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Volume 28, Number 4—April 2022
Research Letter

Tularemia Transmission to Humans, the Netherlands, 2011–2021

Jolianne M. Rijks1Comments to Author , Anna D. Tulen1, Daan W. Notermans, Frans A.G. Reubsaet, Maaike C. de Vries, Miriam G.J. Koene, Corien M. Swaan, and Miriam Maas
Author affiliations: Dutch Wildlife Health Centre, Utrecht University, Utrecht, the Netherlands (J.M. Rijks); European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden (A.D. Tulen); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (A.D. Tulen, D.W. Notermans, F.A.G. Reubsaet, M.C. de Vries, C.M. Swaan, M. Maas); Wageningen Biodiversity Research, Wageningen University and Research, Lelystad, the Netherlands (M.G.J. Koene)

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Table

Overview of autochthonous human tularemia infections reported in the Netherlands, 2011–2021

Life cycle Transmission mode Probable or confirmed mode Year Occupational exposure Clinical manifestation Basal clade Reference
Terrestrial Aerosols from contaminated vegetation
 Probable 2016 Yes Pneumonic B.6-B.11 (4)
Probable 2017 Yes Pneumonic ND
Contact with (or consumption of) infected hare carcass
 Probable 2014 No Ulceroglandular ND (3)
Probable 2014 No Ulceroglandular ND (3)
Confirmed 2014 No Glandular B.12-B.20
Confirmed 2016 No Ulceroglandular ND
Probable 2016 No Ulceroglandular B.6-B.11
Probable 2017 No Unclear (fatigue) ND
Probable 2019 No Oculoglandular and oropharyngeal ND
Probable 2021 No Glandular ND
Mouse bite Probable 2021 No Ulceroglandular B.6-B.11
Tick bite Probable 2019 No Glandular ND
Probable 2020 No Glandular B.12-B.33
Insect bite while on land Probable 2013 No Ulceroglandular B.6-B.11
Probable† 2016 No Glandular B.12-B.33
Probable
 2021
 Yes
 Ulceroglandular
 B.6-B.11
Aquatic Contact with contaminated water/mud
 Probable† 2016 No Glandular ND (5)
Probable 2016 Yes Ulceroglandular ND
Probable 2016 No Glandular ND
Probable 2016 No Ulceroglandular ND
Contact with contaminated water or insect bite
 Probable† 2015 No Ulceroglandular B.6-B.10
Probable 2021 No Oculoglandular and ulceroglandular ND
Insect bite while on water
 Probable
 2011
 No
 Ulceroglandular
 B.6-B.11
 (2)
Unclear Unclear Probable 2016 No Glandular ND
Probable 2018 No Ulceroglandular B.12
Probable 2018 No Glandular B.6

*Data are for 26 infections caused by Francisella tularensis subspecies holarctica. ND, not determined. †Water, sampled within 6 weeks from waterbodies in the area where infection was assumed to have occurred, tested positive for F. tularensis subsp. holarctica by quantitative PCR, indicating presence of the bacterium in the local environment around the time of infection and highlighting the interconnection between lifecycles (7).

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References
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1These first authors contributed equally to this article.

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