Incidence Estimates of Acute Q Fever and Spotted Fever Group Rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014

View More View Less
  • 1 Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina;
  • | 2 Duke Global Health Institute, Duke University, Durham, North Carolina;
  • | 3 Programme in Emerging Infectious Diseases, Duke-National University of Singapore, Singapore;
  • | 4 Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
  • | 5 Centers for Disease Control and Prevention, Rickettsial Zoonoses Branch, Atlanta, Georgia;
  • | 6 Centre for International Health, University of Otago, Dunedin, New Zealand;
  • | 7 Department of Medicine, University of Otago, Christchurch, New Zealand;
  • | 8 Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom;
  • | 9 Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom;
  • | 10 Kilimanjaro Christian Medical University College, Moshi, Tanzania;
  • | 11 Mawenzi Regional Referral Hospital, Moshi, Tanzania;
  • | 12 Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania;
  • | 13 Sokoine University of Agriculture, Morogoro, Tanzania

Q fever and spotted fever group rickettsioses (SFGR) are common causes of severe febrile illness in northern Tanzania. Incidence estimates are needed to characterize the disease burden. Using hybrid surveillance—coupling case-finding at two referral hospitals and healthcare utilization data—we estimated the incidences of acute Q fever and SFGR in Moshi, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014. Cases were defined as fever and a four-fold or greater increase in antibody titers of acute and convalescent paired sera according to the indirect immunofluorescence assay of Coxiella burnetii phase II antigen for acute Q fever and Rickettsia conorii (2007–2008) or Rickettsia africae (2012–2014) antigens for SFGR. Healthcare utilization data were used to adjust for underascertainment of cases by sentinel surveillance. For 2007 to 2008, among 589 febrile participants, 16 (4.7%) of 344 and 27 (8.8%) of 307 participants with paired serology had Q fever and SFGR, respectively. Adjusted annual incidence estimates of Q fever and SFGR were 80 (uncertainty range, 20–454) and 147 (uncertainty range, 52–645) per 100,000 persons, respectively. For 2012 to 2014, among 1,114 febrile participants, 52 (8.1%) and 57 (8.9%) of 641 participants with paired serology had Q fever and SFGR, respectively. Adjusted annual incidence estimates of Q fever and SFGR were 56 (uncertainty range, 24–163) and 75 (uncertainty range, 34–176) per 100,000 persons, respectively. We found substantial incidences of acute Q fever and SFGR in northern Tanzania during both study periods. To our knowledge, these are the first incidence estimates of either disease in sub-Saharan Africa. Our findings suggest that control measures for these infections warrant consideration.

Author Notes

Address correspondence to Matthew Rubach, Moshi, Kilimanjaro, United Republic of Tanzania. E-mail: matthew.rubach@duke.edu

Presented in part as: Pisharody S, Rubach MP, Nicholson WL, Perniciaro JL, Carugati M, Biggs HM, Maze MJ, Hertz JT, Halliday JE, Allan KJ, Mmbaga BT, Saganda W, Lwezaula BF, Kazwala RR, Cleaveland S, Maro VP, Crump JA. Incidence of acute Q fever and spotted fever group rickettsioses, Kilimanjaro, Tanzania, 2007–2008 and 2012–2014. Abstract LB-5149. 68th American Society of Tropical Medicine and Hygiene Annual Meeting, National Harbor, MD, 20–24 November 2019.

Financial support: This research was supported by the joint US National Institutes of Health (NIH; www.nih.gov)-National Science Foundation (NSF; www.nsf.gov) Ecology of Infectious Disease program (R01TW009237) and the Research Councils UK, Department for International Development (UK) and UK Biotechnology and Biological Sciences Research Council (BBSRC; www.bbsrc.ac.uk) (grant numbers BB/J010367/1, BB/L018926, BB/L017679, BB/L018845, BB/S013857/1), US National Institutes of Health International Studies on AIDS Associated Co-infections (ISAAC) award (grant number U01 AI062563), US National Institutes for Allergy and Infectious Diseases awards (grant number R01 AI121378), and the Bill & Melinda Gates Foundation-funded Typhoid Fever Surveillance in sub-Saharan Africa Program (TSAP) grant (OPPGH5231). MJM received support from the Frances G. Cotter Scholarship and the McGibbon Travel Fellowship from the University of Otago. HMB received support from the National Institutes of Health Interdisciplinary Research Training Program in AIDS (grant number NIAID-AI007392). KJA received support from the Wellcome Trust (096400/Z/11/Z). MPR received support from National Institutes of Health Research Training Grants (R25 TW009337) funded by the Fogarty International Center and from US NIH K23 AI116869. SP received support from Doris Duke Foundation through the Doris Duke International Clinical Research Fellowship. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure: Presented in part at the American Society of Tropical Medicine and Hygiene 68th annual meeting, National Harbor, MD, 20–24 November 2019. Abstract LB-5149.

Authors’ addresses: Sruti Pisharody, Duke University School of Medicine, Durham, NC, E-mail: sdpisharody@gmail.com. Matthew P. Rubach and Holly Biggs, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, E-mails: matthew.rubach@duke.edu and hollybiggs1@gmail.com. Manuela Carugati, Hanes House, Trent Drive, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, E-mail: manuela.carugati@duke.edu. William L. Nicholson and Jamie L. Perniciaro, Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: wan6@cdc.gov and uvo6@cdc.gov. Michael J. Maze, University of Otago, Christchurch, Christchurch, New Zealand, E-mail: michael.maze@otago.ac.nz. Julian Hertz, Duke University School of Medicine, Department of Surgery, Durham, NC, E-mail: julian.hertz@duke.edu. Jo E. B. Halliday and Kathryn J. Allan, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK, E-mail: jo.halliday@glasgow.ac.uk and kathryn.allan@glasgow.ac.uk. Blandina T. Mmbaga, Kilimanjaro Christian Medical University College and Kilimanjaro Christian Medical Centre and Kilimanjaro Clinical Research Institute, Moshi, Tanzania, E-mail: blaymt@gmail.com. Wilbrod Saganda and Bingileki F. Lwezaula, Department of Medicine, Mawenzi Regional Referral Hospital, Moshi, Tanzania, E-mails: wilbrodsaganda@gmail.com and lwezaula@gmail.com. Rudovick R. Kazwala, Sokoine University of Agriculture, Morogoro, Tanzania, E-mail: kazwala@gmail.com. Sarah Cleaveland, College of Medical, Veterinary and Life Sciences, University, of Glasgow, Glasgow, UK, E-mail: sarah.cleaveland@glasgow.ac.uk. Venance P. Maro, Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, and Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania, E-mail: venmaro@ymail.com. John A. Crump, Duke University Division of Infectious Diseases and International Health, Duke University Medical Centre, Durham, NC, E-mail: john.crump@duke.edu.

Save