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COMMUNICABLE DISEASE MANUAL POLICIES/PROCEDURES
ROCKY MOUNTAIN SPOTTED FEVER
OBJECTIVE:
Control and management of Rocky Mountain Spotted Fever
DESCRIPTION:
Rocky Mountain Spotted Fever (RMSF) is a serious, systemic tick-borne
infectious disease occurring throughout the South Atlantic, southeastern, and
south central states. It is caused by Rickettsia rickettsii and is characterized by
chills, fever, severe headaches, myalgia, mental confusion, and rash. The rash
usually occurs before the 6th day of illness. It first appears as erythematous
macules on the wrists and ankles, then, within hours, it spreads over the
extremities, trunk, face, and usually on the palms and soles. In later stages, the
rash may become maculopapular and frequently petechial. Although early
development of a rash is a useful diagnostic sign, in some cases the rash fails to
develop or develops only late in the illness. Less frequent symptoms are
abdominal pain and cough. The disease may last as long as three weeks and
can be severe with prominent central nervous system involvement; involvement
of cardiac, pulmonary, gastrointestinal, renal, or other organs; disseminated
intravascular coagulation; and shock leading to death. The incubation period for
RMSF is 3-14 days “and it is transmitted to humans by tick bites”. RMSF is not
directly transmitted from person to person, although it can be transmitted
through blood transfusions on rare occasions.
EQUIPMENT:
MDSS User Manual and disease specific form found in MDSS. Also MDCH
Web site at www.michigan.gov/mdch, www.michigan.gov/cdinfo and CDC
Web site at www.cdc.gov/ncidod/diseases.
POLICY:
Legal Responsibility: Michigan's communicable disease rules of Act No. 368 of
the Public Acts of 1978, as amended, being 333.5111 of the Michigan Compiled
Laws. Follow-up time within 72 hours post referral and enter into MDSS
within 24 hours of receipt of referral.
PROCEDURE:
A.
B.
Case Investigation:
1.
Referral received per phone
automatically through MDSS.
2.
Document all case investigation proceedings.
3.
Contact MD and/or client to start process of completing disease
specific form in MDSS.
laboratory
results,
or
Epidemiology:
1.
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call,
Persons with occupational or recreational exposure to the tick
vector (e.g., pet owners, animal handlers, and outdoor persons)
are at an increased risk of acquiring the organism. Persons of all
ages, races, socio-economic status, and both sexes can be
infected, but most cases occur in those younger than 15 years of
age.
2.
C.
D.
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The dog tick (Dermacentor variabilis) is primarily responsible for
transmission and April through September are the months for
highest prevalence.
Lab Criteria for Diagnosis:
1.
Fourfold or greater rise in antibody titer to Rickettsia rickettsii
antigen by immunofluorescence antibody (IFA), complement
fixation (CF), latex agglutination (LA), microagglutination (MA), or
indirect hemagglutination antibody (IHA) test in acute- and
convalescent-phase specimens ideally taken > 3 weeks apart, or
2.
Positive polymerase chain reaction assay to R. rickettsii, or
3.
Demonstration of positive immunofluorescence of skin lesion
(biopsy) or organ tissue (autopsy), or
4.
Isolation of R. rickettsii from clinical specimen.
5.
Case Classification:
a.
Probable: A clinically compatible case with a single IFA
serologic titer of > 64 or a single CF titer of > 16 or other
supportive serology (fourfold rise in titer or a single titer >
320 by Proteus OX-19 or OX-2, or a single titer > 128 by
an LA, IHA, or MA test).
b.
Confirmed: A clinically compatible case that is laboratory
confirmed.
Control Measures:
1.
Avoid tick-infested areas.
2.
Wear clothing that covers as much of the arms and legs as
possible.
3.
Tick repellents can be sprayed on clothing to prevent tick
attachments.
4.
Tick repellents used on exposed areas require repeated
applications every 1-2 hours to be effective. (NOTE: If Deet is
used it should be applied sparingly because seizures have been
reported in young children).
6.
Daily inspections and prompt removal of
recommended.
7.
Remove ticks carefully without crushing, using gentle, steady
traction with forceps (tweezers) applied close to the skin to avoid
leaving mouth parts in the skin; protect hands with gloves, cloth or
tissue when removing ticks from man or animals.
any ticks are
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E.
Complete case investigation using the disease specific forms located in
MDSS. (See MDSS User Manual for entry instructions.)
F.
Refer to current Red Book, current Control of Communicable
Diseases Manual for more specific educational material.