Sweden: Elevated tularemia activity reported in multiple areas, especially Vasterbotten, through October

Event

Health authorities have reported elevated tularemia activity in multiple areas of Sweden, with more than 450 locally acquired cases Jan. 1-Sept. 30 compared to the 258 cases reported in 2022. Vasterbotten (131 cases) is the most affected area, followed by Gavleborg (96 cases), Dalarna (61 cases), Orebro (31 cases), Vasternorrland (28 cases), and Varmland (27 cases). Swedish health officials recommend that the public take the necessary prevention measures, such as using mosquito repellent and avoiding close contact with dead rodents. This represents the most complete information available as of Oct. 12.

Context

The risk of tularemia in Sweden is highest August-October, with most cases reported during late summer and early autumn, usually peaking in September. Health authorities identified roughly 258 locally acquired cases of tularemia in Sweden in 2022, 323 cases in 2021, 254 cases in 2020, and 1,040 cases in 2019.

Tularemia is a bacterial disease that infects both animals and humans. It mainly affects various animals, such as rabbits, hares, and rodents, but infection can be transmitted to humans in several ways. People primarily get infected through direct contact with an infected animal. Other means of infection are through tick, mosquito, and deer fly bites, ingestion of contaminated water, and inhalation of dust contaminated with urine or feces of sick animals. There are no reports of person-to-person transmission. Symptoms usually develop within 3-5 days of being exposed. The specific symptoms a person develops depend on the route of infection and include high fever, headache, and nausea; a wound and swollen lymph nodes at the site of infection when one has been infected through direct contact with a sick animal or through insect bite; sores in the mouth and throat if a person ingested contaminated water; and a cough, chest pain, and difficulty breathing if contaminated dust was inhaled.

Advice

Practice basic health precautions. Avoid contact with rabbits, hares, and rodents and their potential habitats. Practice food and water precautions and cook game meat thoroughly before eating. Avoid mosquito bites and remove standing water to reduce the number of biting mosquitoes. If the weather permits, wear long-sleeved shirts, pants, and socks, or use insect protection containing DEET, picaridin, or another approved repellent. After being in wooded areas where ticks may be present, bathe or shower as soon as possible and conduct a full-body tick check using a hand-held or full-length mirror to view all parts of the body. Seek medical attention if symptoms develop within two weeks of being in affected areas.