title: Colorado tick fever in the United States, 2002-2012.
abstract: BACKGROUND
  Colorado tick fever (CTF) is an acute systemic febrile illness caused by the CTF virus (CTFV). The last national summary of CTF cases in the United States included cases reported through 2001. This study summarizes national surveillance data for CTF from 2002 through 2012 and examines trends in the epidemiology and testing of identified CTF cases.
  
  
  METHODS
  Because CTF is not nationally notifiable, we identified CTF cases through solicited reports from state health departments and diagnostic laboratory records. For all cases, we collected data on age, sex, county of residence, travel history, symptom onset date, laboratory testing, and clinical outcome. Poisson regression was used to examine trends over time in case counts, and simple linear regression and logistic regression were used to examine trends in case characteristics.
  
  
  RESULTS
  From 2002 through 2012, 75 CTF cases were identified with a median of five cases per year (range 3-14). Forty-seven (63%) cases occurred in males and 49 (65%) occurred in people aged ≥40 years. The majority (80%) of cases had onset of illness during May through July. Cases occurred in residents of 14 states but the infections were acquired in six western states. Wyoming had the highest annual incidence of CTF among residents (3.4 cases per million population), followed by Montana (1.5 per million), and Utah (0.5 per million). Over the 11 years, there was an increase in the proportion of cases diagnosed by RT-PCR testing and in the proportion of cases among travelers to another state.
  
  
  CONCLUSIONS
  CTF cases continue to occur annually among residents and visitors to the western United States. Public health prevention messages about decreasing tick exposure should be targeted to residents and travelers who will spend time outdoors in an endemic region during the spring and summer months.
authors.affiliation: 1Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado.|2Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Yendell
authors.affiliation: 1Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.affiliation: 1Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: J Erin
authors.initials: JE
authors.lastname: Staples
mesh_terms: D000818:Animals; D003121:Colorado Tick Fever / Q000453:epidemiology*; D003122:Colorado tick fever virus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance; D012621:Seasons; D014481:United States / Q000453:epidemiology; D015047:Zoonoses
keywords: Colorado tick fever virus; Coltivirus; Public health surveillance; Tick-borne diseases