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National Surveillance of Spotted Fever Group Rickettsioses in the United States, 2008–2012

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  • Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Spotted fever group (SFG) rickettsioses are notifiable conditions in the United States caused by the highly pathogenic Rickettsia rickettsii and less pathogenic rickettsial species such as Rickettsia parkeri and Rickettsia sp. 364D. Surveillance data from 2008 to 2012 for SFG rickettsioses are summarized. Incidence increased from 1.7 cases per million person-years (PY) in 2000 to 14.3 cases per million PY in 2012. During 2008–2012, cases of SFG rickettsiosis were more frequently reported among males, persons of white race, and non-Hispanic ethnicity. Overall, case fatality rate (CFR) was low (0.4%), however, risk of death was significantly higher for American Indian/Alaska Natives (relative risk [RR] = 5.4) and Asian/Pacific Islanders (RR = 5.7) compared with persons of white race. Children aged < 10 years continue to experience the highest CFR (1.6%). Higher incidence of SFG rickettsioses and decreased CFR likely result from increased reporting of tick-borne disease including those caused by less pathogenic species. Recently, fewer cases have been confirmed using species-specific laboratory methods (such as cell culture and DNA detection using polymerase chain reaction [PCR] assays), causing a clouded epidemiological picture. Use of PCR and improved documentation of clinical signs, such as eschars, will better differentiate risk factors, incidence, and clinical outcomes of specific rickettsioses in the future.

Author Notes

* Address correspondence to Naomi A. Drexler, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop A-30, Atlanta, GA 30329. E-mail: isj3@cdc.gov

Financial support: This study was supported by the Centers for Disease Control and Prevention (CDC) and in part supported by an appointment to the Research Participation Program at the CDC administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC.

Authors' addresses: Naomi A. Drexler, F. Scott Dahlgren, Kristen Nichols Heitman, Robert F. Massung, Christopher D. Paddock, and Casey Barton Behravesh, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: isj3@cdc.gov, iot0@cdc.gov, wwd7@cdc.gov, rfm2@cdc.gov, cdp9@cdc.gov, and dlx9@cdc.gov.

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