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Transcript
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. D:\840988709.docPage 1 of 3 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. D:\840988709.docPage 2 of 3 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 D:\840988709.docPage 3 of 3 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.