Endemic tularemia, Sweden, 2003.(DISPATCHES)

Tularemia cases have been reported in Sweden since 1931, but no cyclical patterns can be identified. In 2003, the largest outbreak of tularemia since 1967 occurred, involving 698 cases. Increased reports were received from tularemia-nonendemic areas. Causal factors for an outbreak year and associated geographic distribution are not yet understood.

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The ability of Francisella tularensis, the bacterial pathogen of tularemia, to infect at low levels and cause a high prevalence of illness and death in humans (1) has led to its inclusion in the ranks of…