Increasing Incidence of Ehrlichiosis in the United States: A Summary of National Surveillance of Ehrlichia chaffeensis and Ehrlichia ewingii Infections in the United States, 2008–2012

Kristen Nichols Heitman Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee

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F. Scott Dahlgren Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee

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Naomi A. Drexler Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee

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Robert F. Massung Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee

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Casey Barton Behravesh Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee

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Human ehrlichiosis is a potentially fatal disease caused by Ehrlichia chaffeensis and Ehrlichia ewingii. Cases of ehrlichiosis are reported to Centers for Disease Control and Prevention through two national surveillance systems: Nationally Notifiable Diseases Surveillance System (NNDSS) and Case Report Forms. During 2008–2012, 4,613 cases of E. chaffeensis infections were reported through NNDSS. The incidence rate (IR) was 3.2 cases per million person-years (PYs). The hospitalization rate (HR) was 57% and the case fatality rate (CFR) was 1%. Children aged < 5 years had the highest CFR of 4%. During 2008–2012, 55 cases of E. ewingii infection were reported through NNDSS. The national IR was 0.04 cases per million PY. The HR was 77%; no deaths were reported. Immunosuppressive conditions were reported by 26% of cases. The overall rate for ehrlichiosis has increased 4-fold since 2000. Although previous literature suggests E. ewingii primarily affects those who are immunocompromised, this report shows most cases occurred among immunocompetent patients. This is the first report to show children aged < 5 years with ehrlichiosis have an increased CFR, relative to older patients. Ongoing surveillance and reporting of tick-borne diseases are critical to inform public health practice and guide disease treatment and prevention efforts.

Author Notes

* Address correspondence to Kristen Nichols Heitman, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A30, Atlanta, GA 30329. E-mail: wwd7@cdc.gov

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

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