Page 89 - Journal of Special Operations Medicine - Winter 2016

intravenously [IV] daily) for 10 days. Ciprofloxacin Recommended Internet Links
(500mg orally [PO] twice daily) and doxycycline (100mg https://www.cdc.gov/tularemia/clinicians/index.html
PO/IV twice daily) with 21-day treatments have also https://wwwn.cdc.gov/nndss/conditions/tularemia/
been used but are not US Food and Drug Administra- case-definition/1999/
tion approved for this indication and are associated with http://www.cdc.gov/tularemia/resources/whotulare-
higher rates of relapse. Postexposure prophylaxis, as in miamanual.pdf
a biowarfare setting, is ciprofloxacin (500mg PO twice
daily), doxycycline (100mg PO twice daily), or tetracy-
cline (500mg PO 4 times daily) for 14 days after contact.
COL Burnett is currently Chief of Pediatric Infectious Dis-
Vaccination eases at Tripler Army Medical Center in Hawaii, and is the
Pediatric Subspecialties Consultant to the U.S. Army Surgeon
There is no vaccination commercially available for the General. He is Board Certified in Pediatrics and Pediatric In-
prevention of tularemia. fectious Diseases. He has served overseas in Korea, Germany,
Kosovo, Iraq, Afghanistan, Kuwait, and as the JSOTF-P Sur-
geon in the Philippines. He is a graduate of the University of
Importance in a Deployed Setting Wisconsin-Madison, and the Medical College of Wisconsin.
Six US states (Missouri, Arkansas, Montana, Oklahoma,
South Dakota, and Kansas) account for over half of the Keywords: tularemia; Francisella tularensis
100 to 150 annual reported cases in the United States,
and the disease has a wide distribution across much of
the Northern Hemisphere where Special Operations
Forces may be deployed or training in the field. Many
cases likely go undiagnosed and, thus, unreported. F. tu-
larensis is a very infectious organism; with only 10 to 50
organisms needed to cause disease. It has already been
weaponized and tested as an aerosolized biowarfare
agent and as such should be in the differential diagnosis
if numerous ill persons present with similar symptoms.

Disclaimer
The views expressed in this publication are those of the
author, and do not reflect the official policy or position
of the Department of the Army, Department of Defense,
or the US Government.

Disclosure
The author has nothing to disclose.

Bibliography
American Academy of Pediatrics. Tularemia. In: Kimberlin DW,
Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Re-
port of the Committee on Infectious Diseases. 30th ed. Elk
Grove Village IL: American Academy of Pediatrics; 2015:
839–841.
Harik NS. Tularemia: epidemiology, diagnosis, and treatment. Pe-
diatr Ann. 2013;42:288–292.
Weber IB, et al. Clinical recognition and management of tularemia
in Missouri: a retrospective records review of 121 cases. Clin
Infect Dis. 2012;55:1283–1290.
Tularemia. In: Quick Bio-Agents USAMRIID’s pocket reference
guide to biological select agents & toxins. Fort Detrick, MD:
US Army Medical Research Institute of Infectious Diseases;
2012 (www.usamriid.army.mil).

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