What to know about 'rabbit fever' amid 3 probable cases reported in New York
Tularemia is a rare bacterial illness commonly spread by ticks or deer flies.
Health officials in New York are reporting at least three probable cases of a rare bacterial illness on Long Island.
The Suffolk County Department of Health said laboratory testing is needed to confirm the cases of tularemia, also known as "rabbit fever," which may take several weeks.
"Confirmation of a tularemia diagnosis requires a combination of laboratory testing and fulfillment of specific clinical or epidemiologic criteria," the department told ABC 7 New York. "The laboratory testing to confirm a tularemia diagnosis may take several weeks."
Here's what you need to know about the disease including how it spreads, the symptoms to look for and how to prevent illness.
What is tularemia?
Tularemia is a rare, potentially serious illness caused by the bacterium Francisella tularensis, according to the Centers for Disease Control and Prevention (CDC).
It is commonly spread through tick bites and deer flies that have fed on infected animals, such as wild rabbits, hares, muskrats and rodents. The disease does not spread from person to person.
Humans can also become infected when handling the skin of infected animal tissue by inhaling dust or aerosols contaminated with the bacteria or by drinking contaminated water, the CDC says.
"It's often called rabbit fever because hunters who shoot rabbits and then skin and eviscerate them can become contaminated by that close contact with their tissues," Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University Medical Center in Nashville, told ABC News.
Tularemia is more common in males and more commonly occurs from May through September, according to the CDC.
Since 2019 and through 2023, fewer than 200 cases have been reported annually, CDC data shows.
What are the signs and symptoms?
Symptoms of tularemia can vary depending on how a person became infected, and illnesses range from mild to life-threatening, according to the CDC.
All forms of the illness include a fever that can be as high as 104 degrees. Dr. Zoe Weiss, director of clinical microbiology at Tufts Medical Center in Boston, told ABC News the period from exposure to when symptoms appear is typically three to five days, but can be up to three weeks.
"Tularemia presents the way a bad flu starts -- sudden fever, chills, headache, body aches, feeling wiped out," Weiss said. "What sets it apart is what shows up alongside that: a sore or ulcer where you were bitten and a swollen, painful lymph node near it."
Those who touched an infected animal tissue and then their eyes can develop oculoglandular tularemia, which includes irritation and inflammation of the eye and swelling of lymph glands in front of the ear.
Patients who ate or drank contaminated food and water can develop oropharyngeal tularemia, which may include a sore throat, mouth ulcers, tonsillitis and swelling of neck lymph glands, according to the CDC.
The most serious form, known as pneumonic tularemia, develops after someone breathes in infected dust or aerosols. Symptoms include cough, chest pain and difficulty breathing. It can also occur when other forms of the illness are left untreated and the bacteria spreads through the bloodstream to the lungs, the CDC says.
Tularemia can be difficult to diagnose because of how rare it is, and the symptoms can resemble other more common illnesses.
"Most kinds of pneumonia are very, very similar in their presentation because they all cause inflammation of the same organ, the lungs, and so distinguishing the causes depends upon two things: one, getting a good specimen and sending it to the laboratory, and the other is ... having the physician inquire about what sources," Schaffner said.
How to prevent, treat tularemia
"Tularemia is highly treatable with commonly used antibiotics," Weiss said. "It used to be deadly, but now it is much more treatable with antibiotics."
The CDC said that until recently, a vaccine was available to protect laboratory workers who interact with the bacteria that causes tularemia. However, the vaccine is currently under review by the Food and Drug Administration and is not generally available in the U.S.
When hiking or camping, the CDC recommends using Environmental Protection Agency-registered insect repellents containing DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone.
People should wear long pants, long sleeves and long socks to protect against ticks and deer flies. If a tick attaches, promptly remove it.
When mowing or landscaping, do not mow over sick or dead animals. If hunting, trapping or skinning animals, use gloves when handling animals and cook game meat thoroughly before eating, according to the CDC.
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