Abstract

BACKGROUND: Notified tularemia cases have been increasing in both the European Union and Austria, yet no contemporary seroprevalence data are available. This study aimed to estimate the current tularemia seroprevalence in Western Austria and to inform prevention programmes by comparing seroprevalence-derived incidence rates with notified case numbers.

METHODS: Between December 2023 and February 2024, serum samples from 3008 healthy blood donors aged 18-70 years in Western Austria were collected and analysed for anti-Francisella-tularensis-IgG-antibodies using a commercially available ELISA. In the absence of confirmatory serological assays, the manufacturer's cutoff values were increased to enhance specificity, as recommended by a previous serological evaluation.

RESULTS: Overall seroprevalence was 2.0% (95%CI 1.6-2.6), with comparable results in Vorarlberg and Tyrol. The 10-year mean notified incidence rate in Western Austria was 0.30/100000/year, compared to 29/100000/year based on seroprevalence data, indicating a substantial proportion of unreported infections (mean manifestation index of 1.05%). Seroprevalence varied markedly across districts, identifying potential tularemia hotspots.

CONCLUSION: Estimated annual tularemia incidence rates were substantially higher than notified case numbers, underscoring the need for public education, increased clinical awareness, and targeted prevention programmes. The observed district-level variation in seroprevalence should be used to inform the geographic prioritisation of such interventions.