RMSF (Rocky Mountain Spotted Fever) 3 rd Arizona Statewide Tribal, IHS, ADHS, CDC Rocky Mountain...
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RMSF (Rocky Mountain Spotted Fever) 3 rd Arizona Statewide Tribal, IHS, ADHS, CDC Rocky Mountain Spotted Fever Meeting December 3, 2013
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Transcript of RMSF (Rocky Mountain Spotted Fever) 3 rd Arizona Statewide Tribal, IHS, ADHS, CDC Rocky Mountain...
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CDC unpublished data from chart review of RMSF cases in two communities in Arizona, 2002-2011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
