On Oct. 3, 2024, the Nebraska Department of Health and Human Services announced that 18 cases of tularemia had been reported to date in 2024, an increase above the annual average of 10.8 cases over the last five years (2019–2023).

Of particular concern is an increase in reported cases during the month of September. In contrast with the previous five years in which only one case was reported on average, seven cases have been reported to date in September 2024. Of these, four (57%) have been classified as the pneumonic form of tularemia, which is characterized by cough,chest pain, and difficulty breathing.

This results from inhaling dusts or aerosols containing Francisella tularensis. Inhalation of infective aerosols can be generated while handling animal hides, cleaning are as contaminated with dried rodent carcasses, moving contaminated grain, or by mowing over infected animal carcasses. Healthcare providers should keep tularemia as a differential diagnosis for individuals presenting with pneumonia-like symptoms particularly for patients with a compatible exposure history.

Tularemia is caused by the bacteria Francisella tularensis. This bacterium is found in nature in rabbits, muskrats, prairie dogs, and other rodents. Human infection occurs through several routes, including tick or deer fly bites, skin contact with infected animals, bites from infected cats, ingestion of contaminated water, or inhalation of contaminated dusts or aerosols.

Disease signs and symptoms vary depending on how the bacteria enters the body, with illness severity ranging from mild to life-threatening. All forms are accompanied by fever, which can be as high as 104°F.