title: An interstate outbreak of tick-borne relapsing fever among vacationers at a Rocky Mountain cabin.
abstract: In July 1995, an outbreak of acute febrile illness affected 11 (48%) of 23 family members from Nebraska and Kansas who had vacationed at a Colorado cabin in June. Similar symptoms were identified among five (17%) of 30 additional persons from Nebraska, Kansas, Florida, and Texas who had vacationed at the same cabin. Symptoms suggested tick-borne relapsing fever (TBRF). Although no spirochetes were detected in available blood smears from five case-patients, Borrelia hermsii was cultured from the blood of one case-patient and two chipmunks trapped near the cabin. Case-patients were more likely than non-ill cabin visitors to have slept on the floor (odds ratio [OR] = 28.0, 95% confidence interval [CI] = 3.0-258) or in the top bunk bed (OR = 5.2, 95% CI = 1.1-25.1). Tick-borne relapsing fever should considered in the differential diagnosis of fever in patients who have stayed overnight in mountain cabins in the western United States.
authors.affiliation: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Trevejo
authors.forename: M E
authors.initials: ME
authors.lastname: Schriefer
authors.forename: K L
authors.initials: KL
authors.lastname: Gage
authors.forename: T J
authors.initials: TJ
authors.lastname: Safranek
authors.forename: K A
authors.initials: KA
authors.lastname: Orloski
authors.forename: W J
authors.initials: WJ
authors.lastname: Pape
authors.forename: J A
authors.initials: JA
authors.lastname: Montenieri
authors.forename: G L
authors.initials: GL
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D016470:Bacteremia / Q000382:microbiology; D001898:Borrelia / Q000302:isolation & purification; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D005431:Florida; D006798:Housing; D006801:Humans; D007124:Immunoenzyme Techniques; D007615:Kansas; D008297:Male; D008875:Middle Aged; D009329:Nebraska; D012061:Relapsing Fever / Q000453:epidemiology*; D012307:Risk Factors; D012377:Rodentia; D013781:Texas; D013987:Ticks; D014195:Travel