Tick-Borne Relapsing Fever Outbreak Among a High School Football Team at an Outdoor Education Camping Trip, Arizona, 2014

Jefferson M. Jones Arizona Department of Health Services, Phoenix, Arizona.
Epidemic Intelligence Service, Atlanta, Georgia.

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Carter R. Hranac Northern Arizona University, Flagstaff, Arizona.

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Mare Schumacher Coconino County Public Health Services District, Flagstaff, Arizona.

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Kim Horn Flagstaff Medical Center, Flagstaff, Arizona.

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Darlene M. Lee Flagstaff Medical Center, Flagstaff, Arizona.

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Joel Terriquez Flagstaff Medical Center, Flagstaff, Arizona.

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David M. Engelthaler Translational Genomics Research Institute, Flagstaff, Arizona.

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Marie Peoples Coconino County Public Health Services District, Flagstaff, Arizona.

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Jennifer Corrigan Coconino County Public Health Services District, Flagstaff, Arizona.

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Adam Replogle Centers for Disease Control Division of Vector-Borne Disease, Fort Collins, Colorado.

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Nina Souders Flagstaff Medical Center, Flagstaff, Arizona.

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Kenneth K. Komatsu Arizona Department of Health Services, Phoenix, Arizona.

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Nathan C. Nieto Northern Arizona University, Flagstaff, Arizona.

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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 Ornithodoros ticks, the vector of TBRF. Blood samples from a chipmunk trapped near the cabin and from patients contained Borrelia hermsii 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.

Author Notes

* Address correspondence to Jefferson M. Jones, Office of Infectious Disease, Arizona Department of Health Services, 150 North 18th Avenue, Phoenix, AZ 85007. E-mail: jjones10@cdc.gov

Authors' addresses: Jefferson M. Jones, Arizona Department of Health Services, Phoenix, AZ, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: jjones10@cdc.gov. Carter R. Hranac and Nathan C. Nieto, Northern Arizona University, Flagstaff, AZ, E-mails: crh244@gmail.com and nathan.nieto@nau.edu. Mare Schumacher, Marie Peoples, and Jennifer Corrigan, Coconino County Public Health Services District, Flagstaff, AZ, E-mails: mschumacher@coconino.az.gov, mpeoples@coconino.az.gov, and jcorrigan@coconino.az.gov. Kim Horn, Darlene M. Lee, Joel Terriquez, and Nina Souders, Flagstaff Medical Center, Flagstaff, AZ, E-mails: hornkimatflag@gmail.com, darlene.lee@nahealth.com, joel.terriquez2@nahealth.com, and nina.souders@nahealth.com. David M. Engelthaler, Translational Genomics Research Institute, Flagstaff, AZ, E-mail: dengelthaler@tgen.org. Adam Replogle, Centers for Disease Control and Prevention Division of Vector-Borne Disease, Fort Collins, CO, E-mail: xhk9@cdc.gov. Kenneth K. Komatsu, Arizona Department of Health Services, Phoenix, AZ, E-mail: ken.komatsu@azdhs.gov.

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