On July 21, 2011, the Taiwan Centers for Disease Control (Taiwan CDC) announced an imported case of tularemia confirmed in Taiwan.This is the first tularemia case ever confirmed in Taiwan since the disease was classified as a notifiable communicable disease in 2007.

According to the epidemiological investigation, the case is a 67-year-old male Taiwanese American Citizen who permanently resides in San Francisco, California, the United States.The case has a medical history of high blood pressure and diabetes.On June 22, 2011, when the case developed fever while he was in U.S., he took fever reducers on his own.On June 26, he traveled to Taiwan to visit his relatives and developed fever, chills and discomfort.He was then brought to a medical center in the northern area of Taiwan by a friend and was hospitalized for treatment.The primary clinical manifestations displayed by the patient include pneumonia and pleural effusion.The case was reported to the health authority as a suspected case by the hospital when his blood culture detected growth of tularemia bacteria.On July 18, the infection was confirmed in the patient by Taiwan CDC.After receiving treatment, the case has become stabilized and is expected to be discharged from the hospital soon.Based on the incubation period of tularemia, the date of disease onset and the arrival date, it is determined that the case became infected with the disease prior to entering Taiwan.As of now, the patient is a single, isolated case who acquired the disease overseas.As the disease is not spread from human-to-human and no other tularemia case has been reported in Taiwan, further transmission is unlikely.

Tularemia is a disease of animals and humans caused by the bacterium, Francisella tularensis. The reservoirs of the bacteria include blood-feeding arthropods, various mammals, birds, rodents, reptiles and fish.The incubation period is usually 3-5 days, but can range from 1-14 days. Tularemia usually results in bacterial sepsis.Transmission to human can occur through a number of routes: bites by blood-feeding arthropods, direct contact with infected animals, consuming contaminated food and water and inhaling airborne bacteria.Different transmission route results in different clinical manifestations.As of now, no human-to-human transmission has been identified.

Tularemia occurs in North America, Europe, the former Soviet Union, China and Japan.In U.S., tularemia occurs year-round. Taiwan CDC urges people visiting the aforementioned endemic areas to prevent bites by arthropods. Rubber gloves should be used when handling dead animals, especially rabbits.Always thoroughly cook rabbits, squirrels, and other game before consumption.Taiwan CDC advises people who develop symptoms of high fever, chills, swollen lymph glands, skin ulcers that appear at the site where the organism entered the body, pharyngitis, abdominal pain, vomiting and diarrhea after returning to Taiwan to seek immediate medical attention and inform the physician of the recent travel and animal contact history.

Taiwan CDC urges people visiting endemic areas to avoid contacting animals such as hares and rodents or consuming raw meat and drinking river water during their trip. Travelers are also advised to seek medical attention as soon as possible if any discomfort occurs. In addition, people planning to travel overseas are encouraged to visit Travel Clinics 2 to 4 weeks prior to the trip for outbreak information at travel destinations or access the Taiwan CDC’s website (http://www.cdc.gov.tw/) for updated information on international epidemics and travel-related communicable diseases.