An outbreak of tularemia in southwestern Turkey.

Introduction: Tularemia has reemerged and spread throughout Turkey, and the number of cases has increased. In this study, we report on a waterborne outbreak of tularemia in the spring of 2013 in a region which was previously disease-free, and we investigated the reasons for the outbreak.

Methodology: The index case, a 17-year-old male, was diagnosed with oropharyngeal tularemia. An outbreak investigation was initiated after receiving information from other patients with similar symptoms from the same village along with Balkıca, Tavas, and Denizli. An epidemiological and environmental investigation was conducted. Tonsil swab specimens/lymph node aspirates collected from patients, and water samples collected from unchlorinated drinking water sources, were cultured. Additionally, a real-time polymerase chain reaction (RT-PCR) was performed on these samples. Serum samples from patients were analyzed for antibody response.

Results: A total of 7 patients were found in this outbreak investigation. The attack rate was found to be 1% among the people of the village and 25% among patients' family members. The drinking-water system was contaminated with F. tularensis during this outbreak.

Conclusions: Lack of appropriate water infrastructure and sanitation was the primary reason for this tularemia outbreak in Turkey. Improving the water source infrastructure and sanitation should be the primary approach to preventing tularemia outbreaks.