Rocky Mountain spotted fever epidemiology and demographics: Difference between revisions

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Revision as of 16:47, 8 January 2016

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

Overview

Incidents of Rocky Mountain Spotted Fever date back to the earlier history of the United States. Since the 1920's the United States Center for Disease Control and Prevention has deemed Rocky Mountain Spotted Fever 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.

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.
In Arizona, where transmission is associated with the brown dog tick, peak months of illness onset are August and September.^[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

The frequency of reported cases of Rocky Mountain spotted fever is highest among males, American Indians, and people aged 50-69.
Individuals with frequent exposure to dogs and who reside near wooded areas or areas with high grass may be at increased risk of infection.
Children ages 0-9 and American Indians have an increased risk of fatal outcome from RMSF.^[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, Caucasians, and children.
Two-thirds of the Rocky Mountain spotted fever cases occur in children under the age of 15 years, with the peak age being 5 to 9 years old.
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.
Infection with Rickettsia rickettsii has also been documented in Argentina, Brazil, Colombia, Costa Rica, Mexico, and Panama. Closely related organisms cause other types of spotted fevers in other parts of the world.

Worldwide Infection

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.

References

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

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

[1]

@@ Line 59: / Line 59: @@
 *Closely related organisms cause other types of spotted fevers in other parts of the world.
-{| style="font-size: 85%;"
-! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
-! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Organism}}
-! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Vector}}
-! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Endemic Regions}}
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Rocky Mountain Spotted Fever]]''' <ref name="RMSF CDC”>  Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  http://www.cdc.gov/rmsf/  Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" |''Rickettsia Rickettsii''
-| style="background: #DCDCDC; padding: 5px;" |''Wood Tick (Dermacentor Variabilis), D. andersoni''
-| style="background: #DCDCDC; padding: 5px;" |'''United States:'''
-*Eastern Region
-*Southwest Region
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Helvetica Spotted Fever]]'''<ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia Helvetica''
-| style="background: #DCDCDC; padding: 5px;" | ''Ixodes Ricinus (European)''
-| style="background: #DCDCDC; padding: 5px;" |'''Europe:'''
-*Sweden
-*Switzerland
-*France
-*Laos
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Ehrlichiosis Anaplasmosis]]''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Ehrlichia Chaffeensis, E. Equi''
-| style="background: #DCDCDC; padding: 5px;" | ''Lone Star Tick (Amblyomma Americanum), Ixodes Scapularis''
-| style="background: #DCDCDC; padding: 5px;" | '''United States:'''
-*South Atlantic Regions
-*South-central Regions
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Tularemia]]''' <ref name="Tulameria CDC”>  Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015).  \http://www.cdc.gov/tularemia/index.html  Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Francisella Tularensis''
-| style="background: #DCDCDC; padding: 5px;" | ''D. Andersoni, D. Variabilis''
-| style="background: #DCDCDC; padding: 5px;" | '''United States:'''
-*Widespread throughout the region, including higher populations in the Southeast, South-central, and the West.
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Human neoehrlichiosis''' <ref name="Ehrlichiosis CDC”">Disease index General  Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Neoehrlichia mikurensis''
-| style="background: #DCDCDC; padding: 5px;" |  ''Lone Star Tick (''Amblyomma Americanum)'
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Europe
-*Asia
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Rickettsiosis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia''
-| style="background: #DCDCDC; padding: 5px;" |  ''No specific species identified''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*South Africa
-*Morocco
-*Mediterranean
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''African tick-bite fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia africae''
-| style="background: #DCDCDC; padding: 5px;" |  ''Amblyomma, Dermacentor, and Rhipicephalus species''
-| style="background: #DCDCDC; padding: 5px;" |'''Africa:'''
-*Sub-Saharan
-*West Indies
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''[[Queensland tick typhus]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia austalis''
-| style="background: #DCDCDC; padding: 5px;" |    ''Ixodes species''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Australia
-*Tasmania
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''[[Q-fever (Typhus-like infection)]]''' <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Coxiella burnetii (mimics the mechanisms of Rickettsia) ''
-| style="background: #DCDCDC; padding: 5px;" |    ''Ixodes holocyclus and Amblyomma triguttatum''
-| style="background: #DCDCDC; padding: 5px;" |'''Australia'''
-*Widespread throughout Australia
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Mediterranean spotted fever (Boutonneuse fever)''' <ref name="MSF”">Oztoprak N, Celebi G, Aydemir H, et al. [Mediterranean spotted fever due to contact with dog-tick]. Mikrobiyol Bul. 2008;42(4):7016.http:// http://www.ncbi.nlm.nih.gov/pubmed/19149095 Accessed on December 30, 2015</ref> <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia conorii''
-| style="background: #DCDCDC; padding: 5px;" |  ''Brown Dog Tick (Rhipicephalus sanguineus)''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Southern Europe
-*Southern and Western Asia
-*Africa
-*India
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Far Eastern spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia heilong-jiangensis''
-| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Far portions of Eastern Russia
-*Northern portions of China
-*Eastern Asia
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Aneruptive fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="Aneruptive Fever”">Fournier PE, Allombert C, Supputamongkol Y, Caruso G, Brouqui P, Raoult D. Aneruptive fever associated with antibodies to Rickettsia helvetica in Europe and Thailand. J Clin Microbiol. 2004;42(2):816-8. http://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC344501/ Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia helvetica''
-| style="background: #DCDCDC; padding: 5px;" |  ''Ixodes species''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Northern and Central portions of Europe
-*Non-specific portions of Asia
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Flinders Island spotted fever (Thai tick typhus)''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="ATI”">Australian Tick Index http://www.karlmcmanusfoundation.org.au/ticks-in-oz  Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia honei''
-| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
-| style="background: #DCDCDC; padding: 5px;" |''' Widespread in Independent Regions'''
-*Australia
-*Thailand
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Japanese spotted fever''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia japonica''
-| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
-| style="background: #DCDCDC; padding: 5px;" |'''Japan'''
-*Widespread yet isolated to portions of Japan
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Mediterranean spotted fever-like disease''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia massiliae and R. monacensis''
-| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-''R.massiliae induced:''
-*France
-*Greece
-*Spain
-*Portugal
-*Switzerland
-*Sicily
-*Central Africa
-*Mali
-''R.monacensis induced:''
-*Europe
-*North Africa
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Maculatum infection'''
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia parkeri''
-| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
-| style="background: #DCDCDC; padding: 5px;" |'''Americas:'''
-*United States
-*Portions of Canada
-*South America
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Tick-borne necrosis and lymphadenopathy''' <ref name="TNL”">Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Oteo JA, Ibarra V, Blanco JR, et al. Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease. Clin Microbiol Infect. 2004;10(4):327-31 http://www.ncbi.nlm.nih.gov/pubmed/15059122 Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia raoultii''
-| style="background: #DCDCDC; padding: 5px;" |  ''Dermacentor marginatus ''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Europe
-*Asia
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''North Asian Tick Typhus''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia sibirica''
-| style="background: #DCDCDC; padding: 5px;" |  ''Tick''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Russia
-*China
-*Mongolia
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''Lymphangitis''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia sibirica mogolotimonae''
-| style="background: #DCDCDC; padding: 5px;" |  'No specific species identified
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Southern France
-*Portugal
-*China
-*Africa
-|-
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |'''TIBOLA''' <ref name="Other Tick-borne Spotted Fever ”">Disease Index General  Information, Rickettsia (2015). http://www.cdc.gov/otherspottedfever / Accessed on December 30, 2015</ref> <ref name="TNL”">TIBOLA acquired in Southwest Germany. Rieg S, Schmoldt S, Theilacker C, et al. Tick borne lymphadenopathy (TIBOLA) acquired in Southwestern Germany. BMC Infect Dis. 2011;11:167. http://www.ncbi.nlm.nih.gov/pubmed/21663601 Accessed on December 30, 2015</ref>
-| style="background: #DCDCDC; padding: 5px;" | ''Rickettsia slovaca''
-| style="background: #DCDCDC; padding: 5px;" |  ''Dermacentor species''
-| style="background: #DCDCDC; padding: 5px;" |'''Widespread:'''
-*Southern and Eastern Europe
-*Asia
-|}
 ==References==
 {{Reflist|2}}