Volume 75, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


To describe the epidemiology of Rocky Mountain spotted fever (RMSF) among American Indians/Alaska Natives (AI/ANs), we conducted a retrospective analysis of hospitalization records with an RMSF diagnosis using Indian Health Service (IHS) hospital discharge data for calendar years 1980–2003. A total of 261 RMSF hospitalizations were reported among AIs, for an average annual hospitalization rate of 1.21 per 100,000 persons; two deaths were reported (0.8%). Most hospitalizations (88.5%) occurred in the Southern Plains region, where the rate was 4.23 per 100,000 persons. Children 1–4 years of age had the highest age-specific hospitalization rate of 2.50 per 100,000 persons. The overall annual RMSF hospitalization rate declined during the study period. Understanding the epidemiology of RMSF among AI/ANs and educating IHS/tribal physicians on the diagnosis of tick-borne diseases remain important for the prompt treatment of RMSF and the reduction of the disease occurrence among AI/ANs, particularly in high-risk areas.


Article metrics loading...

Loading full text...

Full text loading...



  1. Dalton MJ, Clarke MJ, Holman RC, Krebs JW, Fishbein DB, Olson JG, Childs JE, 1995. National surveillance for Rocky Mountain spotted fever 1981–1992: Epidemiologic summary and evaluation of risk factors for fatal outcome. Am J Trop Med Hyg 52 : 405–413.
  2. Treadwell T, Holman RC, Clarke MJ, Krebs JW, Paddock CD, Childs JE, 2000. Rocky Mountain spotted fever in the United States, 1993–1996. Am J Trop Med Hyg 63 : 21–26.
  3. Sexton DJ, Kaye KS, 2002. Rocky Mountain spotted fever. Med Clin N Am 86 : 351–360.
  4. Chapman AS, Murphy SM, Demma LJ, Holman RC, Curns AT, McQuiston JH, Krebs JW, Swerdlow DS, 2006. Rocky Mountain spotted fever in the United States, 1997–2002. Vector-Borne Zoonot 6 : 170–178.
  5. Burgdorfer W, 1975. A review of Rocky Mountain spotted fever (tick-borne typhus), its agent, and its tick vectors in the United States. J Med Entomol 12 : 269–278.
  6. Demma LJ, Traeger MS, Nicholson WL, Paddock CD, Blau DM, Eremeeva ME, Dasch GA, Levin ML, Singleton JJ, Zaki SR, Cheek JE, Swerdlow DL, McQuiston JH, 2005. Rocky Mountain spotted fever in Arizona associated with an unexpected tick vector. N Engl J Med 353 : 587–594.
  7. Helmick CG, Bernard KW, D’Angelo LJ, 1984. Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases. J Infect Dis 150 : 480–488.
  8. O’Reilly M, Paddock C, Elchos B, Goddard J, Childs J, Currie M, 2003. Physician knowledge of the diagnosis and management of Rocky Mountain spotted fever: Mississippi, 2002. Ann N Y Acad Sci 990 : 295–301.
  9. Holman RC, Paddock CD, Curns AT, Krebs JW, McQuiston JH, Childs JE, 2001. Analysis of risk factors for fatal Rocky Mountain spotted fever: Evidence for superiority of tetracyclines for therapy. J Infect Dis 184 : 1437–1444.
  10. McQuiston JH, Holman RC, Childs JE, Groom AV, Kaufman SF, Cheek JE, 2000. Incidence of Rocky Mountain spotted fever among American Indians in Oklahoma. Public Health Rep 115 : 469–475.
  11. Holman RC, Parashar UD, Clarke MJ, Kaufman SF, Glass RI, 1999. Trends in diarrhea-associated hospitalizations among American Indian and Alaska Native children, 1980–1995. Pediatrics 103 : e11.
  12. Holman RC, Curns AT, Kaufman SF, Cheek JE, Pinner RW, 2001. Trends in infectious disease hospitalizations among American Indians and Alaska Natives. Am J Public Health 91 : 425–431.
  13. Holman RC, Curns AT, Cheek JE, Singleton RJ, Anderson LJ, Pinner RW, 2003. Infectious disease hospitalizations among American Indian and Alaska Native infants. Pediatrics 111 : e176–e182.
  14. Cunningham PJ, 1993. Access to care in the Indian Health Service. Health Aff (Millwood) 12 : 224–233.
  15. Indian Health Service, 2003. Trends in Indian Health 2000–2001. Rockville, MD: Indian Health Service.
  16. Indian Health Service, 2005. Inpatient/CHS Inpatient Data Fiscal Years 1979–2004. National Patient Information Reporting System. Albuquerque, NM: Indian Health Service.
  17. Indian Health Service, 2003. Regional Differences in Indian Health 2000–2001. Rockville, MD: Indian Health Service.
  18. Kaufman SF, 1998. Utilization of IHS and Tribal Direct and Contract General Hospitals, FY 1996 and US Non-Federal Short-Stay Hospitals, 1996. Rockville, MD: Indian Health Service.
  19. Public Health Service and Health Care Financing Administration, 1997. International Classification of Diseases, 9th Revision, Clinical Modification (CD-ROM). Washington, DC: US Department of Health and Human Services.
  20. Rhoades DA, D’Angelo AJ, Rhoades ER, 2000. Data sources and subsets of the Indian population. Rhoades ER, ed. American Indian Health: Innovations in Health Care, Promotion, and Policy. Baltimore, MD: The Johns Hopkins University Press, 93–102.
  21. Rotz L, Callejas L, McKechnie D, Wolfe D, Gaw E, Hathcock L, Childs J, 1998. An epidemiologic and entomologic investigation of a cluster of Rocky Mountain spotted fever cases in Delaware. Del Med J 70 : 285–291.
  22. Jones TF, Craig AS, Paddock CD, McKechnie DB, Childs JE, Zaki SR, Schaffner W, 1999. Family cluster of Rocky Mountain spotted fever. Clin Infect Dis 28 : 853–859.
  23. Simonsen L, Conn LA, Pinner RW, Teutsch S, 1998. Trends in infectious disease hospitalizations in the United States, 1980–1994. Arch Intern Med 158 : 1923–1928.
  24. Burhansstipanov L, 2000. Urban Native American health issues. Cancer 88 : 1207–1213.
  25. Demma LJ, Holman RC, McQuiston JH, Krebs JW, Swerdlow DS, 2005. Epidemiology of human ehrlichiosis and anaplasmosis in the United States, 2001–2002. Am J Trop Med Hyg 73 : 400–409.
  26. Carpenter CF, Gandhi TK, Kong LK, Corey GR, Chen S-M, Walker DH, Dumler JS, Breitschwerdt EB, Hegarty B, Sexton DJ, 1999. The incidence of ehrlichia and rickettsial infection in patients with unexplained fever and recent history of tick bite in central North Carolina. J Infect Dis 180 : 900–903.
  27. Centers for Disease Control and Prevention, 1990. National electronic telecommunications system for surveillance—United States. MMWR Morb Mortal Wkly Rep 40 : 502–503.

Data & Media loading...

  • Received : 30 Nov 2005
  • Accepted : 26 Apr 2006

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error