Tularemia — United States, 2011-2022. Rich SN, Hinckley AF, Earley A, et al. 2025. MMWR Morb Mortal Wkly Rep. 73(5152):1152-1156. http://dx.doi.org/10.15585/mmwr.mm735152a1
Tularemia is a rare nationally notifiable zoonosis, caused by the tier-1 select agent _Francisella tularensis_, that has been reported from all USA states except Hawaii. Clinical manifestations typically include fever and localized symptoms that vary by route of infection. The case fatality rate of tularemia is typically <2%, but can be higher depending on clinical manifestation and infecting strain. Tularemia is treatable with antimicrobials. During 2011-2022, a total of 47 states reported 2,462 tularemia cases, but 4 central states (Arkansas, Kansas, Missouri, and Oklahoma) accounted for 50% of all reported cases. Note: This report describes the epidemiology of reported cases and brings attention to this bacteria that has been reported infecting more than 250 species of wild and domestic animals. Infection is through insect or tick bites as well as contact with infected wild animals [e.g., cottontail rabbits] or immersion or ingestion of contaminated water. Ticks may be an important reservoir as they can maintain infection transstadially [pathogen remains within the vector from one life stage (“stadium”) to the next] and transovarially [transmission of a pathogen from an organism (as a tick) to its offspring by infection of eggs in its ovary].