Tularaemia is caused by the bacterium Francisella tularensis which is largely distributed in the Northern hemisphere but not normally found in the tropics or the southern hemisphere.30

The bacterium is usually spread through contaminated water, by contact with wild or domesticated mammals, or through bites from ticks, or occasionally other arthropods such as deer flies. It can also be inhaled. However, the ECDC reported that the majority of the 1,148 cases of tularaemia across Europe in 2016, occurred mainly in Finland and Sweden in the autumn where the main transmission route is mosquito bites.30,31

Depending on the entry site, the disease can appear as ulceration, swollen glands, painful conjunctivitis, and will usually be accompanied by flu-like symptoms. It has the potential to cause meningitis, septic shock or renal failure.32

There is no safe and effective human vaccine against F. tularensis as yet. Treatment is usually with antibiotics, although some patients may need a long period of convalescence. Fatality rates can be up to 15 per cent if untreated, but fall below 2 per cent with appropriate antibiotic treatment.30