RMSF (Rocky Mountain Spotted Fever) 3 rd Arizona Statewide Tribal, IHS, ADHS, CDC Rocky Mountain Spotted Fever Meeting December 3, 2013.

RMSF(Rocky Mountain Spotted Fever)

3rd Arizona Statewide Tribal, IHS, ADHS, CDCRocky Mountain Spotted Fever Meeting

December 3, 2013

RMSF: Background• Caused by Rickettsia rickettsii

– Tickborne , no person-to-person transmission– Found in several species of ticks throughout North

and South America• Intracellular bacterial pathogen• Infects endothelial cells, causes widespread

vascular damage• Effectively treated with doxycycline

– Other antibiotics (even broad spectrum) ineffective

Marc Traeger, MD, Whiteriver Service Unit, IHS

Number of Cases of RMSF

10 years of workWRSU

June 2002 – April 201212 pages = 219 items

Onset of RMSF symptoms by age in two Arizona communities

7 1 5 1 10

20

40

60

80

100

120

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80

Nu

mb

er

of

case

s

Age at onset of Symptoms

Survivors

Fatalities

n=205

CDC unpublished data from chart review of RMSF cases in two communities in Arizona, 2002-2011

Selected reportable disease case counts Arizona, 2011

Data from MMWR: Summary of Notifiable Diseases, United States, 2011

Years of Potential Life Lost (YPLL)

Trends in Indian Health (2002-3)

Risk Profile of

American Indians

2009

Better than Average Worse than Average

0 +250%-250%http://www.azdhs.gov/plan/report/hspam/indian09.pdf

(Percent above or below the

average rate or ratio of all Arizona

residents in 2009)

http://www.azdhs.gov/plan/report/hspam/indian09.pdf

Ticks

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000 USNORSWIZNETHCANDENGERFRSWEAUSUKNZJPN

Source: Commonwealth Fund, based on OECD Health Data 2012.

International Comparison of Spending on Health

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000 USNORSWIZNETHCANDENGERFRSWEAUSUKNZJPNPhx Area IHS

International Comparison of Spending on Health

Clinical Education and Enhanced Surveillance

13

Highly Impacted At RiskWhite Mountain Apache Tribe Ak chin Indian Community Chemehuevi

San Carlos Apache Tribe Colorado River Indian Tribes Cocopah Tribe

Low Impact Ft McDowell Yavapai Nation Ft Mojave Tribe

Tohono O’Odham Nation Havasupai Hualapai Tribe

Hopi Tribe Kaibab Band of Paiute Indians Navajo Tribe

Gila River Indian Community Phoenix Service Unit Quechan Tribe

Salt River Indian Community San Lucy Village

Tonto Apache Tribe of Arizona Yavapai Prescott TribeYavapai Apache Indian Community

RMSF Rodeo Partners

The diagnosis and treatment algorithm for AZ

Patient Presents with Fever (T > 100)

orHistory of Subjective Fever

Yes

No or Unknown

Doxycycline & RMSF Labs

Any 1 of the following:

Rash?

Low Sodium?

Low Platelets?

Elevated AST or ALT?

Recent Exposure to Ticks or Untreated Dogs?

Educate Patient & Follow-up Next Day

Fever > 2 days?

(48 hours)

No

Yes

Where we are…

• Awareness and education• Science• Will• Prevention• Treatment• Infrastructure• Temporary funding