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Hare-to-Human Transmission of Francisella tularensis subsp. holarctica, Germany - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

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Hare-to-Human Transmission of Francisella tularensis subsp. holarctica, Germany - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC



EMERGING INFECTIOUS DISEASES



Volume 21, Number 1—January 2015

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Hare-to-Human Transmission of Francisella tularensis subsp. holarctica, Germany

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Peter Otto, Rebekka Kohlmann, Wolfgang Müller, Sandra Julich, Gabriele Geis, Sören G. Gatermann, Martin Peters, Peter Johannes Wolf, Edvin Karlsson, Mats Forsman, Kerstin Myrtennäs, and Herbert TomasoComments to Author 
Author affiliations: Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Jena, Germany (P. Otto, W. Müller, S. Julich, H. Tomaso); Institute of Medical Laboratory Diagnostics Bochum, Bochum, Germany (R. Kohlmann, G. Geis); Ruhr-University, Bochum (S.G. Gatermann); National Veterinary Laboratory Arnsberg, Arnsberg, Germany (M. Peters); Evangelisches Krankenhaus, Lippstadt, Germany (P.J. Wolf); Swedish Defence Research Agency, Umea, Sweden (E. Karlsson, M. Forsman, K. Myrtennäs)

Abstract

In November 2012, a group of 7 persons who participated in a hare hunt in North Rhine-Westphalia, Germany, acquired tularemia. Two F. tularensis subsp. holarctica isolates were cultivated from human and hare biopsy material. Both isolates belonged to the FTN002–00 genetic subclade (derived for single nucleotide polymorphisms B.10 and B.18), thus indicating likely hare-to-human transmission.
Tularemia is a zoonotic disease caused by the gram-negative bacterium Francisella tularensis (1). Currently, there are 4 validly published subspecies. F. tularensis subsp. tularensis is the most virulent subspecies and occurs only in North America. F. tularensis subsp. holarctica is less virulent and occurs throughout the Northern hemisphere. F. tularensis subsp. mediasiatica was isolated in central Asia, and F. tularensis subsp. novicida, which has low virulence in humans, seems to be distributed globally (2).
Various PCR-based assays have been established for the detection of F. tularensis or for the diagnosis of tularemia. An accurate population structure has been defined by using single nucleotide polymorphisms (SNPs) and insertion/deletion mutations (INDELs) with potential canonical properties. Currently, this population is divided into 4 major genetic clades: B.4, B.6, B.12, and B.16 (3–6). The taxonomic nomenclature of major clades inF. tularensis subsp. holarctica is based on clade-specific canonical SNP markers (3,4). In Europe, the strains of clades B.12 and B.6 dominate (6). The latter is found particularly in large areas in northern, western, and central Europe, including Germany (5–9).
Thumbnail of Area of Germany where hares were hunted on November 2, 2012. Rüthen-Meiste (black star; latitude: 51.512890, longitude: 8.487493, altitude: 380 m), Soest district (white) of the federal state of North Rhine-Westphalia (dark gray).
Figure. Area of Germany where hares were hunted on November 2, 2012: Rüthen-Meiste (black star; latitude 51.512890, longitude 8.487493, altitude 380 m), Soest district (white) of the federal state of North Rhine-Westphalia...
Dr. Otto is the head of the working group, Noro- and Rotaviruses, and an employee of the National Reference Laboratory of Tularemia at the Federal Institute of Bacterial Infections and Zoonoses of the Federal Research Institute of Animal Health, Friedrich Loeffler Institut, Jena, Germany. His interests are focused on the development of diagnostic methods, the incidence and epidemiology of Francisella spp., and other bacterial zoonotic agents in wild animals.

Acknowledgment

We thank Kerstin Cerncic, Renate Danner, Anja Hackbart, Byrgit Hofmann, Wolfram Maginot, Petra Sippach, and Karola Zmuda for their excellent technical assistance; and Franz-Josef Röper for accurate documentation of the data of hunting and the disease outbreak.

References

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Technical Appendix

Suggested citation for this article: Otto P, Kohlmann R, Müller W, Julich S, Geis G, Gatermann SG, et al. Hare-to-human transmission of Francisella tularensis subsp. holarctica, Germany. Emerg Infect Dis. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.131837
DOI: 10.3201/eid2101.131837
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