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Chapter 2 : Public Health: Rickettsial Infections and Epidemiology

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Abstract:

Rickettsial diseases have had a profound impact on human lives for centuries but were poorly understood prior to the beginning of the 20th century. The study of the pathogens is challenging and requires an intimate understanding of arthropod vectors, mammalian hosts, and human nature. This chapter focuses on rickettsial infections of public health importance to humans, primarily focusing on rickettsiae in the United States. It also briefly addresses the global importance of rickettsial pathogens. An understanding of the epidemiology of rickettsial diseases requires not only a look at contemporary public health issues, but also an understanding of the history of these infections and classic approaches to control and prevention. Since the early investigations of Ricketts and others into the origins and ecology of Rocky Mountain spotted fever (RMSF), public health interest in rickettsiae has remained strong in the United States. The chapter concentrates on the historical and current epidemiology and public health importance of rickettsial pathogens known to occur in the United States. infection can be difficult to distinguish from infection with , as extensive serologic cross-reactivity occurs between this and other spotted fever group rickettsial (SFGR) species. From 2000 to 2007, 3,126 cases of presumed and an additional 824 cases classified as "Ehrlichiosis Undetermined/Unspecified/Other Agent (UUOA)" were reported within the United States. Most of these Ehrlichiosis UUOA cases were probably or cases that could not be properly classified.

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2

Key Concept Ranking

Rocky Mountain Spotted Fever
0.5000078
Acute Respiratory Distress Syndrome
0.4625623
Human Monocytic Ehrlichiosis
0.4278701
Human Granulocytic Ehrlichiosis
0.41795805
0.5000078
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FIGURE 1

Reports of tick-borne rickettsial infections in the United States have increased in recent years. Cases are graphed by onset year, as reported to the Centers for Disease Control and Prevention through the NNDSS. doi:10.1128/9781555817336.ch2f1

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 2

Transmission cycle for maintenance of in the United States.doi:10.1128/9781555817336.ch2f2

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 3

Historical trends in reported incidence and case fatality rate of RMSF in the United States, 1920 to 2008. doi:10.1128/9781555817336.ch2f3

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 4

Incidence of RMSF by U.S. county, 2000 to 2007. doi:10.1128/9781555817336.ch2f4

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 5

RMSF incidence by age group, United States, 2000 to 2007. doi:10.1128/9781555817336.ch2f5

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 6

RMSF case fatality rate by age group, United States, 2000 to 2007. doi:10.1128/9781555817336.ch2f6

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 7

Transmission cycle for maintenance of in the United States. doi:10.1128/9781555817336.ch2f7

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 8

Transmission cycle for maintenance of in the United States. doi:10.1128/9781555817336.ch2f8

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 9

Reported cases of , United States, 1992 to 2008. The majority of the reports ( = 868; 91%) were from Texas (CDC, unpublished). doi:10.1128/9781555817336.ch2f9

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 10

Reported cases of by state, 1992 to 2008 (CDC, unpublished). doi:10.1128/9781555817336.ch2f10

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 11

Reported cases of by age group, United States, 1992 to 2008 (CDC, unpublished). doi:10.1128/9781555817336.ch2f11

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 12

Transmission cycle for maintenance of in the United States. doi:10.1128/9781555817336.ch2f12

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 13

Annual incidence of infections with and and Ehrlichiosis UUOA, United States, 2000 to 2007. doi:10.1128/9781555817336.ch2f13

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 14

Incidence of infections with (A), (B), and Ehrlichiosis UUOA (C) by U.S. county, 2000 to 2007. PY, person-years. doi:10.1128/9781555817336.ch2f14

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 15

Incidence of infections with and and Ehrlichiosis UUOA by age group, United States, 2000 to 2007. doi:10.1128/9781555817336.ch2f15

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 16

Hospitalization rates for infections with and and Ehrlichiosis UUOA infections by age group, United States, 2000 to 2007. doi:10.1128/9781555817336.ch2f16

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 17

Transmission cycle for maintenance of in the United States. doi:10.1128/9781555817336.ch2f17

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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FIGURE 18

Surveillance for notifiable diseases in the United States. doi:10.1128/9781555817336.ch2f18

Citation: McQuiston J, Paddock C. 2012. Public Health: Rickettsial Infections and Epidemiology, p 40-83. In Palmer G, Azad A (ed), Intracellular Pathogens II: . ASM Press, Washington, DC. doi: 10.1128/9781555817336.ch2
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