Health officials in Suffolk County, Long Island, have confirmed four cases of tularemia, a rare bacterial infection commonly known as rabbit fever.
The fourth case on Long Island was confirmed this month, bringing the local total to four while health authorities have recorded 64 cases nationwide this year. State health officials confirmed that one patient, a woman from Riverhead, is currently undergoing treatment for the infection.
Suffolk County encompasses the eastern portion of Long Island, including the Hamptons, an exclusive coastal enclave known for its celebrity residents, private clubs, and multimillion-dollar estates. Health officials note that the county typically reports between three and six cases of tularemia annually, placing the current cluster within expected seasonal ranges.
Tularemia is caused by the bacterium Francisella tularensis, an organism that infects mammals, particularly wild rabbits, hares, and rodents. Humans can contract the infection through tick or deer fly bites, direct contact with infected animal tissues, consumption of contaminated food or water, or inhalation of airborne bacterial dust.
Symptoms and Transmission Routes
The disease presents sudden flu-like symptoms including high fever, chills, and extreme fatigue, accompanied by painfully swollen lymph nodes and sores near the point of entry. When bacteria enter through the eyes, such as when a person touches an infected animal and rubs their eyes, it produces severe swelling and redness. Swallowing contaminated food or water causes intestinal infection.
Dr Andrew Handel, a New York-based board-certified pediatric infectious disease specialist, explained that diagnosing the condition is challenging due to its diverse manifestations. "It's a really tricky disease because it has so many different forms, and it's rare, so it's not at the top of our mind often when patients do come in," Handel said.
In severe cases, bacteria invade the lungs and cause respiratory illness. "If you inhale tularemia, it goes into your lungs and causes severe pneumonia, and again, that can make you critically, critically ill," Handel warned. The New York State Department of Health warned that residents can inhale bacteria while mowing lawns or performing landscaping if power equipment disturbs contaminated animal carcasses or nests.
Handel referenced a historical outbreak in Cape Cod in 2000, where several people became infected after lawnmowers struck dead rabbits and blasted contaminated particles into the air, causing pneumonic infections.
Pediatric Case and Medical Care
Among the patients affected earlier this year was nine-year-old John Detmer, who spent weeks battling severe illness after an infected tick latched onto his scalp. His family said the connection between the scalp wound and his illness was not initially clear.
"It's like painful, like my neck was hurting me. Sometimes my legs would," the boy told News4. "It hurt it really bad when I touched it."
His mother, Tracey Detmer, noted that even the specialist treating her son had encountered rabbit fever only once before during his career. Following 11 days of fever and intense pain around the scalp wound, John recovered after several courses of antibiotics. Handel noted that while patients typically begin improving within several days of starting antibiotics, lingering fatigue, headaches, and general malaise can persist after the bacteria are eliminated.
Direct human-to-human transmission of Francisella tularensis is extremely rare. "I wouldn't say [human transmission is] impossible, but it's very uncommon to happen," Handel said. "In the hospital, often there's a lot of precaution because we're dealing directly with someone who's infected. If you're around someone who's known to be infected, obviously you want to be careful and not touch the wound [or] come in close contact with it."
Biblical References and Prevention
Some researchers have suggested that tularemia may explain the biblical plague of tumors described in the Book of Samuel, which struck the Philistines after they captured the Ark of the Covenant. However, the Bible does not identify the specific disease, and experts have proposed several competing explanations for the ancient outbreak.
Tularemia cases are most commonly detected during spring, summer, and fall when ticks and rabbits are active and outdoor activity increases. Experts warned that domestic pets could also carry the bacteria and spread it to their owners. "Obviously, the year's not over, we're still in the heat of the summer," Handel warned. "If there are many more cases, it's possible it'll be more than typical."
Despite the severe potential complications, Handel emphasized that general public risk remains low. "This is not something that I think people need to have excessive alarm about," he said. "When we think about tick-borne infections, it's among the most rare that occur." He added that tick bites are likely the primary transmission route on Long Island due to widespread tick populations.
State health officials and medical experts advise residents to check yards for animal carcasses and nests before mowing, consider wearing masks during landscaping work, apply insect repellent, treat clothing with permethrin, avoid tall grass and leaf litter, and seek prompt medical attention if fever or illness develops after a tick bite.
