Tularemia is considered an important emerging zoonosis in Europe. In the Netherlands, between 1953 and 2011 no autochthonous tularemia was reported. However between January 2011 and October 2014, five indigenous human infections with Francisella tularensis supsp holarctica have been reported, as well as three in hares (Lepus europaeus).
The first tularemia patient from 2011 had no history of foreign travel. Most probably, the route of transmission was via insect bites during a boat trip the North-East of the Netherlands .
In July 2011 a non-targeted monitoring in hares started in collaboration between veterinary and human public health institutes. The first F. tularensis infected hare was found in the South of the Netherlands in May 2013 . In July 2013 a visitor of a nature reserve, several kilometers from the location of the positive hare, developed ulceroglandular tularemia through insect bites. The 1953 case also originated from this region.
In January 2014, a man from the South-West of the Netherlands was infected while skinning a hare that had been caught that same day by greyhounds. He developed fever and a painful swelling in the armpit. Samples of the patient as well as haunches of the hare revealed the presence of F. tularensis.
In the North of the Netherlands, two men became feverish in March 2014 after skinning a hare that was found dead. One of them also developed a skin ulcer resulting from a cut by a sharp bone. Sera showed high titers of antibodies against Francisella. Unfortunately, no material of the hare was left to confirm the source.Above cases among humans and hares show the reemergence of F. tularensis in the Netherlands. An important achievement is that different organizations, with various scientific backgrounds, are actively cooperating on risk assessment, surveillance and control measures of tularemia in the Netherlands.