Seasonal and regional distribution of tularemia cases in Amasya, Turkey

Abstract

Tularemia have attracted attention due to increased number of cases since 2009 in Amasya region which is located at Central Blacksea Region of Turkey. The aims of this letter were to provide information about the disease, to emphasize the importance of early treatment due to the outbreak peak in our province between 2009-2012 and water chlorination in epidemic areas. A total of 250 tularemia-suspected patients (117 female, 133 male; mean age: 42 yrs) who were admitted to our hospital with the symptoms of sore throat, fever, malaise and/or presence of neck mass, from 20 differ- ent locations within last four years were included in the study. Serum samples of 73 (29.2%) patients yielded ≥ 1/160 titers with F.tularensis microagglutination test which were considered as positive. All positive cases presented with the oropharyngeal form of the disease. The year with the highest number of tularemia cases was 2010. When the regional distribution was evaluated, it was detected that positive cases have precipitated especially in the southeastern (highland area) and northeastern (lowland area) parts of Amasya (34/73; 46.6%). Majority of the tularemia cases (53/73; 72.6%) were identified in colder seasons. The number of cases in rural and urban centers have decreased after 2010. In con- clusion, it is considered that the emergence of new cases is likely to persist due to the geographical characteristics of Amasya and occupational properties (livestock breeding) of the population. Therefore, the clinicians should consider tularemia in differential diagnosis of the cases originated from risky rural areas.