Case Study (2 pages)

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Case Study : Outbreak of Primary Tularemia on Martha’s Vineyard

Read the NEJM article “An Outbreak of Primary Tularemia on Martha’s Vineyard,” As you read this article, focus on how the interaction of host-, environment-, and agen t-specific factors led to this outbreak.

Answer the questions below. Keep in mind that the host/agent/environment distinctions are not always clear-cut. For instance, overcrowded conditions can be a result of social behavior on the part of the hosts, but it is also a condition of the social environment.

Don’t worry if you can’t put everything in an easily defined category. Also, many of the questions ask for your ideas about contributory factors in this outbreak.

We are not necessarily looking for a “right” answer in these cases; we want to see that you are thinking about these issues in a broad sense, informed by the concept of the epidemiologic triangle.


Question 1: Describe the agent of tularemia (e.g., what kind of organism, host preferences, transmissibility, and environmental conditions that support growth and transmission).

Question 2: How do these agent-specific factors facilitate transmission and persistence of this infection?

Question 3: Do any agent-specific factors inhibit transmission?

Question 4: Describe the climatic conditions that were present during the Martha’s Vineyard outbreak. Do you think these climatic conditions directly enhanced tularemia transmission?

Question 5: Describe the physical environment in which people became infected (i.e., urban vs. rural, indoor vs. outdoor, forested areas, etc.). How might this physical environment facilitate transmission?

Question 6: What host-specific factors enabled this outbreak to occur? Was infection related to age, immune function, other health problems, or occupation?

Question 7: How might mowing lawns increase the risk of infection?

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