
  
  RESULTS
  A total of 386 small mammals were trapped. F. tularensis was detected in five different rodent species with carrier rates of 2.04, 6.94 and 10.87% per trapping area. None of the ticks or fleas (n = 432) tested positive for F. tularensis. We were able to demonstrate F. tularensis-specific DNA in one of 28 water samples taken in one of the outbreak areas.
  
  
  CONCLUSIONS
  The findings of our study stress the need for long-term surveillance of natural foci in order to get a better understanding of the reasons for the temporal and spatial patterns of tularemia in Germany.
authors.affiliation: Bundeswehr Institute of Microbiology, Munich, Germany. philippkaysser@bundeswehr.org
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaysser
authors.forename: Erik
authors.initials: E
authors.lastname: Seibold
authors.forename: Kerstin
authors.initials: K
authors.lastname: Mätz-Rensing
authors.forename: Martin
authors.initials: M
authors.lastname: Pfeffer
authors.forename: Sandra
authors.initials: S
authors.lastname: Essbauer
authors.forename: Wolf D
authors.initials: WD
authors.lastname: Splettstoesser
mesh_terms: D000818:Animals; D004196:Disease Outbreaks; D004197:Disease Reservoirs / Q000382:microbiology; D019353:Endemic Diseases / Q000706:statistics & numerical data; D005604:Francisella tularensis / Q000235:genetics / Q000302:isolation & purification*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D012008:Recurrence; D012377:Rodentia / Q000382:microbiology*; D005423:Siphonaptera / Q000382:microbiology; D013987:Ticks / Q000382:microbiology; D014406:Tularemia / Q000453:epidemiology* / Q000382:microbiology; D014871:Water Microbiology