Tularemia is a bacterial zoonosis caused by Francisella tularensis, a gram-negative organism classified as a category A biological agent due to its low infectious dose and capacity for airborne transmission [1]. The multiple routes of infection result in several distinct clinical forms, potentially affecting any body site [1].
Disease overview
BacterialTularemia
土拉菌病
Evidence-backed informationEN 5/7 applicable sections · ZH 5/7 applicable sectionsUpdated Sep 3, 2026
Tularemia, also known as rabbit fever, is a re-emerging zoonotic disease in the Northern Hemisphere, especially in Europe, caused by the gram-negative bacterium Francisella tularensis [1]. It can be transmitted through arthropod bites, airborne exposure, and contaminated food or water, and multiple infection routes produce six classical clinical forms [1]. Because of its low infectious dose and ease of aerosol dissemination, F. tularensis is classified as a category A bioterrorism agent [1][2]. Untreated disease can reach fatality rates of up to 60%, particularly in pneumonic and typhoidal forms, while existing live attenuated vaccine candidates do not yet meet criteria for general licensure [1][2].
Read the full clinical and epidemiological profile6
Multiple exposure routes give rise to six typical clinical pictures: ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, and pneumonic tularemia, alongside less common presentations that may affect any body site [1]. The pneumonic form occurs as part of the spectrum of atypical community-acquired pneumonia caused by zoonotic pathogens, often with extrapulmonary manifestations that can help distinguish it clinically from typical bacterial pneumonia [3]. During pregnancy, tularemia has been associated with complications including lymph node aspiration or excision, maternal bleeding, spontaneous abortion, intrauterine fetal demise, and preterm birth, with oropharyngeal and ulceroglandular forms most frequently reported [4].
Tularemia, caused by Francisella tularensis, is recognized as a re-emerging disease in the Northern Hemisphere and, in particular, across Europe in recent years, prompting renewed attention to its epidemiology [1].
Francisella tularensis is a zoonotic bacterium that can be acquired through arthropod-borne, airborne, food-borne, and water-borne routes, with the ease of aerosol transmission being a defining epidemiologic feature [1]. As an atypical pneumonia pathogen of zoonotic origin, exposure can often be inferred from a relevant animal or environmental contact history [3].
Prevention relies on environmental and animal control strategies, appropriate signaling of clinical suspicion to laboratory staff to reduce occupational exposure, and the use of postexposure prophylaxis when indicated [1]. Although live attenuated and subunit vaccine candidates are under investigation, no vaccine is currently safe and fully licensed for general use [2].
- 1Antonello RM et al. Tularemia for clinicians: An up-to-date review on epidemiology, diagnosis, prevention and treatment. Eur J Intern Med. 2025 May. PMID: 40107886. doi: 10.1016/j.ejim.2025.03.013.PubMed: https://pubmed.ncbi.nlm.nih.gov/40107886/
- 2Putzova D et al. Tularemia vaccines. Folia Microbiol (Praha). 2016 Nov. PMID: 27194547. doi: 10.1007/s12223-016-0461-z.PubMed: https://pubmed.ncbi.nlm.nih.gov/27194547/
- 3Cunha BA et al. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. 2006 May. PMID: 16669925. doi: 10.1111/j.1469-0691.2006.01393.x.PubMed: https://pubmed.ncbi.nlm.nih.gov/16669925/
- 4Fleck-Derderian S et al. Systematic Review of Tularemia During Pregnancy. Clin Infect Dis. 2024 Jan 31. PMID: 38294114. doi: 10.1093/cid/ciad686.PubMed: https://pubmed.ncbi.nlm.nih.gov/38294114/
- 5Asano S et al. Granulomatous lymphadenitis. J Clin Exp Hematop. 2012. PMID: 22706525. doi: 10.3960/jslrt.52.1.PubMed: https://pubmed.ncbi.nlm.nih.gov/22706525/
Coverage
Reporting countries and regions
AustraliaAU
AustriaAT
BelgiumBE
BulgariaBG
CanadaCA
CroatiaHR
CyprusCY
CzechiaCZ
EstoniaEE
FinlandFI
FranceFR
GermanyDE
GreeceGR
HungaryHU
IcelandIS
IrelandIE
ItalyIT
JapanJP
LatviaLV
LiechtensteinLI
LithuaniaLT
LuxembourgLU
MaltaMT
NetherlandsNL
NorwayNO
PolandPL
PortugalPT
RomaniaRO
SlovakiaSK
SloveniaSI
South KoreaKR
SpainES
SwedenSE
SwitzerlandCH
Taiwan, ChinaTW
United KingdomGB
United StatesUS
Trends by reporting country
Monthly patterns over time
Research Radar
Recent related research
PCR-Based Detection of Priority Bacterial Biological Threat Agents: Advances in Diagnosis of Anthrax, Tularemia and Brucellosis
One Health Journal
Tularemia: a re-emerging zoonosis.
Medicina clinica
Macular serpiginous chorioretinitis associated with Francisella tularensis: A case report.
Retinal cases & brief reports
Literature links are provided for discovery and do not alter or validate the surveillance series above.
Data access
Page dataset index with source links and update metadata.
Official sourcesAuthority, cadence, notes51
Austria AGES Radar for Infectious Diseases
Austria
AGES Radar monthly national source. Internal ingestion retains native categories; public release is disabled pending licence review.
Australia NINDSS
Australia
Australian national notifiable diseases surveillance dashboard.
Australia NINDSS — Australian Capital Territory
Australian Capital Territory, Australia
Australian NINDSS monthly state/territory notifications for Australian Capital Territory, kept separate from the Australia national aggregate.
Australia NINDSS — New South Wales
New South Wales, Australia
Australian NINDSS monthly state/territory notifications for New South Wales, kept separate from the Australia national aggregate.
Australia NINDSS — Northern Territory
Northern Territory, Australia
Australian NINDSS monthly state/territory notifications for Northern Territory, kept separate from the Australia national aggregate.
Australia NINDSS — Queensland
Queensland, Australia
Australian NINDSS monthly state/territory notifications for Queensland, kept separate from the Australia national aggregate.
Australia NINDSS — South Australia
South Australia, Australia
Australian NINDSS monthly state/territory notifications for South Australia, kept separate from the Australia national aggregate.
Australia NINDSS — Tasmania
Tasmania, Australia
Australian NINDSS monthly state/territory notifications for Tasmania, kept separate from the Australia national aggregate.
Australia NINDSS — Victoria
Victoria, Australia
Australian NINDSS monthly state/territory notifications for Victoria, kept separate from the Australia national aggregate.
Australia NINDSS — Western Australia
Western Australia, Australia
Australian NINDSS monthly state/territory notifications for Western Australia, kept separate from the Australia national aggregate.
ECDC Surveillance Atlas — Belgium Annual Baseline
Belgium
Belgium annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Bulgaria Annual Baseline
Bulgaria
Bulgaria annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Canada PHAC CNDSS Annual
Canada
Canada is the national jurisdiction; subdivision feeds are registered separately.
Public Health Ontario IDTO Monthly
Ontario, Canada
Ontario-level current-year preliminary monthly case counts from Public Health Ontario's IDTO report.
Switzerland FOPH IDD
Switzerland
Switzerland FOPH/BAG IDD mandatory reporting API normalized to national case rows. Monthly series may use the dashboard CHFL aggregate where CH-only monthly series are not exposed.
ECDC Surveillance Atlas — Cyprus Annual Baseline
Cyprus
Cyprus annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Czechia Annual Baseline
Czechia
Czechia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Germany RKI SurvStat 2.0
Germany
RKI SurvStat national weekly notification export; raw ZIP exports are retained and recent weeks are overwritten for revisions.
ECDC Surveillance Atlas — Estonia Annual Baseline
Estonia
Estonia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Spain Annual Baseline
Spain
Spain annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Finland THL Infectious Diseases Register
Finland
Finland THL Infectious Diseases Register national monthly case counts. The current month is ingested as provisional and the latest three months are refreshed for source revisions.
ECDC Surveillance Atlas — France Annual Baseline
France
France annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — United Kingdom Annual Baseline
United Kingdom
United Kingdom annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Greece Annual Baseline
Greece
Greece annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Croatia Annual Baseline
Croatia
Croatia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Hungary Annual Baseline
Hungary
Hungary annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Ireland HPSC Notifiable Diseases Hub
Ireland
Ireland HPSC national weekly notifiable-disease totals from the official ArcGIS FeatureServer. Internal ingestion is enabled; public release remains disabled pending written redistribution permission.
Iceland Directorate of Health Annual Dashboard
Iceland
National annual case notifications by disease. Published values can be revised retrospectively and remain annual period totals.
Iceland Directorate of Health STI Dashboard
Iceland
Monthly STI diagnosis facts from laboratory and registry surveillance; the official dashboard is published on a quarterly schedule.
Iceland Directorate of Health Respiratory Dashboard
Iceland
ISO-week respiratory diagnosis counts. Hospitalizations, samples, and vaccination indicators are separate measures and are not counted as diagnoses.
Iceland Directorate of Health Historical Registry
Iceland
Historical official registry tables for 1997–2021, with annual totals and disease-specific monthly notification facts retained at source grain.
Iceland Directorate of Health Legacy ICD Monthly
Iceland
Historical Saga EHR ICD encounter counts for 1997–2020. This clinical measure is non-comparable with registry notifications and is kept separate.
ECDC Surveillance Atlas — Italy Annual Baseline
Italy
Italy annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
JP NIID Weekly
Japan
Japan weekly infectious disease surveillance via NIID/JIHS.
Korea KDCA EID
South Korea
Korea KDCA notifiable infectious disease OpenAPI or portal/KOSIS downloads aggregated to national monthly notification counts.
ECDC Surveillance Atlas — Liechtenstein Annual Baseline
Liechtenstein
Liechtenstein annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Lithuania Annual Baseline
Lithuania
Lithuania annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Luxembourg Annual Baseline
Luxembourg
Luxembourg annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Latvia Annual Baseline
Latvia
Latvia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Malta Annual Baseline
Malta
Malta annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Netherlands Annual Baseline
Netherlands
Netherlands annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Norway FHI MSIS Statistics Bank
Norway
Norway FHI MSIS national monthly notifications from the official Allvis frontend API; adapter contract checks guard the unversioned endpoint.
ECDC Surveillance Atlas — Poland Annual Baseline
Poland
Poland annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Portugal Annual Baseline
Portugal
Portugal annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Romania Annual Baseline
Romania
Romania annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Sweden Public Health Agency SmiNet
Sweden
Sweden SmiNet national monthly reported cases from the official Public Health Agency statistics pages; public release is enabled with closed-month publication and revisable recent-month refreshes.
ECDC Surveillance Atlas — Slovenia Annual Baseline
Slovenia
Slovenia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Slovakia Annual Baseline
Slovakia
Slovakia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Taiwan, China CDC NIDSS
Taiwan, China
Taiwan, China monthly notifiable infectious disease open-data CSV feed.
US CDC NNDSS
United States
CDC National Notifiable Diseases Surveillance System provisional data.
US CDC NHSS HIV
United States
CDC NNDSS weekly data plus NHSS annual national HIV diagnoses