The Suffolk County Department of Health Services has confirmed a fourth case of tularemia this year, the bacterial infection commonly called rabbit fever. Officials have not confirmed how the person was infected.
Four confirmed cases is a notable number for a county that counts these infections in single digits, but it is not unprecedented. Dr. Gregson Pigott, the county health commissioner, has pointed out that tularemia has been reported in Suffolk for several years. County figures show six confirmed cases in 2025, four in 2024, three in 2023 and one in 2022. This year's total currently sits at the upper end of that recent range rather than outside it.
For Long Island families, the reason to pay attention is not case volume. It is that tularemia is a disease most local clinicians rarely see, and it can look like a bad flu at exactly the moment when a distinguishing detail, a sore at a bite site and a swollen lymph node near it, is the thing that leads to the right antibiotic.
The Confirmation Process Explains Why Counts Move Slowly
Suffolk County health officials have been careful about labels, and that caution is worth understanding.
The department said in a statement that confirmation of a tularemia diagnosis requires a combination of laboratory testing and fulfillment of specific clinical or epidemiologic criteria, and that laboratory testing to confirm a diagnosis may take several weeks.
That is why coverage earlier this month described three probable cases while the county now reports four confirmed. Probable cases move to confirmed as lab work completes, and additional probable cases may still be in the pipeline. Readers should treat any single day count as provisional.
The New York State Department of Health has said it works with local health departments on prevention and treatment guidance.
A Rough Tick Season Is the Backdrop
Dr. Sharon Nachman of Stony Brook Children's Hospital has described this as a very bad tick season on Long Island and raised the open question of why the county may be seeing more tularemia this year than in the past. She has pointed to possibilities including a winter that may not have killed off tick eggs, while noting that the cause is not established. Nationally, she said, there are about 200 tularemia cases a year, so a handful on Long Island is not surprising in itself.
An independent expert offered a clinical description. Dr. Zoe Weiss, director of clinical microbiology at Tufts Medical Center in Boston, told ABC News that tularemia presents the way a bad flu starts, sudden fever, chills, headache, body aches, feeling wiped out, and that 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.
The broader tick picture supports the county's caution. MedicalDaily previously reported that emergency department visits for tick bites rose sharply in early 2026 compared with the same period a year earlier, an early season signal that pointed toward a heavy year.
Surveillance has also found the bacterium locally. Researchers from the state and county health departments, reporting in CDC's Emerging Infectious Diseases, mapped 30 New York tularemia cases from 1993 through 2023, found that 43 percent were from Suffolk County, and detected Francisella tularensis in one pool of nymphal ticks collected in the county, indicating localized risk.
The Groups Most Likely to Be Exposed
Tularemia does not spread from person to person, so this is an exposure question rather than a contagion question.
The people most likely to encounter it are those spending time in wooded or brushy areas, gardeners and landscapers, anyone who mows over a nest or a dead animal, hunters and trappers handling rabbits, hares or rodents, and children playing in yards bordering natural areas. A Riverhead family has described their 9 year old son's illness, one of the cases reported to the county this year. His mother found a tick on his head in late April after he had been playing in the yard, and the family said he endured nearly a month of fevers, swollen glands, body aches and fatigue before diagnosis.
According to CDC, transmission routes include bites from infected ticks or deer flies, contact with the blood or tissue of infected animals, drinking contaminated water, inhaling contaminated dust, and eating undercooked infected rabbit meat. The lone star tick and the American dog tick are the species most closely associated with the disease in the United States.
Symptoms generally appear three to five days after exposure but can take up to three weeks. Other forms can involve sore throat and mouth ulcers, eye inflammation, or pneumonic tularemia, with cough, chest pain and difficulty breathing. Untreated infection can progress to bloodstream infection and sepsis. Tularemia responds to appropriate antibiotics, and outcomes are generally good with treatment.
Practical Prevention for the Rest of the Season
CDC notes tularemia cases cluster from May through September, putting Long Island mid window.
The measures that work are ordinary. Use an EPA registered repellent, wear long sleeves and long pants in wooded or tall grass areas, do a full body tick check within a couple of hours of coming inside, and pay particular attention to the scalp and hairline on children, which is where the Riverhead case began. Shower soon after outdoor activity. Wear gloves and avoid handling dead or visibly sick wild rabbits and rodents, and do not mow over animal carcasses.
If a tick bite is followed by fever, chills and a swollen, painful lymph node, or by a sore that is not healing normally, tell the clinician about the bite and ask specifically about tularemia. Because the infection is uncommon, many physicians see very few cases in a career, and volunteering the exposure history changes what gets tested. Severe symptoms including difficulty breathing, chest pain or rapid deterioration require urgent evaluation.
Suffolk County updates its communicable disease data periodically, and additional probable cases could be confirmed as laboratory work finishes. MedicalDaily will monitor the county's reporting for the remainder of the season. This article is general information and is not a diagnosis.
Frequently Asked Questions
How many cases has Suffolk County confirmed? Four confirmed tularemia cases in 2026, according to the county health department.
Is that unusual? It is at the upper end of the county's recent range, which included six in 2025, four in 2024, three in 2023 and one in 2022.
Can I catch it from another person? No. Tularemia does not spread person to person.
What are the distinguishing symptoms? Sudden fever and body aches plus a sore or ulcer at the bite site and a swollen, painful lymph node nearby.
How soon do symptoms appear? Usually three to five days after exposure, but sometimes up to three weeks.
Is it treatable? Yes, with appropriate antibiotics. Outcomes are generally good when treatment starts promptly.
What should I do about dead rabbits in my yard? Do not handle them bare handed and do not mow over them. Contact local animal control for removal guidance.
