Tularemia prophylaxis

A live attenuated vaccine derived from a less virulent form of F. tularensis is available for laboratory personnel who routinely work with tularemia. Postexposure prophylaxis for contacts of tularemia patients is not recommended, as person-to-person transmission is not known to occur. For persons who may have been exposed to F. tularensis, for example, by an act of bioterrorism, a 14-day oral course of ciprofloxacin or doxycycline is indicated (Dennis et al., 2001). 

Table 2.16 Tularemia treatment in mass casualty situations and for mass prophylaxis ...

Currently, the Working Group on Civilian Biodefense does not recommend tularemia vaccination for pre- or postexposure prophylaxis of the general popnla-tion for two reasons ... 

If health officials fail to detect the release until people start becoming ill, physicians should instruct their patients to begin a fever watch. Those who develop an unexplained fever or flu-like illness within 14 days of exposure should begin treatment as outlined in Tables 2.15 and 2.16, depending on whether the outbreak involves a contained or mass casualty scenario. Patients with tularemia do not require isolation, and close contacts of cases do not require prophylaxis because person-to-person transmission does not occur (43). 

The natural tularemia foci in Kazakhstan occupy 552,400 km2 (26% of the territory of the Republic). The most effective method of prophylaxis is vaccination by live vaccine strain Francisella tularensis holarctica (Russian), which provides reliable immunity for 5 years. Annually, between 70,000 and 100,000 people are vaccinated and revaccinated. We have patented the strain F. tularensis mediasiatica KA-29 for creation of a domestic vaccine that is highly immunogenic, non reactogenic, and will induce crossimmunity [9],... 

Sawyer, Dengerfield, Hogge and Crozier Antibiotic Prophylaxis and Therapy of Airborne Tularemia , Bacteriological Reviews (September 1966), pp. 542-8. 

Antibiotic prophylaxis after exposure to tularemia is difficult. The optimal bactericidal antibiotics such as streptomycin are impractical because they must be given parenterally. Limited studies93 carried out in small numbers of human volunteers showed that treatment with tetracycline begun 24 hours after exposure to an aerosol of tularemia protected subjects from disease. An oral dose of 2 g/d for 14 days was necessary. 

Sawyer WD, Dangerfield HG, Hogge AL, Crozier D. Antibiotic prophylaxis and therapy of airborne tularemia. Bacteriol Rev. 1966 30 542-548. 

Foshay L, Hesselbrock WH, Wittenberg MJ, Rodenberg AH. Vaccine prophylaxis against tularemia in man. Am J Pub Health. 1942 32 1131-1145. 

Antibiotics should be continued for 60 days in patients with anthrax infection. Postexposure antibiotic prophylaxis is recommended after exposure to anthrax, plague, and tularemia. 

Vaccines. Anthrax and smallpox vaccines can be used before exposure and also for postexposuie prophylaxis. A pentavalent (ABODE) botulinum toxoid is currently used for laboratory workers at high risk of exposure. It is not effective for postexposure prophylaxis. Vaccines are not currently available for plague, tularemia, or viral hemorrhagic fevers. 

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