SUFFOLK COUNTY — The Suffolk County Department of Health announced three potential cases of tularemia, prompting health officials to urge caution regarding the tick-borne illness. Four cases of tularemia were reported in Suffolk County in 2024, representing the highest number since before 2014.

Tularemia is also known as rabbit fever and is caused by the bacteria Francisella tularensis. The disease spreads through tick and deer fly bites, contact with infected animals, contaminated food or water, or inhalation of bacteria. Bites from the Lone Star tick and the American dog tick are most closely associated with the infection. Rabbits, hares, and rodents are especially susceptible to tularemia and often die in large numbers during outbreaks.

John Detmer, age 9, was diagnosed with tularemia after becoming sick in late April. He became ill after a tick was removed from his head while he was playing in his yard in Riverhead. Detmer did not touch any wild rabbits before contracting the illness. It took multiple doctor visits for an infectious disease specialist to diagnose him with the condition.

Detmer experienced severe head and neck pain and a fever lasting 10 to 11 days. He was initially given antibiotics other than doxycycline, which is normally prescribed after any suspicion of a tick-borne illness. After receiving the correct diagnosis, he was treated with multiple rounds of antibiotics and is now feeling better.

Dr. Sharon Nachman, a doctor at Stony Brook Children’s Hospital, stated that tularemia symptoms can be intense and often prompt emergency care. "You have a headache, your muscles hurt, your joints hurt, you're miserable and you are often in the emergency room," Nachman said. She added that the severity distinguishes it from common minor ailments. "This is not the kind of illness that you're at home going, I feel a little unwell," she said.

Tularemia symptoms generally appear three to five days after exposure but can take up to 21 days to develop. Common signs include abdominal pain, fever, chills, headache, loss of appetite, muscle aches, swollen lymph nodes, nausea, and vomiting. Additional symptoms can include pink eye, skin rash, sore throat, cough, diarrhea, and confusion. Confirmation of a tularemia diagnosis requires a combination of laboratory testing and fulfillment of specific clinical or epidemiologic criteria.

Complications from tularemia can include acute respiratory distress syndrome and inflammation of the brain, heart, bone, or liver. The disease does not spread from person to person. Tularemia is treated with antibiotics such as streptomycin, gentamicin, and amikacin.

An antibiotic course for the illness is usually prescribed for two to three weeks. A vaccine for tularemia was previously available for lab workers but is under review by the US Food and Drug Administration and is not generally available in the United States.

Tularemia cases are more common from May through September. In 2023, fewer than 200 cases of tularemia were reported in the United States. Suffolk County reported three cases of tularemia in 2023 and one case in 2022.

The Centers for Disease Control and Prevention recommends using insect repellent, wearing gloves when handling sick or dead animals, and wearing long pants, long sleeves, and long socks outside to prevent transmission. The agency also recommends wearing a mask while mowing and avoiding mowing over dead animals.

The four cases reported in Suffolk County in 2024 mark a significant increase compared to recent years, with only one case reported in 2022 and three in 2023. This spike shows the challenges in diagnosing the illness, as seen in the case of John Detmer, who required multiple medical visits and specialized testing to receive appropriate treatment. The difficulty in identification reflects the importance of awareness among healthcare providers and the public, particularly during peak transmission months from May through September.

While tularemia remains rare nationally with fewer than 200 cases reported across the United States in 2023, the potential for severe complications such as acute respiratory distress syndrome and organ inflammation necessitates prompt medical attention. Public health recommendations focus on preventive measures including protective clothing and careful handling of potential animal vectors, as no generally available vaccine exists for the general population.

Why It Matters

The four tularemia cases reported in Suffolk County in 2024 mark the highest number since before 2014, signaling a notable local increase for a disease that affects fewer than 200 people nationally each year. Because confirmation requires specific laboratory testing and clinical criteria, delays in diagnosis can lead to severe complications involving the brain, heart, or lungs. With no generally available vaccine, prevention relies entirely on protective measures during peak transmission months from May through September.