Rocky Mountain spotted fever epidemiology and demographics: Difference between revisions

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Latest revision as of 18:39, 18 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

Since the 1920's the United States Center for Disease Control and Prevention has deemed Rocky Mountain spotted fever (RMSF) as a reportable disease. RMSF cases were most often reported within the Rocky Mountain region, although recent data reveals that the disease is widespread throughout the United States. Areas that currently harbor the majority of RMSF infections are Oklahoma, Tennessee, and Arkansas. The disease has also been reported throughout the Western Hemisphere. ^[1] Incidence is highest among children the between the ages of 5-9 years and adults between the ages of 40-64 years. Fatality rates are also higher among these groups, with the highest fatality rate in the elderly at 60 years or more. In terms of demographics, Rocky Mountain spotted fever has been reported at higher rates among males, especially of White and Native American descent. ^[2]

Epidemiology and Demographics

Incidence

Rocky Mountain spotted fever has been a reportable disease in the United States since the 1920s.
In the last 50 years, approximately 250-1200 cases of Rocky Mountain spotted fever have been reported annually, although it is likely that many more cases go unreported.
CDC compiles the number of cases reported by the state health departments.
To ensure standardization of reporting across the country, CDC advises that a consistent case definition be used by all states. ^[1]

Seasonal Distribution of Rocky Mountain spotted fever

Over 90% of patients with Rocky Mountain spotted fever are infected during April through September.
This period is the season for increased numbers of adult and nymphal Dermacentor ticks.
A history of tick bite or exposure to tick-infested habitats is reported in approximately 60% of all cases of Rocky Mountain spotted fever.^[1]

**Proportion of RMSF cases reported to CDC by month of onset, 1993 through 2010:** This figure shows the percent of cases reported from 1993 through 2010 by month of onset to give the seasonality of cases. There are cases reported in each month of the year, however most are reported between May and August. Roughly 20% of cases are reported in both June and July.

Geography of Rocky Mountain spotted fever

RMSF cases have been reported throughout most of the contiguous United States, five states (North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri) account for over 60% of RMSF cases. The primary tick responsible for R. rickettsii in these states is the American dog tick (Dermacentor variabilis Dermacentor andersoni).
In eastern Arizona, RMSF cases have recently been identified in an area where the disease had not been previously seen. Through 2009, over 90 cases had been reported, and approximately 10% of the people diagnosed with the disease in this part of the state have died. The tick responsible for transmission of R. rickettii in Arizona is the brown dog tick (Rhipicephalus sanguineus), which is found on dogs and around people’s homes.
Almost all of the cases occurred within communities with a large number of free-roaming dogs.^[1]
Other incidences have recently been reported in portions of California, the Northwest (Washington, and Oregon), and in portions of the Southwest (Arizona, Texas, and New Mexico.)

**Geographic distribution of RMSF incidence in 2010:** This figure shows the annual reported incidence of RMSF cases by state in 2010 per million persons. RMSF was not notifiable in Alaska and Hawaii in 2010. The incidence rate was zero for Connecticut, Kansas, Massachusetts, Nevada, South Dakota, Vermont and West Virginia. Incidence ranged between 0.2 to 1.5 cases per million persons for California, Colorado, Florida, Kentucky, Louisiana, Michigan, Minnesota, New Hampshire, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, Texas, Utah, Washington and Wisconsin. Annual incidence ranged from 1.5 to 19 cases per million persons in Alabama, Arizona, the District of Columbia, Georgia, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Mississippi, Montana, Nebraska, New Jersey, New York, Rhode Island, South Carolina, Virginia and Wyoming. The highest incidence rates, ranging from 19 to 63 cases per million persons were found in Arkansas, Delaware, Missouri, North Carolina, Oklahoma, and Tennessee.

Age

Incidence rate is highest among children between the ages of less than 10 years of age, particularly 5-9, and adults between the ages of 40-64. ^[2]
Children ages 0-9 and adults ages 60 or higher are at a higher risk of fatality.^[1]

**Average annual incidence of Rocky Mountain spotted fever by age-group, 2000 through 2010:** This figure shows the average annual incidence of RMSF per million persons by age groups for 2000 through 2010. The graph shows that cases have been reported in every age group with increased incidence as age increases. There is a slightly higher incidence rate in the 5-9 year old age group, which surpasses 4 cases per million persons. The highest incidence rate in observed in age groups 55-59 and 60-64 years old, both of which surpass 8 cases per million persons.

Demographics

The frequency of reported cases of Rocky Mountain spotted fever is highest among males, particularly of Caucasian and American Indian descent.
Two-thirds of the Rocky Mountain spotted fever cases occur in children.
Individuals with frequent exposure to dogs and who reside near wooded areas or areas with high grass may also be at increased risk of infection. ^[2]

Worldwide Infection

Incidences of Rocky Mountain spotted fever are most prominent in the Western hemisphere.
Infections have been documented in portions of Argentina, Brazil, Colombia, Costa Rica, Mexico, and Panama.
Some synonyms for Rocky Mountain spotted fever in other countries include tick typhus, Tobia fever(Colombia), São Paulo fever, fiebre maculosa (Brazil), and fiebre manchada (Mexico).
Closely related organisms cause other types of spotted fevers in other parts of the world.

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Rocky Mountain Spotted Fever Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/stats/ Accessed on December 30, 2015
↑ ^2.0 ^2.1 ^2.2 Dantas-Torres, Filipe. Lancet Infect Disease 2007;7:724-32. Department of Immunology, Center of Research Aggeu Magalhaes, Oswaldo Cruz Foundation. Recife Pernambuco, Brazil. Volume 7, November 2007. Accessed on January 11, 2016

[RMSF_Stats_CDC”-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 Rocky Mountain Spotted Fever Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/stats/ Accessed on December 30, 2015

[RMSF_DeptImmuno”-2] 2.0 ^2.1 ^2.2 Dantas-Torres, Filipe. Lancet Infect Disease 2007;7:724-32. Department of Immunology, Center of Research Aggeu Magalhaes, Oswaldo Cruz Foundation. Recife Pernambuco, Brazil. Volume 7, November 2007. Accessed on January 11, 2016

[1]

[2]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Rocky Mountain spotted fever}}
-{{CMG}}
+{{CMG}} {{AE}} {{IMD}}
+==Overview==
+Since the 1920's the United States Center for Disease Control and Prevention has deemed Rocky Mountain spotted fever (RMSF) as a reportable disease. RMSF cases were most often reported within the Rocky Mountain region, although recent data reveals that the disease is widespread throughout the United States. Areas that currently harbor the majority of RMSF infections are Oklahoma, Tennessee, and Arkansas. The disease has also been reported throughout the Western Hemisphere. <ref name="RMSF Stats CDC”">Rocky Mountain Spotted Fever Statistics. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/stats/  Accessed on December 30, 2015</ref> Incidence is highest among children the between the ages of 5-9 years and adults between the ages of 40-64 years. Fatality rates are also higher among these groups, with the highest fatality rate in the elderly at 60 years or more. In terms of demographics, Rocky Mountain spotted fever has been reported at higher rates among males, especially of White and Native American descent. <ref name="RMSF DeptImmuno”">Dantas-Torres, Filipe. Lancet Infect Disease 2007;7:724-32. Department of Immunology, Center of Research Aggeu Magalhaes, Oswaldo Cruz Foundation. Recife Pernambuco, Brazil. Volume 7, November 2007. Accessed on January 11, 2016</ref>
-==Overview==
+== Epidemiology and Demographics==
-== Epidemiology ==
+===Incidence===
-Rocky Mountain spotted fever has been a reportable disease in the United States since the 1920s. In the last 50 years, approximately 250-1200 cases of Rocky Mountain spotted fever have been reported annually, although it is likely that many more cases go unreported. CDC compiles the number of cases reported by the state health departments. To ensure standardization of reporting across the country, CDC advises that a consistent case definition be used by all states.
+*Rocky Mountain spotted fever has been a reportable disease in the United States since the 1920s.
+*In the last 50 years, approximately 250-1200 cases of Rocky Mountain spotted fever have been reported annually, although it is likely that many more cases go unreported.
+*CDC compiles the number of cases reported by the state health departments.
+*To ensure standardization of reporting across the country, CDC advises that a consistent case definition be used by all states. <ref name="RMSF Stats CDC”">Rocky Mountain Spotted Fever Statistics. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/stats/  Accessed on December 30, 2015</ref>
-[[Image:Epidem1.gif|center|frame|Epidemiology Graph 1 - Reported cases of Rocky Mountain spotted fever in the United States, 1942-1996]]
+[[Image:Rmsf incid.jpg|center|400px|thumb|'''Incidence and case fatality from 1920-2010:'''
+''Cases of RMSF have been recorded from the 1920s through present day. Trends in RMSF incidence can be observed as ebbs and flows of several years at a time. Periods of increased incidence can be seen between 1930 and 1950 and 1968 through 1990. More recently there has been a more dramatic increase in incidence of RMSF increasing from 1.9 cases per million persons in 2000 to an all-time high of 8.4 cases per million persons in 2008. Case fatality rate was first reported in 1940. Case fatality rates vary from year-to-year, but have had an overall decreasing trend from 28% case fatality in 1944 to <1% case fatality beginning in 2001.'']]
+=====Seasonal Distribution of Rocky Mountain spotted fever=====
-[[Image:EpiGraph1.gif|center|frame|Epidemiology Graph 2 - Number of Rocky Mountain spotted fever cases in the United States, 1997-2002, as determined by the number of cases reported to the Centers for Disease Control and Prevention by the states via the National Electronic Telecommunications System for Surveillance (NETSS).]]
+*Over 90% of patients with Rocky Mountain spotted fever are infected during April through September.
+*This period is the season for increased numbers of adult and nymphal Dermacentor ticks.
+*A history of tick bite or exposure to tick-infested habitats is reported in approximately 60% of all cases of Rocky Mountain spotted fever.<ref name="RMSF Stats CDC”">Rocky Mountain Spotted Fever Statistics. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/stats/  Accessed on December 30, 2015</ref>
-'''Seasonal Distribution of Rocky Mountain Spotted Fever'''
+[[Image:RMSF cases reported by month.jpg|center|500px| thumb| '''Proportion of RMSF cases reported to CDC by month of onset, 1993 through 2010:'''
-Over 90% of patients with Rocky Mountain spotted fever are infected during April through September.  This period is the season for increased numbers of adult and nymphal Dermacentor ticks. A history of tick bite or exposure to tick-infested habitats is reported in approximately 60% of all cases of Rocky Mountain spotted fever.
+''This figure shows the percent of cases reported from 1993 through 2010 by month of onset to give the seasonality of cases. There are cases reported in each month of the year, however most are reported between May and August. Roughly 20% of cases are reported in both June and July.'' ]]
-[[Image:EpiGraph2.gif|center|frame|Epidemiology Graph 3 - Total number of Rocky Mountain spotted fever cases by month of onset during 2002, as determined on the basis of case report forms submitted by the states to the Centers for Disease Control and Prevention.]]
+=====Geography of Rocky Mountain spotted fever=====
+*RMSF cases have been reported throughout most of the contiguous United States, five states (North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri) account for over 60% of RMSF cases. The primary tick responsible for R. rickettsii in these states is the American dog tick (Dermacentor variabilis Dermacentor andersoni).
+*In eastern Arizona, RMSF cases have recently been identified in an area where the disease had not been previously seen. Through 2009, over 90 cases had been reported, and approximately 10% of the people diagnosed with the disease in this part of the state have died. The tick responsible for transmission of R. rickettii in Arizona is the brown dog tick (Rhipicephalus sanguineus), which is found on dogs and around people’s homes.
+*Almost all of the cases occurred within communities with a large number of free-roaming dogs.<ref name="RMSF Stats CDC”">Rocky Mountain Spotted Fever Statistics. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/stats/  Accessed on December 30, 2015</ref>
+*Other incidences have recently been reported in portions of California, the Northwest (Washington, and Oregon), and in portions of the Southwest (Arizona, Texas, and New Mexico.)
-'''Geography of Rocky Mountain Spotted Fever'''
+[[Image:Epidemiology Map.jpg|center|500px| thumb| '''Geographic distribution of RMSF incidence in 2010:'''
-Over half of Rocky Mountain spotted fever infections are reported from the south-Atlantic region of the United States (Delaware, Maryland, Washington D.C., Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida). Infection also occurs in other parts of the United States, namely the Pacific region (Washington, Oregon, and California) and west south-central (Arkansas, Louisiana, Oklahoma, and Texas) region.
+''This figure shows the annual reported incidence of RMSF cases by state in 2010 per million persons. RMSF was not notifiable in Alaska and Hawaii in 2010. The incidence rate was zero for Connecticut, Kansas, Massachusetts, Nevada, South Dakota, Vermont and West Virginia. Incidence ranged between 0.2 to 1.5 cases per million persons for California, Colorado, Florida, Kentucky, Louisiana, Michigan, Minnesota, New Hampshire, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, Texas, Utah, Washington and Wisconsin. Annual incidence ranged from 1.5 to 19 cases per million persons in Alabama, Arizona, the District of Columbia, Georgia, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Mississippi, Montana, Nebraska, New Jersey, New York, Rhode Island, South Carolina, Virginia and Wyoming. The highest incidence rates, ranging from 19 to 63 cases per million persons were found in Arkansas, Delaware, Missouri, North Carolina, Oklahoma, and Tennessee.'' ]]
-The states with the highest incidences of Rocky Mountain spotted fever are North Carolina and Oklahoma; these two states combined accounted for 35% of the total number of U.S. cases reported to CDC during 1993 through 1996. Although Rocky Mountain spotted fever was first identified in the Rocky Mountain states, less than 3% of the U.S. cases were reported from that area during the same interval (1993-1996).
+===Age===
+*Incidence rate is highest among children between the ages of less than 10 years of age, particularly 5-9, and adults between the ages of 40-64. <ref name="RMSF DeptImmuno”">Dantas-Torres, Filipe. Lancet Infect Disease 2007;7:724-32. Department of Immunology, Center of Research Aggeu Magalhaes, Oswaldo Cruz Foundation. Recife Pernambuco, Brazil. Volume 7, November 2007. Accessed on January 11, 2016</ref>
+*Children ages 0-9 and adults ages 60 or higher are at a higher risk of fatality.<ref name="RMSF Stats CDC”">Rocky Mountain Spotted Fever Statistics. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/stats/  Accessed on December 30, 2015</ref>
-[[Image:RMSFMAP.gif|center|frame|Epidemiology Image 4 - Annual incidence per million population for Rocky Mountain spotted fever by state in the United States for 2002, as determined on the basis of cases reported to the National Electronic Telecommunications System for Surveillance.]]
+[[Image:Average incidence.jpg|center|500px| thumb| '''Average annual incidence of Rocky Mountain spotted fever by age-group, 2000 through 2010:'''
-'''Worldwide Infection'''
+''This figure shows the average annual incidence of RMSF per million persons by age groups for 2000 through 2010. The graph shows that cases have been reported in every age group with increased incidence as age increases. There is a slightly higher incidence rate in the 5-9 year old age group, which surpasses 4 cases per million persons. The highest incidence rate in observed in age groups 55-59 and 60-64 years old, both of which surpass 8 cases per million persons.'']]
-Infection with Rickettsia rickettsii has also been documented in Argentina, Brazil, Colombia, Costa Rica, Mexico, and Panama. Some synonyms for Rocky Mountain spotted fever in other countries include tick typhus, Tobia fever (Colombia), São Paulo fever and fiebre maculosa (Brazil), and fiebre manchada (Mexico). Closely related organisms cause other types of spotted fevers in other parts of the world.
+===Demographics===
+*The frequency of reported cases of Rocky Mountain spotted fever is highest among males, particularly of Caucasian and American Indian descent.
+*Two-thirds of the Rocky Mountain spotted fever cases occur in children.
+*Individuals with frequent exposure to dogs and who reside near wooded areas or areas with high grass may also be at increased risk of infection. <ref name="RMSF DeptImmuno”">Dantas-Torres, Filipe. Lancet Infect Disease 2007;7:724-32. Department of Immunology, Center of Research Aggeu Magalhaes, Oswaldo Cruz Foundation. Recife Pernambuco, Brazil. Volume 7, November 2007. Accessed on January 11, 2016</ref>
-[[Image:Table.jpg|center|Table of Human Disease Around the World Caused by Spotted Fever Group Rickettsiae]]
+=====Worldwide Infection=====
+*Incidences of Rocky Mountain spotted fever are most prominent in the Western hemisphere.
+*Infections have been documented in portions of Argentina, Brazil, Colombia, Costa Rica, Mexico, and Panama.
+*Some synonyms for Rocky Mountain spotted fever in other countries include tick [[typhus]], Tobia fever(Colombia), São Paulo fever, fiebre maculosa (Brazil), and fiebre manchada (Mexico).
+*Closely related organisms cause other types of spotted fevers in other parts of the world.
 ==References==
 {{Reflist|2}}
+[[Category:Bacterial diseases]]
+[[Category:Rickettsiales]]
+[[Category:Zoonoses]]
+[[Category:Dermatology]]