Tularemia in the Netherlands: a One Health journey

Abstract

After decades of absence from the Netherlands, autochthonous tularemia (Francisella tularensis subspecies holartica) was diagnosed in five humans and three hares (Lepus europaeus) in 2011-2014. The Dutch One Health Signaling Forum Zoonoses (SOZ) initiated targeted activities to inform physicians and hunters, keeping the complex ecology of tularemia in mind. A sudden increase in tularemia-associated hare deaths in 2015 in Friesland province triggered a multidisciplinary investigation in order to increase knowledge on tularemia ecology in the Netherlands and to improve risk management.
The investigation occurred during 2015 and, except for the hares, was restricted to Friesland province. Laboratory records were searched retrospectively for compatible human cases for further investigation. Prospectively, biopsies from compatible human cases were tested by PCR. Nationwide dead hares were examined using histopathology and PCR. Live-captured rodents, mosquito, biting-flies, ticks, and water and sediment specimens were tested using PCR. Interviews were held with local stakeholders to gain information about hare mortality and size of the affected area.
High mortality with confirmed tularemia in 11/12 examined hares was reported in an area of approximately 50km2 from late February to mid-May, compared to 0/7 from that area in the second half of 2015, and 3/74 from elsewhere in the country in the whole year. Water and/or sediment specimens tested positive at 11 sites. No human cases were identified in Friesland, and no rodents or vectors tested positive.
This is the first documented tularemia epidemic in Dutch hares. The detection of F. tularensis in water and sediment specimens indicates an aquatic cycle in the Netherlands. An important consequence of this study, besides confirming the need to understand drivers of emergence to optimize risk communication, was the realization by SOZ-partners that tularemia is an optimal test case to develop generic tools to assess emerging wildlife zoonoses in the Netherlands.

Authors

Jolianne Rijks (Dutch Wildlife Health Centre (DWHC), Utrecht)
Miriam Maas (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Miriam Koene (Central Veterinary Institute of Wageningen UR (CVI), Lelystad)
Ingmar Janse (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Daan Notermans (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Marieta Braks (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Arjan Stroo (Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht)
Frans Reubsaet (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Adolfo Ibanez-Justicia (Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht)
Corien Swaan (Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht)
Maaike de Vries (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Marc Engelsma (Central Veterinary Institute of Wageningen UR (CVI), Lelystad)
Mauro de Rosa (Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht)
Peter van der Tas (Public Health Service Friesland (GGD Fryslan), Leeuwaarden)
Ewout Fanoy (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Roan Pijnacker (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Sip van Wieren (Environmental Sciences, Wageningen UR (WUR), Wageningen)
Ton Oomen (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Wilfrid van Pelt (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Piet Vellema (GD Animal Health (GD), Deventer)
Kitty Maassen (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Tineke Kramer (National Institute for Public Health and the Environment (RIVM), Bilthoven)
Andrea Gröne (Dutch Wildlife Health Centre (DWHC), Utrecht)
Hendrik-jan Roest (Central Veterinary Institute of Wageningen UR (CVI), Lelystad)
Joke van der Giessen (National Institute for Public Health and the Environment (RIVM), Bilthoven)

Topic Areas

Topics: Emerging Diseases , Topics: One Health , Topics: Disease Surveillance/Response

Session

MON-PS » Poster Session & Break (09:50 - Monday, 1st August, Main Lobby)

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