Tularemia in North Dakota

• Sudden onset of *fever*, *chills*, *headache*, and *muscle aches*.
• A skin *ulcer* appearing at the site of infection (e.g., tick bite), often with a black center.
• *Swollen and painful lymph nodes* near the ulcer or site of exposure.
• Fatigue and general weakness.
• (Less common, but can occur) Cough, chest pain, sore throat, or diarrhea depending on the infection route.

Tularemia is primarily transmitted through the bite of infected ticks or deer flies. It can also spread through direct contact with infected sick or dead animals (e.g., skinning rabbits) or by inhaling contaminated aerosols (e.g., dust from contaminated soil). Ingestion of contaminated food or water is another potential, though less common, route. It is not known to spread from person to person.

• Avoid direct contact with sick or dead animals, especially rabbits, hares, and rodents.
• Use insect repellent (containing DEET or picaridin) to prevent tick and deer fly bites.
• Wear gloves when handling wild animals (e.g., during hunting or trapping).
• Cook game meat thoroughly to an internal temperature of at least 165°F (74°C).
• Use treated or boiled water for drinking if unsure of source quality in endemic areas.
• A vaccine is available, primarily recommended for individuals with high-risk occupational exposure (e.g., laboratory workers).