1159), but because of its toxicity, most physicians prefer other drugs with powerful antibiotic properties. There are also treatments known as "cocktails" which are generally combinations of streptomycin and some other antibiotic drug. In most cases, once an infected individual was undergone drug therapy for tularemia, they become immune to any future infections in the long-term, yet depending on the severity of the infection, relapses have been reported (Glanze, 2002, p. 1160).

Since the overall source of tularemia is generally through the bite of an insect, such as a tick, a mite or a fly, there are any number of ways to prevent becoming infected with the illness. For example, when a person is outdoors, such as in a heavily-wooded region of the countryside, wearing protective clothing often helps to prevent being bitten by an infected insect.

Also, along with protective clothing, one should use some type of insect repellent, most preferably containing DEET (N, N-diethylmetatoluamide). As pointed out on the official United States Army medical information website, soldiers in the field are almost always required to use DEET as a way of preventing being contaminated with tularemia ("Tularemia, 2006, Internet).

As to decontamination procedures, the Department of Health and Human Services of the U.S. Federal government recommends a number of ways which have been shown to effectively eliminate the tularemia bacillus. Under extreme conditions, such as during some type of widespread tularemia infection as one might find in a war zone or possibly as a result of deliberate infection via a terrorist attack, all medical instruments that have been used to treat victims with cutaneous tularemia "should be autoclaved or decontaminated with 0.5% hypochlorite, a 1:10 dilution of common household bleach." All clothing and bedding should be placed...

If there are spills of infected body fluid, any aerosol must be allowed to settle first and then liberal amounts of hypochlorite must be gently applied so as to avoid further contamination. Before clean-up of these spills can be finished, they must be allowed to sit for at least twenty minutes and then only cleaned up by working from the perimeter to the center, meaning to wipe from the outside of the spill toward the center ("Decontamination," 2009, Internet).
If the personnel involved in the clean-up procedure becomes infected, all outer clothing must be removed and then placed in labeled plastic bags for immediate disposal. This would be followed by showering with hot water and soap. Overall, the most effective method for decontaminating a surface, object or person is to use hypochlorite and some other powerful antiseptic ("Decontamination," 2009, Internet). Of course, all instances of tularemia infection must be reported to local and state departments of health and should be reported to the CDC in Washington, D.C.

REFERENCES

"Decontamination -- Infection Control." (2009). Internet. Accessed June 22, 2009 from http://www.doh.was.gov/phepr/providerfactsheets/tularemiahcp.doc.

Glanze, Walter D., ed. (2002). Mosby's Medical, Nursing and Allied Health Encyclopedia.

St. Louis, MO: C.V. Mosby Company.

"Tularemia." (2006). Internet. Accessed June 22, 2009 from http://chppm-www.apgea.

army.mil/documents/FACT/18-006-0406-Tularemia-JusttheFactsApril2006.pdf.