From 1950 to 1977, 5049 human tularemia cases were registered that had been associated with a large number of non-immunized people coming to Kazakh tularemia endemic areas from different places of Soviet Union to harvest the grain. Since 1978, the number of tularemia patients has considerably decreased and during 1992-2001 thirty-one human cases were reported. Epidemiological analysis showed that infection was transmitted by a variety of routes, including bites of infected arthropod, ingestion of infected food and water, transfer to mouth by contaminated hands and direct contact from skinning musk-rats and hares. The disease presented mainly as glandular-bubonic (62.5%), bubonic (25.0%) or pulmonary (12.5%) forms.
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