Suffolk County health officials have confirmed a fourth case of tularemia on Long Island this year, extending a steady rise in the rare but potentially deadly tick-borne illness that has no vaccine available to the public.
Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services, confirmed the latest case to ABC News on Thursday. The bacterial infection, caused by the organism Francisella tularensis, is commonly known as "rabbit fever" because hunters who skin and gut wild rabbits risk direct exposure. It spreads to humans primarily through tick bites, deer fly bites, handling infected animal tissue, breathing contaminated dust, or drinking contaminated water. It does not spread person to person.
The case marks the fourth confirmed tularemia infection on Long Island in 2026, and it fits a pattern. Suffolk County recorded three cases in 2023, four in 2024, and six in 2025. Year over year, the numbers keep ticking upward in a county that sits barely an hour's drive from midtown Manhattan.
Earlier this summer, a 9-year-old child was among those infected, contracting the disease through a tick bite. The boy suffered swollen lymph nodes and a fever that lasted roughly 11 days, the New York Post reported. That case was one of three probable infections the Suffolk County Department of Health Services had already identified before confirming the fourth.
The condition of the fourth patient, age, sex, and how the person became infected, has not been disclosed by health officials.
Nationally, tularemia remains rare. The CDC says fewer than 200 cases were reported each year from 2019 through 2023. But the trend line is moving the wrong direction. Fox News reported that tularemia cases rose 56 percent between 2011 and 2022 compared with the previous decade, with 196 U.S. cases logged in 2023. The CDC classifies Francisella tularensis as a "tier-1 select agent" because of its potential for mass casualties if weaponized, a designation that puts it alongside anthrax and plague.
New York has become a growing hotspot for tick-borne illness more broadly. The state recently confirmed its first case of Bourbon virus, another rare tick-borne disease with no approved treatment, a reminder that the risk portfolio for outdoor activity in the Northeast keeps expanding.
Dr. Zoe Weiss, director of clinical microbiology at Tufts Medical Center in Boston, told ABC News that the illness starts with generic misery.
"Tularemia presents the way a bad flu starts, sudden fever, chills, headache, body aches, feeling wiped out. What sets it apart is what shows up alongside that: a sore or ulcer where you were bitten and a swollen, painful lymph node near it."
Fevers can spike as high as 104 degrees. Symptoms typically appear three to five days after exposure, though the incubation period can stretch to three weeks, according to Weiss.
That delay makes diagnosis tricky. Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University Medical Center in Nashville, explained to ABC News that when tularemia reaches the lungs, a form called pneumonic tularemia, it looks like many other pneumonias.
"Most kinds of pneumonia are very, very similar in their presentation because they all cause inflammation of the same organ, the lungs, and so distinguishing the causes depends upon two things: one, getting a good specimen and sending it to the laboratory, and the other is... having the physician inquire about what sources."
In other words, a doctor who does not ask whether a patient has been hiking, hunting, or handling wild animals may miss the diagnosis entirely. That matters because tularemia, while treatable, can turn dangerous fast without the right antibiotics.
Vector-borne diseases are an increasing concern across the Northeast. Rhode Island recently elevated its West Nile virus threat level after mosquitoes tested positive near Providence, illustrating how the region faces mounting pressure from multiple insect-borne pathogens during summer months.
Weiss offered reassurance that the disease is far less lethal than it once was.
"Tularemia is highly treatable with commonly used antibiotics. It used to be deadly, but now it is much more treatable with antibiotics."
But the public has no preventive option. A tularemia vaccine was once available to laboratory workers who handled the bacterium. It is no longer in use. The CDC says the vaccine is "currently under review by the Food and Drug Administration and is not generally available in the U.S." No timeline for that review has been disclosed.
Dr. Daniel Ruderfer, chief of pediatric infectious diseases at Hackensack Meridian K. Hovnanian Children's Hospital, put the stakes plainly in comments reported by Fox News: "The infection is absolutely dangerous and potentially life-threatening if not treated with appropriate antibiotics."
That warning is worth taking seriously. Tularemia cases peak between May and September, the exact months when families are most likely to be outdoors, hiking trails, and letting children play in tall grass. The CDC says the disease is more common in males.
Emerging infectious diseases have drawn increasing attention worldwide. Concerns over Ebola's spread beyond central Africa and unusual quarantine responses to suspected hantavirus cases in Europe reflect a broader reality: rare diseases demand faster recognition and clearer public guidance than health bureaucracies often deliver.
With no vaccine on the horizon, the CDC's prevention advice is straightforward. Hikers and campers should use EPA-registered insect repellents containing DEET, picaridin, IR3535, Oil of Lemon Eucalyptus, or 2-undecanone. Long pants, long sleeves, and long socks reduce skin exposure. Attached ticks should be removed promptly.
Hunters face additional risk. Schaffner explained the origin of the disease's nickname:
"It's often called rabbit fever because hunters who shoot rabbits and then skin and eviscerate them can become contaminated by that close contact with their tissues."
The CDC recommends wearing gloves when handling wild animals, cooking game meat thoroughly, and never mowing over sick or dead animals, a scenario that can aerosolize the bacteria and send it straight into the lungs.
Four cases in one county may sound small. But Suffolk County's steady climb, three, four, six, and now four already with summer far from over, suggests the bacterium is establishing a firmer foothold in a densely populated part of the country. The FDA's vaccine review drags on without a public timeline. Local health departments are left issuing the same warnings season after season, hoping residents listen before the next tick latches on.
When rare diseases stop being rare, the public deserves more than pamphlets and press releases, it deserves a government that moves as fast as the ticks do.
