Marc Traeger - Academia.edu (original) (raw)

Papers by Marc Traeger

Vector-borne and Zoonotic Diseases, Dec 1, 2006

During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in... more During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in a rural community in Arizona where the disease had not been previously reported. The outbreak was associated with Rickettsia rickettsii in an unexpected tick vector, the brown dog tick (Rhipicephalus sanguineus), which had not been previously associated with RMSF transmission in the United States. We investigated the extent of exposure to R. rickettsii in the local area through serologic evaluations of children and dogs in 2003-2004, and in canine sera from 1996. Antibodies to R. rickettsii at titers Ն 32 were detected in 10% of children and 70% of dogs in the outbreak community and 16% of children and 57% of dogs in a neighboring community. In comparison, only 5% of canine samples from 1996 had anti-R. rickettsii antibodies at titers Ն 32. These results suggest that exposures to RMSF have increased over the past 9 years, and that RMSF may now be endemic in this region.

Emerging Infectious Diseases, Oct 1, 2002

, the first inhalational anthrax case in the United States since 1976 was identified in a media c... more , the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities.

American Journal of Tropical Medicine and Hygiene, Sep 2, 2015

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian re... more Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000

Oxford University Press eBooks, Oct 1, 2021

This chapter describes anthrax as a disease caused by the gram-positive, aerobic bacterium Bacill... more This chapter describes anthrax as a disease caused by the gram-positive, aerobic bacterium Bacillus anthracis, which was recognized in antiquity. Anthrax figures prominently in the history of modern medicine because it was the first bacterial illness for which successful vaccines were prepared by William Smith Greenfield in London and Louis Pasteur in Paris. Anthrax is a zoonosis of herbivores encountered worldwide, and human cases continue to be seen in southern Europe, Eurasia, south Asia, and sub-Saharan Africa. Grazing wild ruminants and cattle are very susceptible to anthrax, and human disease in animal husbandmen and herders is closely tied to exposure to infected beasts. The chapter analyzes reports of some areas of rural Kenya in which a substantial percentage of herdsmen are serologically positive for B. anthracis.

American Journal of Public Health, May 1, 2006

Objectives. The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influe... more Objectives. The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influenza vaccination campaign during the 2002–2003 influenza season to bridge the vaccination gap between American Indians and Alaska Natives and the US population as a whole.Methods. In our vaccination program, we used a multidisciplinary approach that included staff and community education, standing orders, vaccination of hospitalized patients, and employee, outpatient, community, and home vaccinations without financial barriers.Results. WRSU influenza vaccination coverage rates among persons aged 65 years and older, those aged 50 to 64 years, and those with diabetes were 71.8%, 49.6%, and 70.2%, respectively, during the 2002–2003 influenza season. We administered most vaccinations to persons aged 65 years and older through the outpatient clinics (63.6%) and public health nurses (30.0%). The WRSU employee influenza vaccination rate was 72.8%.Conclusions. We achieved influenza vaccination rates in targeted groups of an American Indian population that are comparable to or higher than rates in other US populations. Our system may be a useful model for other facilities attempting to bridge disparity for influenza vaccination.

Public Health Reports, May 1, 2010

Objective. Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the U... more Objective. Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population. Methods. We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates. Results. In 2007, pneumococcal vaccination coverage rates among people 65 years of age and among high-risk people aged 18-64 years were 96.0% and 61.2%, respectively, exceeding Healthy People 2010 goals. Government Performance and Results Act analyses reports revealed a 2.7-fold increase (36.0% to 98.0%) of coverage from 2000 to 2007 among people 65 years of age at Whiteriver Service Unit in Whiteriver, Arizona. Conclusions. We achieved pneumococcal vaccination rates in targeted groups of an American Indian population that reached Healthy People 2010 goals and were higher than rates in other U.S. populations. Our program may be a useful model for other communities attempting to meet Healthy People 2010 goals.

Archives of pediatrics & adolescent medicine, Aug 1, 1993

Open Forum Infectious Diseases

Background Rocky Mountain spotted fever (RMSF) is a deadly tickborne disease disproportionately a... more Background Rocky Mountain spotted fever (RMSF) is a deadly tickborne disease disproportionately affecting Arizona tribal communities. While the acute clinical effects of RMSF are well-documented, more complete understanding of the long-term health consequences is needed to provide guidance for providers and patients in highly impacted areas. Methods We performed a retrospective review of hospitalized RMSF cases from 2 tribal communities in Arizona during 2002–2017. Medical records from acute illness were abstracted for information on clinical presentation, treatment, and status at discharge. Surviving patients were interviewed about disease recovery, and patients reporting incomplete recovery were eligible for a neurologic examination. Results Eighty hospitalized cases of RMSF met our inclusion criteria and were reviewed. Of these, 17 (21%) resulted in a fatal outcome. Among surviving cases who were interviewed, most (62%) reported full recovery, 15 (38%) reported ongoing symptoms o...

Annals of the New York Academy of Sciences, Oct 1, 2006

A recent epidemiologic investigation identified 16 cases and 2 deaths from Rocky Mountain spotted... more A recent epidemiologic investigation identified 16 cases and 2 deaths from Rocky Mountain spotted fever (RMSF) in two eastern Arizona communities. Prevalence studies were conducted by collecting free-living ticks (Acari: Ixodidae) from the home sites of RMSF patients and from other home sites within the community. Dry ice traps and flagging confirmed heavy infestations at many of the home sites. Only Rhipicephalus sanguineus ticks were identified and all developmental stages were detected. It is evident that under certain circumstances, this species does transmit Rickettsia rickettsii to humans and deserves reconsideration as a vector in other geographic areas.

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian re... more Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 19, 2015

Rocky Mountain spotted fever (RMSF) has emerged as a significant cause of morbidity and mortalit... more Rocky Mountain spotted fever (RMSF) has emerged as a significant cause of morbidity and mortality since 2002 on tribal lands in Arizona. The explosive nature of this outbreak and the recognition of an unexpected tick vector, Rhipicephalus sanguineus, prompted an investigation to characterize RMSF in this unique setting, and compare RMSF cases to similar illnesses. We compared medical records of 205 RMSF cases and 175 non-RMSF illnesses that prompted RMSF testing during 2002-2011 from two Indian reservations in Arizona. RMSF cases occurred year-round and peaked later (July-September) than RMSF cases reported from other U.S regions. Cases were younger (median age 11 years) and reported fever and rash less frequently as well as less tick exposure compared to other U.S. cases. Fever was present in 81% of cases but not significantly different from that in non-RMSF illnesses. Classic laboratory abnormalities such as low sodium and platelet counts had small and subtle differences betwee...

American Journal of Tropical Medicine and Hygiene, 2015

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian re... more Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000

Clinical Infectious Disease, 2015

The Journal of Pediatrics, 2015

To evaluate whether cosmetically relevant dental effects occurred among children who had received... more To evaluate whether cosmetically relevant dental effects occurred among children who had received doxycycline for treatment of suspected Rocky Mountain spotted fever (RMSF). Children who lived on an American Indian reservation with high incidence of RMSF were classified as exposed or unexposed to doxycycline, based on medical and pharmacy record abstraction. Licensed, trained dentists examined each child's teeth and evaluated visible staining patterns and enamel hypoplasia. Objective tooth color was evaluated with a spectrophotometer. Fifty-eight children who received an average of 1.8 courses of doxycycline before 8 years of age and who now had exposed permanent teeth erupted were compared with 213 children who had never received doxycycline. No tetracycline-like staining was observed in any of the exposed children's teeth (0/58, 95% CI 0%-5%), and no significant difference in tooth shade (P = .20) or hypoplasia (P = 1.0) was found between the 2 groups. This study failed to demonstrate dental staining, enamel hypoplasia, or tooth color differences among children who received short-term courses of doxycycline at <8 years of age. Healthcare provider confidence in use of doxycycline for suspected RMSF in children may be improved by modifying the drug's label.

Public health reports (Washington, D.C. : 1974)

Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United State... more Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population. We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates. In 2007, pneumococcal vaccination coverage rates among people > or = 65 years of age and among high-risk people aged 18-64 years were 96.0% and 61.2%, respectively...

American journal of diseases of children (1960), 1993

MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, Jan 31, 2006

Tickborne rickettsial diseases (TBRD) continue to cause severe illness and death in otherwise hea... more Tickborne rickettsial diseases (TBRD) continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low cost, effective antimicrobial therapy. The greatest challenge to clinicians is the difficult diagnostic dilemma posed by these infections early in their clinical course, when antibiotic therapy is most effective. Early signs and symptoms of these illnesses are notoriously nonspecific or mimic benign viral illnesses, making diagnosis difficult. In October 2004, CDC's Viral and Rickettsial Zoonoses Branch, in consultation with 11 clinical and academic specialists of Rocky Mountain spotted fever, human granulocytotropic anaplasmosis, and human monocytotropic ehrlichiosis, developed guidelines to address the need for a consolidated source for the diagnosis and management of TBRD. The preparers focused on the practical aspects of epidemiology, clinical assessment, treatment, and laboratory diagnosis of TBRD. This report will assist...

New England Journal of Medicine, 2005

background Rocky Mountain spotted fever is a life-threatening, tick-borne disease caused by Ricke... more background Rocky Mountain spotted fever is a life-threatening, tick-borne disease caused by Rickettsia rickettsii. This disease is rarely reported in Arizona, and the principal vectors, Dermacentor species ticks, are uncommon in the state. From 2002 through 2004, a focus of Rocky Mountain spotted fever was investigated in rural eastern Arizona. methods We obtained blood and tissue specimens from patients with suspected Rocky Mountain spotted fever and ticks from patients' homesites. Serologic, molecular, immunohistochemical, and culture assays were performed to identify the causative agent. On the basis of specific laboratory criteria, patients were classified as having confirmed or probable Rocky Mountain spotted fever infection. results A total of 16 patients with Rocky Mountain spotted fever infection (11 with confirmed and 5 with probable infection) were identified. Of these patients, 13 (81 percent) were children 12 years of age or younger, 15 (94 percent) were hospitalized, and 2 (12 percent) died. Dense populations of Rhipicephalus sanguineus ticks were found on dogs and in the yards of patients' homesites. All patients with confirmed Rocky Mountain spotted fever had contact with tick-infested dogs, and four had a reported history of tick bite preceding the illness. R. rickettsii DNA was detected in nonengorged R. sanguineus ticks collected at one home, and R. rickettsii isolates were cultured from these ticks. conclusions This investigation documents the presence of Rocky Mountain spotted fever in eastern Arizona, with common brown dog ticks (R. sanguineus) implicated as a vector of R. rickettsii. The broad distribution of this common tick raises concern about its potential to transmit R. rickettsii in other settings.

Vector borne and zoonotic diseases (Larchmont, N.Y.), 2006

During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in... more During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in a rural community in Arizona where the disease had not been previously reported. The outbreak was associated with Rickettsia rickettsii in an unexpected tick vector, the brown dog tick (Rhipicephalus sanguineus), which had not been previously associated with RMSF transmission in the United States. We investigated the extent of exposure to R. rickettsii in the local area through serologic evaluations of children and dogs in 2003-2004, and in canine sera from 1996. Antibodies to R. rickettsii at titers > or = 32 were detected in 10% of children and 70% of dogs in the outbreak community and 16% of children and 57% of dogs in a neighboring community. In comparison, only 5% of canine samples from 1996 had anti-R. rickettsii antibodies at titers > or = 32. These results suggest that exposures to RMSF have increased over the past 9 years, and that RMSF may now be endemic in this region.

Vector-borne and Zoonotic Diseases, Dec 1, 2006

During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in... more During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in a rural community in Arizona where the disease had not been previously reported. The outbreak was associated with Rickettsia rickettsii in an unexpected tick vector, the brown dog tick (Rhipicephalus sanguineus), which had not been previously associated with RMSF transmission in the United States. We investigated the extent of exposure to R. rickettsii in the local area through serologic evaluations of children and dogs in 2003-2004, and in canine sera from 1996. Antibodies to R. rickettsii at titers Ն 32 were detected in 10% of children and 70% of dogs in the outbreak community and 16% of children and 57% of dogs in a neighboring community. In comparison, only 5% of canine samples from 1996 had anti-R. rickettsii antibodies at titers Ն 32. These results suggest that exposures to RMSF have increased over the past 9 years, and that RMSF may now be endemic in this region.

Emerging Infectious Diseases, Oct 1, 2002

, the first inhalational anthrax case in the United States since 1976 was identified in a media c... more , the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities.

American Journal of Tropical Medicine and Hygiene, Sep 2, 2015

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian re... more Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000

Oxford University Press eBooks, Oct 1, 2021

This chapter describes anthrax as a disease caused by the gram-positive, aerobic bacterium Bacill... more This chapter describes anthrax as a disease caused by the gram-positive, aerobic bacterium Bacillus anthracis, which was recognized in antiquity. Anthrax figures prominently in the history of modern medicine because it was the first bacterial illness for which successful vaccines were prepared by William Smith Greenfield in London and Louis Pasteur in Paris. Anthrax is a zoonosis of herbivores encountered worldwide, and human cases continue to be seen in southern Europe, Eurasia, south Asia, and sub-Saharan Africa. Grazing wild ruminants and cattle are very susceptible to anthrax, and human disease in animal husbandmen and herders is closely tied to exposure to infected beasts. The chapter analyzes reports of some areas of rural Kenya in which a substantial percentage of herdsmen are serologically positive for B. anthracis.

American Journal of Public Health, May 1, 2006

Objectives. The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influe... more Objectives. The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influenza vaccination campaign during the 2002–2003 influenza season to bridge the vaccination gap between American Indians and Alaska Natives and the US population as a whole.Methods. In our vaccination program, we used a multidisciplinary approach that included staff and community education, standing orders, vaccination of hospitalized patients, and employee, outpatient, community, and home vaccinations without financial barriers.Results. WRSU influenza vaccination coverage rates among persons aged 65 years and older, those aged 50 to 64 years, and those with diabetes were 71.8%, 49.6%, and 70.2%, respectively, during the 2002–2003 influenza season. We administered most vaccinations to persons aged 65 years and older through the outpatient clinics (63.6%) and public health nurses (30.0%). The WRSU employee influenza vaccination rate was 72.8%.Conclusions. We achieved influenza vaccination rates in targeted groups of an American Indian population that are comparable to or higher than rates in other US populations. Our system may be a useful model for other facilities attempting to bridge disparity for influenza vaccination.

Public Health Reports, May 1, 2010

Objective. Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the U... more Objective. Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population. Methods. We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates. Results. In 2007, pneumococcal vaccination coverage rates among people 65 years of age and among high-risk people aged 18-64 years were 96.0% and 61.2%, respectively, exceeding Healthy People 2010 goals. Government Performance and Results Act analyses reports revealed a 2.7-fold increase (36.0% to 98.0%) of coverage from 2000 to 2007 among people 65 years of age at Whiteriver Service Unit in Whiteriver, Arizona. Conclusions. We achieved pneumococcal vaccination rates in targeted groups of an American Indian population that reached Healthy People 2010 goals and were higher than rates in other U.S. populations. Our program may be a useful model for other communities attempting to meet Healthy People 2010 goals.

Archives of pediatrics & adolescent medicine, Aug 1, 1993

Open Forum Infectious Diseases

Background Rocky Mountain spotted fever (RMSF) is a deadly tickborne disease disproportionately a... more Background Rocky Mountain spotted fever (RMSF) is a deadly tickborne disease disproportionately affecting Arizona tribal communities. While the acute clinical effects of RMSF are well-documented, more complete understanding of the long-term health consequences is needed to provide guidance for providers and patients in highly impacted areas. Methods We performed a retrospective review of hospitalized RMSF cases from 2 tribal communities in Arizona during 2002–2017. Medical records from acute illness were abstracted for information on clinical presentation, treatment, and status at discharge. Surviving patients were interviewed about disease recovery, and patients reporting incomplete recovery were eligible for a neurologic examination. Results Eighty hospitalized cases of RMSF met our inclusion criteria and were reviewed. Of these, 17 (21%) resulted in a fatal outcome. Among surviving cases who were interviewed, most (62%) reported full recovery, 15 (38%) reported ongoing symptoms o...

Annals of the New York Academy of Sciences, Oct 1, 2006

A recent epidemiologic investigation identified 16 cases and 2 deaths from Rocky Mountain spotted... more A recent epidemiologic investigation identified 16 cases and 2 deaths from Rocky Mountain spotted fever (RMSF) in two eastern Arizona communities. Prevalence studies were conducted by collecting free-living ticks (Acari: Ixodidae) from the home sites of RMSF patients and from other home sites within the community. Dry ice traps and flagging confirmed heavy infestations at many of the home sites. Only Rhipicephalus sanguineus ticks were identified and all developmental stages were detected. It is evident that under certain circumstances, this species does transmit Rickettsia rickettsii to humans and deserves reconsideration as a vector in other geographic areas.

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian re... more Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 19, 2015

Rocky Mountain spotted fever (RMSF) has emerged as a significant cause of morbidity and mortalit... more Rocky Mountain spotted fever (RMSF) has emerged as a significant cause of morbidity and mortality since 2002 on tribal lands in Arizona. The explosive nature of this outbreak and the recognition of an unexpected tick vector, Rhipicephalus sanguineus, prompted an investigation to characterize RMSF in this unique setting, and compare RMSF cases to similar illnesses. We compared medical records of 205 RMSF cases and 175 non-RMSF illnesses that prompted RMSF testing during 2002-2011 from two Indian reservations in Arizona. RMSF cases occurred year-round and peaked later (July-September) than RMSF cases reported from other U.S regions. Cases were younger (median age 11 years) and reported fever and rash less frequently as well as less tick exposure compared to other U.S. cases. Fever was present in 81% of cases but not significantly different from that in non-RMSF illnesses. Classic laboratory abnormalities such as low sodium and platelet counts had small and subtle differences betwee...

American Journal of Tropical Medicine and Hygiene, 2015

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian re... more Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000

Clinical Infectious Disease, 2015

The Journal of Pediatrics, 2015

To evaluate whether cosmetically relevant dental effects occurred among children who had received... more To evaluate whether cosmetically relevant dental effects occurred among children who had received doxycycline for treatment of suspected Rocky Mountain spotted fever (RMSF). Children who lived on an American Indian reservation with high incidence of RMSF were classified as exposed or unexposed to doxycycline, based on medical and pharmacy record abstraction. Licensed, trained dentists examined each child's teeth and evaluated visible staining patterns and enamel hypoplasia. Objective tooth color was evaluated with a spectrophotometer. Fifty-eight children who received an average of 1.8 courses of doxycycline before 8 years of age and who now had exposed permanent teeth erupted were compared with 213 children who had never received doxycycline. No tetracycline-like staining was observed in any of the exposed children's teeth (0/58, 95% CI 0%-5%), and no significant difference in tooth shade (P = .20) or hypoplasia (P = 1.0) was found between the 2 groups. This study failed to demonstrate dental staining, enamel hypoplasia, or tooth color differences among children who received short-term courses of doxycycline at <8 years of age. Healthcare provider confidence in use of doxycycline for suspected RMSF in children may be improved by modifying the drug's label.

Public health reports (Washington, D.C. : 1974)

Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United State... more Streptococcus pneumoniae (S. pneumoniae) causes significant mortality throughout the United States and greater mortality among American Indian/Alaska Natives. Vaccination reduces S. pneumoniae illness. We describe the methods used to achieve the Healthy People 2010 coverage rate goals for adult pneumococcal vaccine among those at high risk for severe disease in this population. We implemented a pneumococcal vaccination project to bolster coverage followed by an ongoing multidisciplinary program. We used community, home, inpatient, and outpatient vaccinations without financial barriers together with data improvement, staff and patient education, standing orders, and electronic and printed vaccination reminders. We reviewed local and national coverage rates and queried our electronic database to determine coverage rates. In 2007, pneumococcal vaccination coverage rates among people > or = 65 years of age and among high-risk people aged 18-64 years were 96.0% and 61.2%, respectively...

American journal of diseases of children (1960), 1993

MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, Jan 31, 2006

Tickborne rickettsial diseases (TBRD) continue to cause severe illness and death in otherwise hea... more Tickborne rickettsial diseases (TBRD) continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low cost, effective antimicrobial therapy. The greatest challenge to clinicians is the difficult diagnostic dilemma posed by these infections early in their clinical course, when antibiotic therapy is most effective. Early signs and symptoms of these illnesses are notoriously nonspecific or mimic benign viral illnesses, making diagnosis difficult. In October 2004, CDC's Viral and Rickettsial Zoonoses Branch, in consultation with 11 clinical and academic specialists of Rocky Mountain spotted fever, human granulocytotropic anaplasmosis, and human monocytotropic ehrlichiosis, developed guidelines to address the need for a consolidated source for the diagnosis and management of TBRD. The preparers focused on the practical aspects of epidemiology, clinical assessment, treatment, and laboratory diagnosis of TBRD. This report will assist...

New England Journal of Medicine, 2005

background Rocky Mountain spotted fever is a life-threatening, tick-borne disease caused by Ricke... more background Rocky Mountain spotted fever is a life-threatening, tick-borne disease caused by Rickettsia rickettsii. This disease is rarely reported in Arizona, and the principal vectors, Dermacentor species ticks, are uncommon in the state. From 2002 through 2004, a focus of Rocky Mountain spotted fever was investigated in rural eastern Arizona. methods We obtained blood and tissue specimens from patients with suspected Rocky Mountain spotted fever and ticks from patients' homesites. Serologic, molecular, immunohistochemical, and culture assays were performed to identify the causative agent. On the basis of specific laboratory criteria, patients were classified as having confirmed or probable Rocky Mountain spotted fever infection. results A total of 16 patients with Rocky Mountain spotted fever infection (11 with confirmed and 5 with probable infection) were identified. Of these patients, 13 (81 percent) were children 12 years of age or younger, 15 (94 percent) were hospitalized, and 2 (12 percent) died. Dense populations of Rhipicephalus sanguineus ticks were found on dogs and in the yards of patients' homesites. All patients with confirmed Rocky Mountain spotted fever had contact with tick-infested dogs, and four had a reported history of tick bite preceding the illness. R. rickettsii DNA was detected in nonengorged R. sanguineus ticks collected at one home, and R. rickettsii isolates were cultured from these ticks. conclusions This investigation documents the presence of Rocky Mountain spotted fever in eastern Arizona, with common brown dog ticks (R. sanguineus) implicated as a vector of R. rickettsii. The broad distribution of this common tick raises concern about its potential to transmit R. rickettsii in other settings.

Vector borne and zoonotic diseases (Larchmont, N.Y.), 2006

During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in... more During 2002 through 2004, 15 patients with Rocky Mountain spotted fever (RMSF) were identified in a rural community in Arizona where the disease had not been previously reported. The outbreak was associated with Rickettsia rickettsii in an unexpected tick vector, the brown dog tick (Rhipicephalus sanguineus), which had not been previously associated with RMSF transmission in the United States. We investigated the extent of exposure to R. rickettsii in the local area through serologic evaluations of children and dogs in 2003-2004, and in canine sera from 1996. Antibodies to R. rickettsii at titers > or = 32 were detected in 10% of children and 70% of dogs in the outbreak community and 16% of children and 57% of dogs in a neighboring community. In comparison, only 5% of canine samples from 1996 had anti-R. rickettsii antibodies at titers > or = 32. These results suggest that exposures to RMSF have increased over the past 9 years, and that RMSF may now be endemic in this region.