Date: Tue 22 Oct 2019
Source: Diario Palentino [In Spanish, trans., edited]
The Epidemiological Surveillance Network confirmed today [22 Oct 2019] 2 new cases of tularemia in the basic health area of Saldana and Jardinillos [Palencia, Castile and Leon], in addition to the 23 patients who are under investigation with symptoms similar to those of the disease. With these new positive environmental exposure cases without requiring hospitalization, the overall figure rises to 54 affected in the province, according to data provided by the Junta of Castile and Leon.
The Basic Health Zone of Paredes de Nava with 16 cases reported; Villarramiel with 9 cases, and Villada with 5 cases are the foci of greater incidence of the disease transmitted by voles. In addition, the health area of rural Palencia has reported 5 cases, while Eras del Bosque and Jardinillos, in the capital, have reported 2 case.
[The manifestations of tularemia are not stated and it would not be surprising if oropharyngeal tularemia is occurring as this outbreak, given its size, may be waterborne.
Outbreaks of water-transmitted tularemia include 64 cases in Dagestan, Russia associated with a flood-plain swamp (1), 49 cases in Tuscany, Italy linked to an unchlorinated water system (2), an outbreak in the Smolensk province of Russia also attributed to contamination of a water supply (3), improperly prepared water for washing in the Czech Republic (4), and a Swedish outbreak associated with a contaminated well used for drinking water (5). Additionally, during the period 1936 to 1963, there were approximately 30 outbreaks of water-borne tularemia reported from the then Soviet Union (6).
1. Tikhenko NI, Efremenko VI, Omarieva E, et al. [Outbreak of tularemia in the Republic of Dagestan]. Zh Mikrobiol Epidemiol Immunobiol. 2001; (6 Suppl):68-72; abstract available at
2. Greco D, Allegrini G, Tizzi T, et al. A waterborne tularemia outbreak. Eur J Epidemiol 1987; 3:35-8; abstract available at
3. Rogutskii SV, Khramtsov MM, Avchinikov AV, et al. [An epidemiological investigation of a tularemia outbreak in Smolensk Province]. Zh Mikro Epidemiol Immunobiol 1997; 2:33-7; abstract
4. Pazdiora P, Moravkova I, Nocarova D, et al. [A water-borne epidemic of tularemia in Chlumcany]. Epidemiol Mikrobiol Imunol. 2002; 51:23-5; abstract available at
5. Tarnvik A, Sandstrom G, and Sjostedt A. Infrequent manifestations of tularemia in Sweden. Scand J Inf Dis. 1997; 29:443-46; abstract
6. Pollitzer, R. History and incidence of tularemia in Soviet Union -- a review. Institute for Contemporary Russian Studies, Fordham University, Bronx, New York, 1967. - ProMED Mod.LL]
[HealthMap/ProMED-mail map of Castile and Leon, Spain: