Fig. 4.

Number of cases of tularaemia reported each year in the EU/EEA. Data is shown for every country with >100 total cases reported between 2008 and 2016. Human tularaemia is not a notifiable disease in Denmark, Portugal and Liechtenstein, however, notification is mandatory in most EU/EEA member states [16] (Fig. 4). A voluntary surveillance system is in place for Belgium and the United Kingdom [48]. Sweden reported the highest total number of cases, 3164, followed by Finland, Czech Republic, Norway and Hungary. France, Germany, Spain and Slovakia experienced much lower incidences, fewer than 1 in 100,000 cases reported each year on average. 2015 saw the highest number of reported cases of tularaemia over 2008–2016, with 64% of these occurring in Sweden. Sweden generally reported more cases each year than any other country, except in 2009 when Finland saw twice its average yearly cases, and in 2016 when Finnish cases reached a peak of 699, 3.6 times its yearly average. In 2011 Norway also saw three times its average number of cases, affecting almost 4 in every 100,000 people. In both 2010 and 2014 Hungary experienced outbreaks, reporting 126 and 140 cases respectively, compared to the yearly average of 56. Dataset provided by ECDC based on data provided by WHO and Ministries of Health from the affected countries [10]. Figure generated using GraphPad Prism v.6.0.1.