Key Points:
·
CDC issued
a Health Advisory through the CDC Health Alert Network to notify
clinicians, health departments and the public about an outbreak of Rocky
Mountain spotted fever (RMSF) among people in the United States with recent
travel to or residence in the city of Tecate, state of Baja California, Mexico.
The CDC Health Advisory is attached to this LINCS message and can also be accessed
at the following link: Severe
and Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent
Travel to Tecate, Mexico
·
As of
December 8, 2023, five patients in the United States have been diagnosed with
confirmed RMSF since late July 2023; all had travel to or residence in Tecate
within 2 weeks of illness onset. New Jersey has not identified any cases
related to this outbreak.
·
RMSF is
endemic in multiple border states in northern Mexico, including but not
exclusive to Baja California, Sonora, Chihuahua, Coahuila, and Nuevo León, and
areas of the southwestern United States. In these regions, the pathogen (Rickettsia
rickettsii) can be transmitted by brown dog ticks which are closely
associated with domestic dogs in urban and peri-urban environments.
· RMSF signs and symptoms can be relatively mild and non-specific during the first 1–4 days of illness and include a low-moderate fever, headache, gastrointestinal symptoms, abdominal pain, myalgia, rash, and edema around the eyes and on the back of hands.
· RMSF is
a rapidly progressive disease and without early administration of doxycycline
can be fatal within days. Healthcare providers should consider initiating
doxycycline based on presumptive clinical and epidemiologic findings, and do
not delay treatment pending the result of a confirmatory laboratory test. Early
treatment with doxycycline saves lives.
Action Items:
(1)
Healthcare providers:
a.
Know
that RMSF signs and symptoms can include fever, headache, and rash. The absence
of a classical “spotted” rash does not exclude the diagnosis, particularly
during the first few days of illness.
b.
Consider
RMSF in your differential diagnosis of patients who have reported recent travel
to Tecate, Mexico or other areas of northern Mexico and subsequently develop
signs or symptoms of RMSF or unexplained severe febrile illness.
c.
Inquire
about recent travel history and exposure to ticks or tick-infested dogs when
evaluating patients with signs and symptoms suggestive of RMSF.
d.
Collect whole blood and serum samples from
acutely ill people for testing. Rickettsia
by molecular and serologic testing is available at commercial laboratories.
e.
Do not
delay treatment pending the result of a confirmatory laboratory test. Doxycycline
is the recommended antibiotic treatment for RMSF in adults and children of all
ages, including pregnant people.
f.
Report cases of RMSF to the local health
department where the patient resides. A directory of local health departments
can be found at: nj.gov/health/lh/community/
(2)
Local health departments:
a.
Notify NJDOH of any reported RMSF cases with a
travel history to Tecate or other areas in northern Mexico endemic for RMSF in
the 2 weeks prior to illness onset.
b.
Perform prompt investigation for any RMSF cases
in your jurisdictions, including asking about travel history. All information
should be documented in CDRSS. An investigational worksheet may be used to
assist in a patient or healthcare provider interview: https://www.nj.gov/health/cd/topics/rocky.shtml
c.
Provide tick prevention guidance to the public
i.
Protect against tick bites by treating your dog
for ticks (speak to a veterinarian about proper tick prevention in dogs), using
EPA-registered insect repellent,
and wearing protective clothing.
ii.
Perform thorough tick checks on yourself and
children after outdoor activities or when around dogs with ticks. Promptly
remove any ticks.
iii.
Additional tick prevention guidance can be found
at: nj.gov/health/cd/topics/tickborne.shtml
Contact
Information:
·
Name: CDS Vector Team
·
Email: cdsvectorteam@doh.nj.gov
·
Phone: New Jersey Department of Health,
Communicable Disease Service 609-826-4872 during business hours, or
609-392-2020 outside of business hours
References and
Resources:
·
CDC HAN 502: Severe
and Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent Travel
to Tecate, Mexico
·
NJDOH Spotted Fever Group Rickettsiosis webpage:
nj.gov/health/cd/topics/rocky.shtml
·
NJDOH Tick-borne Diseases & Conditions
webpage: nj.gov/health/cd/topics/tickborne.shtml
·
LHD Directory: nj.gov/health/lh/community/
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