Occurrence and Control of Tularemia in Drinking Water

2015 © American Water Works Association JOURNAL AWWA OCTOBER 2015 | 107:10 Tularemia is an acute febrile zoonotic disease caused by the bacterium Francisella tularensis. Shortly after the initial isolation of the organism in Tulare County, Calif. (McCoy & Chapin 1912), the first case of a human infection was reported from Cincinnati, Ohio (Wherry & Lamb 1914). The first documented waterborne outbreak occurred in Russia (Karpoff & Antonoff 1936). Drinking water has since been implicated as the source of infection in numerous published case reports and outbreak investigations. F. tularensis is considered a biothreat agent (Dennis et al. 2001); thus, from the water supply perspective, the organism has the potential to be associated with naturally occurring waterborne outbreaks or intentional acts of contamination (Khan et al. 2001, Burrows & Renner 1999). This review focuses on tularemia acquired from contaminated drinking water and the adequacy of control measures for preventing waterborne transmission.