Tularemia is a bacterial infection which can be transmitted through several ways, including the bite of infected American dog ticks. Other means of transmission include skin contact with infected animals, ingestion of contaminated water, inhalation of contaminated dust, or deer fly bites. Infection through the bite of a tick usually results in an ulcer at the site of the bite along with a fever. Tularemia is not commonly reported in West Virginia. In the past 10 years, only 2 cases have been reported among West Virginia residents.