Identifying sites of transmission largely depends on epizootic activity, particularly outbreaks of human disease. TSA HDAC supplier Human Type A outbreaks manifest as a small number of cases, with reports ending quickly as the epizootic rapidly disappears [5], probably due to the mortality of the putative rodent reservoirs. This sporadic nature of Type A epidemiology has greatly hindered identifying the determinants of perpetuation and human risk. The island of Navitoclax nmr Martha’s Vineyard, Massachusetts is unique in the ecology of Type A tularemia in that it is the site of a sustained outbreak of the disease. Nearly 90 human cases have

been identified there since 2000 (Massachusetts Department of Public Health, personal communication). Although ulceroglandular disease is the most commonly reported form of tularemia in the

U.S., the majority of the 90 cases reported during 2000–2008 on Martha’s Vineyard have presented with the pneumonic form of the disease [11]. A large proportion of the case-patients worked as landscapers: a case control study implicated lawn mowing and brush cutting as high risk activities, but the nature of the fomites remains undescribed [12]. In addition to the distinctive presentation of disease, the Martha’s Vineyard tularemia outbreak is unique in its longevity in that cases have occurred Salubrinal datasheet for 9 consecutive years. This prolonged epizootic may represent a new level of transmission on the island. In our longitudinal studies of tularemia epidemiology there, we identified dog ticks, Dermacentor variabilis, as fundamental to the perpetuation of F. tularensis tularensis. Dog ticks appear to be the mode of exposure for the ulceroglandular cases that have been identified there. The main hosts for adult dog ticks (skunks and raccoons) are commonly seropositive whereas no other animal appears to be commonly exposed [13]. Prevalence of F. tularensis DNA in dog ticks collected from sites throughout the island and over the course of the outbreak ranges from < 1% to 5%. And, the start

of the outbreak in 2000 was associated with an island wide increase in dog ticks [11]. Thus, by focusing on the ecology of dog ticks and in particular, by using them as sampling devices, we may better understand the perpetuation of Type A tularemia. Molecular epidemiological isometheptene methods have greatly enhanced our capacity to analyze microbial population structure. The description of variable number tandem repeat (VNTR) loci for F. tularensis now allows the discrimination of individual strains. Using VNTR analyses (also known as multilocus variable number tandem repeat analysis, MLVA), we demonstrated previously that the diversity of F. tularensis tularensis in dog ticks from Martha’s Vineyard is as great as that measured for all existing F. tularensis isolates from across North America [14, 15].