Volume 94, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Spotted fever group (SFG) species are etiologic agents of a wide range of human infections from asymptomatic or mild infections to severe, life-threatening disease. In the United States, recent passive surveillance for SFG rickettsiosis shows an increased incidence and decreased severity of reported cases. The reasons for this are not well understood; however, we hypothesize that less pathogenic rickettsiae are causing more human infections, while the incidence of disease caused by more pathogenic rickettsiae, particularly , is relatively stable. During the same period, the range of has expanded. is frequently infected with “ Rickettsia amblyommii”, a SFG of unknown pathogenicity. We tested our hypothesis by modeling incidence rates from 1993 to 2013, hospitalization rates from 1981 to 2013, and case fatality rates from 1981 to 2013 regressed against the presence of , the decade of onset of symptoms, and the county of residence. Our results support the hypothesis, and we show that the expanding range of is associated with changes in epidemiology reported through passive surveillance. We believe epidemiological and acarological data collected on individual cases from enhanced surveillance may further elucidate the reasons for the changing epidemiology of SFG rickettsiosis.


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  • Received : 10 Aug 2015
  • Accepted : 09 Sep 2015
  • Published online : 06 Jan 2016

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