title: Investigating an airborne tularemia outbreak, Germany.
abstract: In November 2005, an outbreak of tularemia occurred among 39 participants in a hare hunt in Hesse, Germany. Previously reported tularemia outbreaks in Germany dated back to the 1950s. We conducted a retrospective cohort study among participants and investigated the environment to identify risk factors for infection. Ten participants had serologic evidence of acute Francisella tularensis infection; 1 other participant died before laboratory confirmation was obtained. Presence within 5 meters of the place where disemboweled hares were rinsed with a water hose was the risk factor most strongly associated with infection (risk ratio 22.1; 95% confidence interval 13.2-154.3). Swabs taken at the game chamber and water samples were PCR negative for F. tularensis. Eleven of 14 hare parts showed low-level concentrations of F. tularensis, compatible with cross-contamination. More than half of case-patients may have acquired infection through inhalation of aerosolized droplets containing F. tularensis generated during rinsing of infected hares.
authors.affiliation: Hesse State Health Office, Dillenburg, Germany. anja.hauri@hlpug.hessen.de
authors.forename: Anja M
authors.initials: AM
authors.lastname: Hauri
authors.forename: Iris
authors.initials: I
authors.lastname: Hofstetter
authors.forename: Erik
authors.initials: E
authors.lastname: Seibold
authors.forename: Philip
authors.initials: P
authors.lastname: Kaysser
authors.forename: Juergen
authors.initials: J
authors.lastname: Eckert
authors.forename: Heinrich
authors.initials: H
authors.lastname: Neubauer
authors.forename: Wolf D
authors.initials: WD
authors.lastname: Splettstoesser
mesh_terms: D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000368:Aged; D000818:Animals; D002648:Child; D004196:Disease Outbreaks; D005604:Francisella tularensis; D005858:Germany / Q000453:epidemiology; D034621:Hares; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012698:Serologic Tests; D014406:Tularemia / Q000453:epidemiology* / Q000635:transmission*; D055815:Young Adult; D015047:Zoonoses / Q000635:transmission*
chemical_list: D000336:Aerosols