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Indian reservations hit hard by Rocky Mountain spotted fever
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Rocky Mountain spotted fever has had a major financial impact on two hard-hit Indian reservations in Arizona, suggesting that prevention and control efforts may save money as well as lives, according to research conducted by the CDC and Indian Health Services.
“Rocky Mountain spotted fever is completely preventable,” study researcher Naomi A. Drexler, MPH, epidemiologist for the CDC, said in a press release. “State, federal and tribal health authorities have been working together since the start of the epidemic to build effective community-based tick control programs, and these efforts have produced remarkable reductions in human cases. These programs are costly, but medical expenses and lives lost cost four times more than [Rocky Mountain spotted fever] prevention efforts. Increasing access to these prevention efforts is critical to save lives and protect communities.”
According to the researchers, Rocky Mountain spotted fever (RMSF) began affecting residents of tribal lands in Arizona in 2003, and two Arizona Indian reservations highlighted in the study suffered an estimated $13.2 million (95% CI, $12.9 million-$13.5 million) in losses due to RMSF cases from 2002 to 2011. Of these costs, an estimated $11.6 million (95% CI, $11.3 million-$12 million) was due to early loss of life (15 of 205 cases studied) and associated productivity, with the majority of the rest stemming from acute medical expenses that reached an estimated $1.4 million. The researchers wrote: “We believe this to be a significant underestimate of the cost of the epidemic, but it underlines the severity of the disease and need for a more comprehensive study.”
Naomi A. Drexler
According to Drexler and colleagues, American Indians experienced four times the burden of RMSF as whites from 2000 to 2007, and the fatality rate for those included in the study (7%) was much higher than the national average of less than 1%. The median age of persons who died of RMSF on the two reservations studied was 14 years (range, 1-78). The most common symptoms included respiratory failure (11%), disseminated intravascular coagulation (9%), renal insufficiency (8%) and multisystem organ failure (7%).
Figure 1. A young child with a late stage rash from Rocky Mountain spotted fever.
Source: CDC
“The recent emergence of RMSF in Arizona has left devastation in its wake. This severe, but relatively isolated outbreak has caused millions of dollars in medical fees and economic productivity lost. The average lifetime productivity lost per fatal case of RMSF ($775,467 per death) is far greater than similar estimates for pneumococcal disease ($140,862 per death) and West Nile virus ($293,960 per death),” Drexler and colleagues wrote. “This RMSF epidemic largely affects children and young adults who were previously healthy, who would otherwise have the most potential to contribute economically to society.”
There is no vaccine to combat RMSF, so preventing tick bites is the most reliable way to prevent the disease, according to the release. However, efficient treatment can help save lives.
“Severe illness and death from RMSF can be averted and millions of dollars saved with aggressive prevention and early treatment with doxycycline,” Drexler told Infectious Disease News. – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.
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