All ETDs from UAB

Advisory Committee Chair

Nicole Wright

Advisory Committee Members

Tamika Smith

Katia Bruxvoort

Document Type


Date of Award


Degree Name by School

Master of Science (MS) School of Public Health


Background: Tularemia or Rabbit Fever was discovered in 1911 in a plague-like outbreak among rodents in Tulare County, California. Tularemia in the US has expanded from rural to more metropolitan areas, which may be potentially correlated with the escalating exposure of humans to animal vectors. There has not been a recent study evaluating trends in Tularemia, especially one that has evaluated if the trends in Tularemia over time differ by demographic characteristics. Methods: This is an ecological study to evaluate the temporal trends and if trends Tularemia incidence over time differs by age and sex in the United States from 2010-2019. The National Notifiable Diseases Surveillance System database was used to obtain tularemia data, and incidence rates were calculated based on annual US Census data. A generalized linear model was used to assess temporal trends in Tularemia and if trends differed by age and sex using interaction terms. Results: The average Tularemia incidence between 2010 – 2019 was 0.07 per 100,000 people, with the highest incidence of 0.10 in 2015 and the lowest incidence of 0.04 in 2010. The generalized linear model showed that over the study period, Tularemia incidence increased by 0.004 per 100,000 persons (p = 0.001). Men had the highest incidence of Tularemia, ranging from 0.05 in 2010 to 0.11 in 2019 compared to 0.03 and 0.07 in 2010-2019 in women, respectively. However, there were no difference in the temporal trends by sex (p = 0.24). Tularemia incidence was highest in those 65 years of age and older, especially in the 2015 spike, but there were no differences in incidence over time by age group (p = 0.08). Conclusion: Overall Tularemia incidence increased slightly during the study period, with no difference in trends by sex and age. Future studies should focus on the increased risk presented by domestic pets and if vaccines could be helpful.

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