Spotted Fever - _WCTurrent Trends E Rocky Mountain Spotted...

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Unformatted text preview: _WCTurrent Trends E Rocky Mountain Spotted Fever — United States, 1988 In 1988, state health departments reported 615 cases of Rocky Mountain spotted fever (RMSF) to CDC, an increase of 3.9% from the 592 cases reported in 1987. The incidence was 0.3 per 100,000. Of the 615 cases, 200 (32.5%) were reported from the South Atlantic region and 149 (24.2%) from the‘West South Central region. Oklahoma had the highest rate (97 cases, 3.0 per 100,000); other states with high rates were North Carolina (108 cases, 1.7 per 100,000), Arkansas (32 cases, 1.3 per 100,000), Missouri (57 cases, 1.1 per 100,000), and Kansas (26 cases, 1.0 per 100,000) (Figure 1). Detailed case report form-s were submitted on 555 (90.2%) of the 615 cases. Of these, 362 (65.2%) were |abo'ratory-confirmed*, 31 (5.6%) were classified as prob- able*, and 162 (29.2%) were not confirmed. Males accounted for 63.8% of cases; onset of symptoms occurred between April 1 and July 31 in 81.2%, and a tick bite was reported in 62.8%..l:e__y§_r was reported in 92.8% of cases, headache in 84.7%,;g_s_h_,in *A case is considered serologically confirmed if testing reveals an indirect fluorescent antibody (IFA) titer of 21:64, a complement-fixation (CF) titer of 21 :16, or a fourfold rise in titer by the CF, (FA, microagglutination (MA), latex agglutination (LA), or indirect hemagglutination (lHA) assays. ' - TA case is considered probable if testing reveals a fourfold rise in titer or a single titer 21:320 in the Well-Felix assay or an LA, MA, or iFA single titer of 21:128. n 514 MMWR July 28, 1989 Rocky Mountain Spotted Fever — Continued 76.5%, and rash on palms in 50.6%. The overall case-fatality rate for 1988 was 3.9%: 8.2% for persons >30 years of age and 1.3% for persons €30. Reported by: State health departments. Viral and Rickettsial Zoonoses Br, Div of Viral and Rickettsial Diseases, Center for Infectious Diseases, CDC. Editorial Note: Although the total number of RMSF cases reported in 1988 increased minimally from 1987, large increases occurred in several states: Missouri (from 19 cases in 1987 to 57 in 1988), Arkansas (from 12 to 32 cases), South Dakota (from one to seven cases), and Kentucky (from 13 to 30 cases). The increase in Missouri may reflect an extension of the area in which RMSF is endemic in the West South Central states (1). Reported cases in Maryland and Tennessee decreased 52.2% and 32.0%, respectively, in 1988. The case—fatality rate for 1988 increased to 3.9% from 3.1% in 1987, reflecting an increase in fatal cases and/or: better surveillance. As in previous years, the case- fatality rate was higher in older patients and in those without a history of tick bites. Because diagnosis may be delayed in persons without a history of a tick bite, the likelihood of serious or fatal complications increases for this group. . Because no vaccine exists for RMSF, the best preventive measure is avoidance of tick-infested areas. Persons who must enter these areas should wear protective clothes and use tick repellant. The most widely used tick repellant is N,N-diethyl- m-toluamide (DEET), the active ingredient in most popular brands of insect repellant. Although DEET is effective in repelling ticks (as well as chiggers, flies, mosquitos, and biting flies), toxic and allergic side effects have been reported (2,3 ). Ticks attached to a person's body should be removed by grasping them with fine tweezers at the point of attachment and pulling gently (4 ). When fingers are used instead of tweezers, they should be protected using facial tissue and washed afterwards. FIGURE 1. Rocky Mountain spotted fever cases and rates, by state — United States, 1988 , 2%], .r/zé/V Vol. 38 I No. 29 MMWR 515 Rocky Mountain Spotted Fever — Continued RMSF should be considered in all patients with an unexplained febrile illness, especially those with a history of tick bite or travel to areas with endemic RMSF. If RMSF is suspected, treatment with tetracycline or chloramphenicol should be promptly instituted. For children $8 years of age and pregnant women, chloram- phenicol is the preferred treatment (5). Cases of RMSF should be reported to CDC through state health departments. References 1. Taylor JP, Istre GR, McChesney TC. The epidemiology of Rocky Mountain spotted fever in Arkansas, Oklahoma, and Texas, 1981 through 1985. Am J Epidemiol 1988;127:1295—301. 2. Abramowicz M, ed. Insect repellents. Med Lett Drugs Ther 1989;31:45—7. 3. Miller JD. Anaphylaxis associated with insect repellant [Letter]. N Engl J Med 1982:3072 1341—2. 4. Needham GR. Evaluation of five popular methods for tick removal. Pediatrics 1985;75: 997—1002. 5. Fishbein DB. Treatment of Rocky Mountain spotted fever. JAMA 1988;260:3192. Notices to Readers Publication of MMWR Recommendations and Reports on "Interpretation and Use of the Western Blot Assay for Serodiagnosis of Human immunodeficiency Virus Type 1 Infections" A new MMWR Recommendations and Reports entitled, "Interpretation and Use of the Western Blot Assay for Serodiagnosis of Human immunodeficiency Virus Type 1 infections" (1), was published July 21, 1989. The Association of State and Territorial Public Health Laboratory Directors and CDC collaborated in preparing this report; it describes various interpretive criteria associated with the Western blot test for human immunodeficiency virus type (HIV-1), evaluates the sensitivity and specificity of these criteria as tools for public health practice, and provides recommendations for using the Western blot and for reporting results. Reference 1. CDC. Interpretation and use of the Western blot assay for serodiagnosis of human immuno- deficiency virus type 1 infections. MMWR 1989;38(no. S-7). Second Conference on International Travel Medicine The Second Conference on international Travel Medicine will be held May 9—12, 1991, in Atlanta. The conference will be cospbnsored by the World Health Organiza- tion (Geneva), World Tourism Organization (Madrid), Emory University School of Medicine (Atlanta), London School of Hygiene and Tropical Medicine, and CDC. Scientific inquiries should be addressed to: Hans O. Lobel, M.D., Mailstop F12, Centers for Disease Control, Atlanta, GA 30333; FAX number: (404) 488-4427. Program and registration information and instructions for submitting abstracts will be available by spring 1990; requests should be addressed to: Second Conference on international Travel Medicine, 104 Woodruff Health Sciences Administration Bldg., 1440 Clifton Rd., NE, Atlanta, GA 30322. ...
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