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. 2010 Jul;83(1):174-82.
doi: 10.4269/ajtmh.2010.09-0752.

Rocky mountain spotted fever in the United States, 2000-2007: interpreting contemporary increases in incidence

John J Openshaw  1 , David L Swerdlow, John W Krebs, Robert C Holman, Eric Mandel, Alexis Harvey, Dana Haberling, Robert F Massung, Jennifer H McQuiston
Affiliations

Rocky mountain spotted fever in the United States, 2000-2007: interpreting contemporary increases in incidence

John J Openshaw et al. Am J Trop Med Hyg. 2010 Jul.

Erratum in

  • Am J Trop Med Hyg. 2010 Sep;83(3):729-30

Abstract

Rocky Mountain spotted fever (RMSF), a potentially fatal tick-borne infection caused by Rickettsia rickettsii, is considered a notifiable condition in the United States. During 2000 to 2007, the annual reported incidence of RMSF increased from 1.7 to 7 cases per million persons from 2000 to 2007, the highest rate ever recorded. American Indians had a significantly higher incidence than other race groups. Children 5-9 years of age appeared at highest risk for fatal outcome. Enzyme-linked immunosorbent assays became more widely available beginning in 2004 and were used to diagnose 38% of cases during 2005-2007. The proportion of cases classified as confirmed RMSF decreased from 15% in 2000 to 4% in 2007. Concomitantly, case fatality decreased from 2.2% to 0.3%. The decreasing proportion of confirmed cases and cases with fatal outcome suggests that changes in diagnostic and surveillance practices may be influencing the observed increase in reported incidence rates.

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Figures

Figure 1.
Figure 1.
Rocky Mountain spotted fever cases by case classification status, 1992–2007, United States (determined by National Electronic Telecommunications System for Surveillance).
Figure 2.
Figure 2.
Rocky Mountain spotted fever cases and incidence (per millions persons), 2000–2007, United States (reported through the National Electronic Telecommunications System for Surveillance).
Figure 3.
Figure 3.
Rocky Mountain spotted fever incidence by county, 2000–2007, United States (reported through the National Electronic Telecommunications System for Surveillance).
Figure 4.
Figure 4.
Rocky Mountain spotted fever incidence by age group, 2000–2007, United States (reported through the National Electronic Telecommunications System for Surveillance).
Figure 5.
Figure 5.
Rocky Mountain spotted fever hospitalizations (A) by year and (B) by age group, 2000–2007, United States (reported through Case Report Forms).
Figure 6.
Figure 6.
Rocky Mountain spotted fever case fatality (A) by year and (B) age group, 2000–2007, United States (reported through Case Report Forms).
Figure 7.
Figure 7.
Rocky Mountain spotted fever cases diagnosed by enzyme-linked immunosorbent assays (ELISA) and latex agglutination (LA), 2000–2007, United States (reported through Case Report Forms).
Figure 8.
Figure 8.
Historical surveillance for Rocky Mountain spotted fever, incidence and case fatality ratios (CFR) based on national surveillance data for the United States, 1920–2007. (From 1980 through 2007, incidence was derived from data reported through the National Electronic Telecommunications System for Surveillance, and percent fatal cases was derived from Case Report Forms).
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