In Mainz-Bingen, Germany, 6 individuals were confirmed to be infected with tularemia, a disease caused by the bacterium Francisella tularensis.  Tularemia is widely zoonotic, though rabbits, hares, and rodents are particularly susceptible.  During an outbreak, these animals are often found dead in vast numbers – a harbinger of the potential human infection if control methods are not taken. But just because you’re not a rodent, doesn’t mean you shouldn’t take this disease seriously! Tularemia is a actually considered a potential agent of bioterrorism, due to its deadly outcome if left untreated.  This is not a bacterium you want to mess around with.

What adds to it’s charm are the multiple ways the bacteria is able to spread to other hosts.  F. tularensis can be transmitted through tick and deer fly bites, skin contact with infected animals, water contamination, and inhalation of contaminated aerosols or dust from agricultural settings. Therefore, prevention of this disease involves insect repellant, use of gloves when handling sick or dead animals and, as it so happens, not running over dead animals with lawn mowers… yep, this actually did happen and aerosolizing a rabbits is evidently a bad thing.  So, when these volunteer grape harvesters came down with tularemia infections, this was a real concern!  The patients presented to the hospital with high fevers, malaise, and marked cervical lymphadenopathy that suggested an oropharyngeal route…. it’s almost as if these volunteers may have been sneaking a few grapes on the side…

Actual diagnosis of Tularemia took some time, however, as doctors were trying to search their histories for exposure to wild game.  Yet, it is distinctly possible that infected animals were also sneaking around the vineyards, spreading their deadly bioterrorism agents to the unsuspecting volunteers.  Once serologic diagnosis was made, the individuals were quickly put on either ciprofloxacin or doxycycline.  Currently, everyone is doing well; however, the epidemiologists are now conducting a large-scale investigation to prevent an outbreak of tularemia in Germany.  The exact causative exposure remains unknown, which is understandable given the vast array of methods that this nasty bacterium can use.  But, all in all, let this be a lesson to volunteer grape pickers… if you sneak a grape or two on the side, the consequences could be catastrophic. 

When it comes to influenza, the constant concern is how quickly a strain can be transmitted across a population. Therefore, it is especially important to understand the differences in strains, how they are transmitted, and what concern it represents to any given human or animal population. Within the past few days, avian influenza has asserted itself in broiler poultry in Hefzi-Ba, located in Israel. This marks Israel as the first Middle Eastern country to become infected by the highly pathogenic strain, H5N8, which is currently sweeping across other regions such as Switzerland and India.

The infected farm, located in Kibbutz, Hefziba, now faces the culling of approximately 40,000 birds in an effort to control the spread of infection. There are currently no approved antivirals to treat infected birds. Sometimes, antibiotics are occasionally brought on board to aid in the treatment of secondary bacterial infections, but such treatment is not feasible for every bird, nor will it prevent the remain birds from contracting and spreading the influenza. Therefore, treatment of avian influenza is nearly impossible, especially given the rapid transmission of the disease. Infected birds shed viral particles in their saliva, nasal secretions, and feces. Given the nature of poultry farming, the close proximity of the birds basically ensures that once a barn is infected, every bird within the shared housing will have the virus soon.

Avian influenza results in devastating loss to poultry farms, so prevention is far more efficacious than treating the disease. This farm was located adjacent to a nature reserve, a hot spot for migratory birds. Avian influenza is sometimes referred to as fowl plague due to its seemingly ubiquitous presence in wild birds, namely gulls, ducks, geese, and swans. However, over 100 different species of wild birds have been verified to have viral infection. All in all, whether it is a low-pathogenic or high-pathogenic strain, avian influenza is out there and controlling wild bird access to poultry is crucial to disease prevention.  Early recognition is also important, as it enables quick elimination of infected birds to control more dramatic losses.  Infected poultry present with lack of coordination, discoloration and swelling of the combs, wattles, and legs, diarrhea, nasal discharge, decreased egg production, coughing sneezing, or… sudden death without clinical signs.  So this is a tricky disease to be certain, but not impossible to overcome.  Certainly, the construction of a poultry farm right next to a nature preserve filled with wild birds may not have been the best choice in prevention.

So what does this mean to people? Is it merely that chicken and egg prices go up?

Fortunately, most of the viruses do not infect people, especially those with competent immune statuses. Transmission to people occurs through inhalation of aerosolized droplets or through contact with mucous membranes after handling birds or equipment that the infected birds have come in contact with. Obviously, the risk is much higher for those who regularly work with poultry or other birds. These people will present with common respiratory influenza symptoms that may progress to severe pneumonia. Antivirals and vaccines do exist for humans so treatment is generally successful with early detection.

Luckily, this particular outbreak has not been shown to be intensely infectious to people. However, tracking the spread of infection is crucial to control. Influenza viruses are notorious for their capability to mutate, so vigilance in disease reporting is required.  Know the risks, utilize personal protective equipment when coming in contact with birds, and as always, wash your hands.