Roaming Dogs, Intense Brown Dog Tick Infestation, and Emerging Rocky Mountain Spotted Fever in Tijuana, México

Janet Foley School of Veterinary Medicine, University of California, Davis, California;

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Andrés M. López-Pérez School of Veterinary Medicine, University of California, Davis, California;
Red de Biología y Conservación de Vertebrados, Instituto de Ecología, Xalapa, México;

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Francesca Rubino School of Veterinary Medicine, University of California, Davis, California;

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Laura Backus School of Veterinary Medicine, University of California, Davis, California;

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Cusi Ferradas School of Veterinary Medicine, University of California, Davis, California;
Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Universidad Peruana Cayetano Heredia, Lima, Perú;

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Julio Barrón-Rodriguez Departamento de Ecología, Fauna Silvestre y Animales de Laboratorio, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, México City, México;

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Hugo Mendoza Departamento de Ecología, Fauna Silvestre y Animales de Laboratorio, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, México City, México;

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Rodolfo Arroyo-Machado Departamento de Epidemiología, Secretaría de Salud de Baja California, Mexicali, México

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Leslie C. Inustroza-Sánchez Departamento de Epidemiología, Secretaría de Salud de Baja California, Mexicali, México

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Oscar E. Zazueta Departamento de Epidemiología, Secretaría de Salud de Baja California, Mexicali, México

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ABSTRACT.

A two decades–long epidemic of Rocky Mountain spotted fever in northern México reached the U.S. border city of Tijuana in 2021. Cases were near the city periphery in marginalized areas, some lacking infrastructure such as streets or utilities. We worked in the three census areas where human cases were reported and in 12 additional control Áreas Geoestadisticas Básicas. There were dogs, the primary tick host and Rickettsia rickettsii reservoir, in 76% of homes, with 2.2 owned dogs per home on average, approximately equal numbers of roaming dogs were seen, and 46.2% of owned dogs were allowed to roam in the street. Sixty-eight percent of people had heard of Rocky Mountain spotted fever (RMSF), and 35% self-reported tick infestation, including 19% of homes without dogs. Ticks appeared to move among houses of adjacent neighbors. Of 191 examined dogs, 61.8% were tick-infested, with 6-fold increased odds if they were allowed to roam. Although no dogs were Rickettsia polymerase chain reaction–positive, we found one R. rickettsii– and 11 Rickettsia massiliae–infected ticks. The rickettsial IgG seroprevalence by immunofluorescence antibody assay was 76.4%, associated with unhealthy body condition, adults, dogs with >10 ticks, more dogs being seen in the area, and dogs being permitted in the street. Insufficient medical and canine management resources have contributed to a case fatality rate of RMSF that has exceeded 50% in areas. High canine seroprevalence suggests risks to people and dogs; unfortunately, herd immunity is impeded by high turnover in the canine population owing to the birth of puppies and high death rates. Binational One Health workers should monitor disease spread, enact canine population management and tick eradication, and provide prevention, diagnostic, and treatment support.

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Author Notes

Financial support: This work was supported by the UC Davis School of Veterinary Medicine.

Authors’ addresses: Janet Foley, Francesca Rubino, and Laura Backus, School of Veterinary Medicine, University of California, Davis, CA, E-mails: jefoley@ucdavis.edu, firubino@ucdavis.edu, and lhbackus@ucdavis.edu. Andrés M. López-Pérez, School of Veterinary Medicine, University of California, Davis, CA, and Red de Biología y Conservación de Vertebrados, Instituto de Ecología, Xalapa, México, E-mail: amlope@ucdavis.edu. Cusi Ferradas, School of Veterinary Medicine, University of California, Davis, CA, and Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Universidad Peruana Cayetano Heredia, Lima, Perú, E-mail: cferradas@ucdavis.edu. Julio Barrón-Rodriguez and Hugo Mendoza, Departamento de Ecología, Fauna Silvestre y Animales de Laboratorio, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, México City, México, E-mails: jjbarronr@ucdavis.edu and hugomegu@gmail.com. Rodolfo Arroyo-Machado, Inustroza-Sánchez, and Oscar E. Zazueta, Departamento de Epidemiología, Secretaría de Salud de Baja California, Mexicali, México, E-mails: rodolfo.arroyo@uabc.edu.mx, lesliecarolina55@gmail.com, and oez512@mail.harvard.edu.

Address correspondence to Andrés M. López-Pérez, Carretera Xalapa-Coatepec #525, Fracc. Joyas de Xalapa, Edif. Brillante, Depto 402, Xalapa, Veracruz, Mexico. CP 91056. E-mail: amlope@ucdavis.edu
  • 1.

    Bustamante M , Varela G , 1943. Una nueva rickettsiosis en México. Existencia de la fiebre manchada americana en los estados de Sinaloa y Sonora. Revista Instituto Salud Enfermidades Tropicales 4: 189211.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Silva-Goytia R , Elizondo A , 1952. Estudios sobre fiebre manchada en México. IV. Características epidemiológicas de casos de fiebre manchada ocurridos en La Laguna. Medicina Revista Mexicana 32: 569579.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Álvarez-Hernández G , Roldán JFG , Milan NSH , Lash RR , Behravesh CB , Paddock CD , 2017. Rocky Mountain spotted fever in Mexico: past, present, and future. Lancet Infect Dis 17: e189e196.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Zavala-Castro JE , Dzul-Rosado KR , León JJA , Walker DH , Zavala-Velázquez JE , 2008. An increase in human cases of spotted fever rickettsiosis in Yucatan, Mexico, involving children. Am J Trop Med Hyg 79: 907910.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Huerta JDL , Barragán RC , 2008. Fiebre manchada de las Montañas Rocosas en pediatría revisión clínica de una serie de 115 casos. Revista de Enfermedades Infecciosas en Pediatría 21: 49.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Zazueta OE , Armstrong PA , Márquez-Elguea A , Milán NSH , Peterson AE , Ovalle-Marroquín DF , Fierro M , Arroyo-Machado R , Rodriguez-Lomeli M , Trejo-Dozal G , 2021. Rocky Mountain spotted fever in a large metropolitan center, Mexico–United States border, 2009–2019. Emerg Infect Dis 27: 1567.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Nicholson WL , Paddock CD , Demma L , Traeger M , Johnson B , Dickson J , McQuiston J , Swerdlow D , 2006. Rocky Mountain spotted fever in Arizona: documentation of heavy environmental infestations of Rhipicephalus sanguineus at an endemic site. Ann NY Acad Sci 1078: 338341.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Eremeeva ME , Zambrano ML , Anaya L , 2011. Rickettsia rickettsii in Rhipicephalus ticks, Mexicali, Mexico. J Med Entomol 48: 418421.

  • 9.

    Biggs HM et al., 2016. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis—United States. MMWR Recomm Rep 65: 144.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Álvarez-López DI , Ochoa-Mora E , Heitman KN , Binder AM , Álvarez-Hernández G , Armstrong PA , 2021. Epidemiology and clinical features of Rocky Mountain spotted fever from enhanced surveillance, Sonora, Mexico: 2015–2018. Am J Trop Med Hyg 104: 190.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Tinoco-Gracia L , Quiroz-Romero H , Quintero-Martínez M , Rentería-Evangelista T , González-Medina Y , Barreras-Serrano A , Hori-Oshima S , Moro M , Vinasco J , 2009. Prevalence of Rhipicephalus sanguineus ticks on dogs in a region on the Mexico-USA border. Vet Rec 164: 59.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Martínez-Medina , Álvarez-Hernández G , Padilla-Zamudio JG , Rojas-Guerra MG , 2007. Fiebre manchada de las Montañas Rocosas en niños: consideraciones clínicas y epidemiológicas. Gac Med Mex 143: 137140.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Field-Cortazares J , Seijo JL , 2011. Rickettsiosis in Baja California. Boletín Clínico Hospital Infantil del Estado de Sonora 28: 4450.

  • 14.

    Tinoco-Gracia L , Quiroz-Romero H , Quintero-Martínez M , Rentería-Evangelista T , Barreras-Serrano A , Romano-Osuna M , García-Prieto B , Escárcega-Ávila A , 2009. Prevalencia de infestación de garrapatas (Rhipicephalus sanguineus) en perros y su asociación a factores de riesgo en la Zona Urbana de Mexicali, Baja California, México. VIII Congreso Nacional de Parasitología Veterinaria, October 26–28, 2009, Mérida, Yucatán, México.

    • PubMed
    • Export Citation
  • 15.

    Field-Cortazares J , Moreno JS-y , 2011. Rickettsiosis en Baja California. Bol Clin Hosp Infant Edo Son 28: 4450.

  • 16.

    Drexler N , Miller M , Gerding J , Todd S , Adams L , Dahlgren FS , Bryant N , Weis E , Herrick K , Francies J , 2014. Community-based control of the brown dog tick in a region with high rates of Rocky Mountain spotted fever, 2012–2013. PLoS One 9: e112368.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Yoder J , Benoit J , Rellinger E , Tank J , 2006. Developmental profiles in tick water balance with a focus on the new Rocky Mountain spotted fever vector, Rhipicephalus sanguineus. Med Vet Entomol 20: 365372.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Bustos A , 2011. Niveles de marginación: una estrategia multivariada de clasi cación. INEGI. Real Datos Espacio 2: 169186.

  • 19.

    Walker JB , Keirans JE , Horak IG , 2000. The genus Rhipicephalus (Acari, Ixodidae): A Guide to the Brown Ticks of the World. Cambridge, England: Cambridge University Press.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Dantas-Torres F , 2010. Biology and ecology of the brown dog tick, Rhipicephalus sanguineus. Parasit Vectors 3: 111.

  • 21.

    Nava S , Beati L , Venzal JM , Labruna MB , Szabó MP , Petney T , Saracho-Bottero MN , Tarragona EL , Dantas-Torres F , Silva MMS , 2018. Rhipicephalus sanguineus (Latreille, 1806): neotype designation, morphological re-description of all parasitic stages and molecular characterization. Ticks Tick Borne Dis 9: 15731585.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Stenos J , Graves SR , Unsworth NB , 2005. A highly sensitive and specific real-time PCR assay for the detection of spotted fever and typhus group rickettsiae. Am J Trop Med Hyg 73: 10831085.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Kato CY , Chung IH , Robinson LK , Austin AL , Dasch GA , Massung RF , 2013. Assessment of real-time PCR assay for detection of Rickettsia spp. and Rickettsia rickettsii in banked clinical samples. J Clin Microbiol 51: 314317.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Webb L , Carl M , Malloy DC , Dasch GA , Azad AF , 1990. Detection of murine typhus infection in fleas by using the polymerase chain reaction. J Clin Microbiol 28: 530534.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Tzianabos T , Anderson BE , McDade J , 1989. Detection of Rickettsia rickettsii DNA in clinical specimens by using polymerase chain reaction technology. J Clin Microbiol 27: 28662868.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    De Sousa R , Barata C , Vitorino L , Santos-Silva M , Carrapato C , Torgal J , Walker D , Bacellar F , 2006. Rickettsia sibirica isolation from a patient and detection in ticks, Portugal. Emerg Infect Dis 12: 1103.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Foley J , Tinoco Gracia L , Rodriguez M , Estrada-Guzman J , Fierro M , Peterson A , Pascoe E , Hori-Oshima S , Paddock CD , Zazueta O , 2019. Unbiased assessment of abundance of Rhipicephalus sanguineus sensu lato ticks, canine exposure to spotted fever group Rickettsia, and risk factors in Mexicali, México. Am J Trop Med Hyg 101: 2232.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Demma LJ , Traeger MS , Nicholson WL , Paddock CD , Blau DM , Eremeeva ME , Dasch GA , Levin ML , Singleton J Jr. , Zaki SR , 2005. Rocky Mountain spotted fever from an unexpected tick vector in Arizona. N Engl J Med 353: 587594.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    McQuiston J , Guerra M , Watts M , Lawaczeck E , Levy C , Nicholson W , Adjemian J , Swerdlow D , 2011. Evidence of exposure to spotted fever group rickettsiae among Arizona dogs outside a previously documented outbreak area. Zoon Publ Health 58: 8592.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Wikswo ME , Hu R , Dasch GA , Krueger L , Arugay A , Jones K , Hess B , Bennett S , Kramer V , Eremeeva ME , 2008. Detection and identification of spotted fever group rickettsiae in Dermacentor species from southern California. J Med Entomol 45: 509516.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Demma LJ et al., 2006. Serologic evidence for exposure to Rickettsia rickettsii in eastern Arizona and recent emergence of Rocky Mountain spotted fever in this region. Vector Borne Zoonotic Dis 6: 423429.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Greene C , Kidd LB , Breitschwerdt E & Greene C Infectious Diseases of the Dog and Cat. St. Louis, MO: Elsevier, 259270.

  • 33.

    Backus L , Foley J , Chung C , Virata S , Zazueta OE , López-Pérez A , 2023. Tick-borne pathogens detected in sheltered dogs during an epidemic of Rocky Mountain spotted fever, a One Health challenge. J Am Vet Med Assoc 261: 375383.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    López-Pérez A , Orozco L , Zazueta O , Fierro M , Gomez P , Foley J , 2020. An exploratory analysis of demography and movement patterns of dogs: new insights in the ecology of endemic Rocky Mountain-spotted fever in Mexicali, Mexico. PLoS One 15: e0233567.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Mesquita JR , Santos-Silva S , de Sousa Moreira A , Baptista MB , Cruz R , Esteves F , Vala H , Barradas PF , 2022. Rickettsia massiliae circulation in sheep and attached Rhipicephalus sanguineus in central Portugal. Trop Anim Health Prod 54: 17.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Beeler E , Abramowicz KF , Zambrano ML , Sturgeon MM , Khalaf N , Hu R , Dasch GA , Eremeeva ME , 2011. A focus of dogs and Rickettsia massiliae–infected Rhipicephalus sanguineus in California. Am J Trop Med Hyg 84: 244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Marquez F , Rodriguez-Liebana J , Soriguer RC , Muniain M , Bernabeu-Wittel M , Caruz A , Contreras-Chova F , 2008. Spotted fever group Rickettsia in brown dog ticks Rhipicephalus sanguineus in southwestern Spain. Parasitol Res 103: 119122.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Eremeeva ME , Bosserman EA , Demma LJ , Zambrano ML , Blau DM , Dasch GA , 2006. Isolation and identification of Rickettsia massiliae from Rhipicephalus sanguineus ticks collected in Arizona. J Appl Environ Microbiol 72: 55695577.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Belkahia H , Selmi R , Zamiti S , Daaloul-Jedidi M , Messadi L , Ben Said M , 2021. Zoonotic Rickettsia species in small ruminant ticks from Tunisia. Front Vet Sci 8: 676896.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Fernández-Soto P , Pérez-Sánchez R , Díaz Martín V , Encinas-Grandes A , Álamo Sanz R , 2006. Rickettsia massiliae in ticks removed from humans in Castilla y León, Spain. EJCMID 25: 811813.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Scarpulla M , Barlozzari G , Marcario A , Salvato L , Blanda V , De Liberato C , D’Agostini C , Torina A , Macrì G , 2016. Molecular detection and characterization of spotted fever group rickettsiae in ticks from central Italy. Ticks Tick Borne Dis 7: 10521056.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Barradas PF , Mesquita JR , Mateus TL , Ferreira P , Amorim I , Gärtner F , de Sousa R , 2021. Molecular detection of Rickettsia spp. in ticks and fleas collected from rescued hedgehogs (Erinaceus europaeus) in Portugal. Exp Appl Acarol 83: 449460.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Barradas PF , Mesquita JR , Ferreira P , Amorim I , Gärtner F , 2020. Detection of tick-borne pathogens in Rhipicephalus sanguineus sensu lato and dogs from different districts of Portugal. Ticks Tick Borne Dis 11: 101536.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    López-Pérez A , Sánchez-Montes S , Foley J , Guzmán-Cornejo C , Colunga-Salas P , Pascoe E , Becker I , Delgado-de la Morae J , Licona-Enriquez J , Suzan G , 2019. Molecular evidence of Borrelia burgdorferi sensu stricto and Rickettsia massiliae in ticks collected from a domestic-wild carnivore interface in Chihuahua, Mexico. Ticks Tick Borne Dis 10: 11181123.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    de Mera IGF , Ruiz-Fons F , de la Fuente G , Mangold AJ , Gortázar C , de la Fuente J , 2013. Spotted fever group rickettsiae in questing ticks, central Spain. Emerg Infect Dis 19: 1163.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Cicuttin GL , Tarragona EL , De Salvo MN , Mangold AJ , Nava S , 2015. Infection with Ehrlichia canis and Anaplasma platys (Rickettsiales: Anaplasmataceae) in two lineages of Rhipicephalus sanguineus sensu lato (Acari: Ixodidae) from Argentina. Ticks Tick Borne Dis 6: 724729.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Babalis T , Tselentis Y , Roux V , Psaroulaki A , Raoult D , 1994. Isolation and identification of a rickettsial strain related to Rickettsia massiliae in Greek ticks. Am J Trop Med Hyg 50: 365372.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Movilla R , Altet L , Serrano L , Tabar M-D , Roura X , 2017. Molecular detection of vector-borne pathogens in blood and splenic samples from dogs with splenic disease. Parasit Vectors 10: 18.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Bechelli J , Smalley C , Milhano N , Walker DH , Fang R , 2015. Rickettsia massiliae and Rickettsia conorii Israeli spotted fever strain differentially regulate endothelial cell responses. PLoS One 10: e0138830.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Vitale G , Mansueto S , Rolain J-M , Raoult D , 2006. Rickettsia massiliae human isolation. Emerg Infect Dis 12: 174.

  • 51.

    Khrouf F , Sellami H , Elleuch E , Hattab Z , Ammari L , Khalfaoui M , Souissi J , Harrabi H , M’ghirbi Y , Tiouiri H , 2016. Molecular diagnosis of Rickettsia infection in patients from Tunisia. Ticks Tick Borne Dis 7: 653656.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Alvarez-Hernandez G , Murillo-Benitez C , del Carmen Candia-Plata M , Moro M , 2015. Clinical profile and predictors of fatal Rocky Mountain spotted fever in children from Sonora, Mexico. Ped Inf Dis J 34: 125130.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Neitz W , 1943. The eradication of the brown dog tick (Rhipicephalus sanguineus Ltr.) from a dog kennel. J S Afr Vet Assoc 14: 9093.

  • 54.

    Dantas-Torres F , 2008. The brown dog tick, Rhipicephalus sanguineus (Latreille, 1806)(Acari: Ixodidae): from taxonomy to control. Vet Parasitol 152: 173185.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Secretaría de Salud México, 2023. Boletines epidemiológicos históricos. Sistema de Vigilancia Epidemiológica, Dirección General de Epidemiologia. Available at: https://www.gob.mx/salud/acciones-y-programas/historico-boletin-epidemiologico. Accessed January 12, 2024.

    • PubMed
    • Export Citation
  • 56.

    Estrada I , Balagot C , Fierro M , Kriner P , Iniguez-Stevens E , Kjemtrup A , Foley J , 2020. Spotted fever group rickettsiae canine serosurveillance near the U.S.-Mexico border in California. Zoon Publ Health 67: 148155.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Kjemtrup AM , Padgett K , Paddock CD , Messenger S , Hacker JK , Feiszli T , Melgar M , Metzger ME , Hu R , Kramer VL , 2022. A forty-year review of Rocky Mountain spotted fever cases in California shows clinical and epidemiologic changes. PLoS Negl Trop Dis 16: e0010738.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Drexler NA , Yaglom H , Casal M , Fierro M , Kriner P , Murphy B , Kjemtrup A , Paddock CD , 2017. Fatal Rocky Mountain spotted fever along the United States–Mexico border, 2013–2016. Emerg Infect Dis 23: 16211626.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    California Department of Public Health , 2022. Vector-Borne Disease Section. Available at: www.cdph.ca.gov/programs/vbds. Accessed January 8, 2023.

    • PubMed
    • Export Citation
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