ABSTRACT
Guides for Emergency Response: Biological Agent or Weapon: Tularemia AGENT: Tularemia is a zoonotic disease caused by Francisella tularesis, a gram-negative bacillus. Humans acquire the disease under natural conditions through inoculation of skin or mucous membranes with blood or tissue fl uids of infected animals, or bites of infected deerfl ies, mosquitoes, or ticks. Less commonly, inhalation of contaminated dusts or ingestion of contaminated food or water may produce clinical disease. A biological warfare or terrorist attack with tularemia disseminated by aerosol would primarily cause typhoidal turaremia, a syndrome expected to have a case fatality rate that may be higher than the 5 to 10 percent when the disease is acquired naturally. It takes only a very small aerosol dose to make people ill. Any attack with dissemination by aerosol would be likely to spread typhoidal tularemia. Strict isolation of patients is not required.
