The Morbidity and Mortality Weekly Report has recently disseminated updated guidance from the US Centers for Disease Control and Prevention (CDC) concerning postexposure prophylaxis and treatment of the tickborne disease tularemia. Acutely rare but nonetheless severe, tularemia infects a handful of Americans each year. Yet, due to the disease’s potential for bioterrorism usage, healthcare providers are in a constant evolution of preparedness.
Tularemia is instigated by the gram-negative bacteria Francisella tularensis and is primarily transmitted through bites from ticks, deer flies, and mosquitoes. Naturally occurring infections predominantly occur in the Northern Hemisphere, recording up to 300 cases in the United States annually. However, with just a small degree of the pathogen required for infection, tularemia qualifies as a bioterrorism agent capable of impacting thousands.
Healthcare providers, in conjunction with public health authorities and preparedness experts, must quickly respond in the event of an intentional release of the pathogen. In doing so, they can work towards mitigating the significant repercussions of a bioterrorism attack. As the CDC notes, the US government currently stockpiles medical countermeasures to handle such scenarios, ushered by the 21st Century Cures Act that mandates the development of evidence-based guidelines for such medicinal usage.
The CDC created comprehensive guidelines after systematic reviews of human tularemia cases through 2023, analysis of surveillance data, outbreak reports, case series, and consultation with expert practitioners in the field. Notably, the treatment recommendation in the aftermath of a bioterrorism attack includes usage of two distinct antimicrobial classes due to the potential threat of engineered antimicrobial resistance.
Crucial to these guidelines are changes from the 2001 directives. For instance, fluoroquinolone antibiotics (ciprofloxacin and levofloxacin) and doxycycline are now deemed as first-line treatments for outbreaks. Moreover, guidance is now provided for specific patient categories, such as newborns, infants breastfeeding, lactating mothers, immunocompromised patients and the elderly. However, it should be noted that these recommendations do not integrate specifics regarding treatment dispensing, diagnostic testing, or adjunct therapists.
Meanwhile, studies are reporting reduced risk of infection and severe outcomes (like preterm births and stillbirths) from maternal COVID-19 vaccination. Despite this, there’s notable reluctance amongst pregnant women with regards to getting vaccinated, reflecting the pervasive uncertainties residing amongst childbearing age women regarding the vaccines’ perceived safety. This dichotomy between scientific evidence and public perception calls for increased efforts in addressing these fears.
Lastly, the number of measles cases continue to rise, leading to breaking records. Unvaccinated individuals form the majority of these patients. Amidst these developments, valuable research is being conducted on vaccines addressing other diseases too, underlining the necessity for continued effort in infectious disease control.