Key points
- People can get tularemia through occupational exposures.
- People who work in a microbiological laboratory and veterinary or other animal care may have higher risk of infection with Francisella tularensis compared to those in human healthcare, where the risk is generally lower.
- Appropriate precautions to decrease risk of tularemia through occupational exposure are important in all settings.
Managing potential exposures
Management options for potentially exposed workers include a "fever watch" or antimicrobial prophylaxis. During a fever watch, workers monitor their temperature for 14 days after exposure and seek immediate medical evaluation and treatment for tularemia if they develop a fever (defined as a single oral temperature above 101 °F or 38.3 °C) or other concerning symptoms such as trouble breathing, skin ulcer, swollen lymph nodes, or abdominal pain.
Doxycycline (100 mg orally BID X 10-14 days) is recommended for prophylaxis in adults, as well as ciprofloxacin (500 mg orally BID X 7 days) and levofloxacin (500 mg orally daily X 7 days).
Due to limited data, there are no established criteria to determine who should undergo fever watch versus immediate prophylaxis. Factors to consider when making this decision include:
- Time since exposure: The typical incubation period for tularemia is 3-7 days (range 1-14 days). Fever watch may be preferred if much of the incubation period has already passed without developing symptoms.
- Type of exposure: Exposures should be assessed as high- or low-risk depending on the material handled, the mechanism of exposure, safety precautions in use, and proximity to the suspect material. Immediate prophylaxis should be considered for high-risk exposures, while fever watch is recommended for lower risk exposures. Examples of potentially high-risk exposures include working with cultures outside a biosafety cabinet, bites from infected animals, needlesticks, scalpel wounds, mucous membrane exposures during necropsies, and aerosol-generating procedures on cultures or tissues conducted without personal protective equipment. Personnel working in the same laboratory where a specimen has been processed by someone else are generally at low risk.
- Personal preference and risk tolerance: Some workers may be more concerned about their risk of infection and prefer immediate prophylaxis, while others may be more concerned about the risks of taking potentially unnecessary antibiotics and prefer fever watch
Fact sheet: Managing occupational exposures to Francisella tularensis