Volume 95, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



During August 2014, five high school students who had attended an outdoor education camp were hospitalized with a febrile illness, prompting further investigation. Ten total cases of tick-borne relapsing fever (TBRF) were identified—six cases confirmed by culture or visualization of spirochetes on blood smear and four probable cases with compatible symptoms (attack rate: 23%). All patients had slept in the campsite's only cabin. Before the camp, a professional pest control company had rodent proofed the cabin, but no acaricides had been applied. Cabin inspection after the camp found rodents and ticks, the vector of TBRF. Blood samples from a chipmunk trapped near the cabin and from patients contained with identical gene sequences (100% over 630 base pairs). Health departments in TBRF endemic areas should consider educating cabin owners and pest control companies to apply acaricides during or following rodent proofing, because ticks that lack rodents for a blood meal might feed on humans.


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  1. Goubau PF, , 1984. Relapsing fevers. A review. Ann Soc Belg Med Trop 64: 335364.
  2. Dworkin MS, Anderson DE, Jr Schwan TG, Shoemaker PC, Banerjee SN, Kassen BO, Burgdorfer W, , 1998. Tick-borne relapsing fever in the northwestern United States and southwestern Canada. Clin Infect Dis 26: 122131.[Crossref]
  3. Dworkin MS, Schwan TG, Anderson DE, Jr Borchardt SM, , 2008. Tick-borne relapsing fever. Infect Dis Clin North Am 22: 449468.[Crossref]
  4. Boyer KM, Munford RS, Maupin GO, Pattison CP, Fox MD, Barnes AM, Jones WL, Maynard JE, , 1977. Tick-borne relapsing fever: an interstate outbreak originating at Grand Canyon National Park. Am J Epidemiol 105: 469479.[Crossref]
  5. Burgdorfer W, Mavros AJ, , 1970. Susceptibility of various species of rodents to the relapsing fever spirochete, Borrelia hermsii . Infect Immun 2: 256259.
  6. Horton JM, Blaser MJ, , 1985. The spectrum of relapsing fever in the Rocky Mountains. Arch Intern Med 145: 871875.[Crossref]
  7. Centers for Disease Control and Prevention, 1991. Outbreak of relapsing fever: Grand Canyon National Park, Arizona, 1990. MMWR 40: 296297, 303.
  8. Mehra R, Londono D, Sondey M, Lawson C, Cadavid D, , 2009. Structure-function investigation of Vsp serotypes of the spirochete Borrelia hermsii . PLoS One 4: e7597.[Crossref]
  9. Bunikis J, Garpmo U, Tsao J, Berglund J, Fish D, Barbour AG, , 2004. Sequence typing reveals extensive strain diversity of the Lyme borreliosis agents Borrelia burgdorferi in North America and Borrelia afzelii in Europe. Microbiology 150: 17411755.[Crossref]
  10. Forrester JD, Kjemtrup AM, Fritz CL, Marsden-Haug N, Nichols JB, Tengelsen LA, Sowadsky R, DeBess E, Cieslak PR, Weiss J, Evert N, Ettestad P, Smelser C, Iralu J, Nett RJ, Mosher E, Baker JS, Van Houten C, Thorp E, Geissler AL, Kugeler K, Mead P, Centers for Disease Control and Prevention (CDC), , 2015. Tickborne relapsing fever: United States, 1990–2011. MMWR 64: 5860.
  11. Trevejo RT, Schriefer ME, Gage KL, Safranek TJ, Orloski KA, Pape WJ, Montenieri JA, Campbell GL, , 1998. An interstate outbreak of tick-borne relapsing fever among vacationers at a Rocky Mountain cabin. Am J Trop Med Hyg 58: 743747.
  12. Bunikis J, Tsao J, Garpmo U, Berglund J, Fish D, Barbour AG, , 2004. Typing of Borrelia relapsing fever group strains. Emerg Infect Dis 10: 16611664.[Crossref]
  13. Schwan TG, Raffel SJ, Schrumpf ME, Porcella SF, , 2007. Diversity and distribution of Borrelia hermsii . Emerg Infect Dis 13: 436442.[Crossref]
  14. Nieto NC, Teglas MB, , 2014. Relapsing fever group Borrelia in southern California rodents. J Med Entomol 51: 10291034.[Crossref]
  15. Fischer RJ, Johnson TL, Raffel SJ, Schwan TG, , 2009. Identical strains of Borrelia hermsii in mammal and bird. Emerg Infect Dis 15: 20642066.[Crossref]
  16. MacNeil A, Ksiazek TG, Rollin PE, , 2011. Hantavirus pulmonary syndrome, United States, 1993–2009. Emerg Infect Dis 17: 11951201.[Crossref]

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  • Received : 21 Jan 2016
  • Accepted : 16 Jun 2016

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