title: Notes from the Field: Tickborne Relapsing Fever Outbreak at an Outdoor Education Camp - Arizona, 2014.
abstract: Tickborne relapsing fever (TBRF) is a bacterial infection characterized by recurring episodes of fever, headache, muscle and joint aches, and nausea. In North America, TBRF primarily is caused by Borrelia hermsii spirochetes transmitted by Ornithodoros hermsii ticks. Once infected, these soft ticks are infectious for life and transmit the spirochete to sleeping humans quickly (possibly within 30 seconds) during short feeds (15-90 minutes). On August 10, 2014, the Coconino County Public Health Services District in Arizona was notified by a local hospital that five high school students who attended the same outdoor education camp had been hospitalized with fever, headache, and myalgias. Hantavirus infection initially was suspected because of reported exposure to rodent droppings, but after detecting spirochetes on peripheral blood smears from all five hospitalized students, TBRF was diagnosed. The camp was instructed to close immediately, and the health department, in collaboration with local university experts, investigated to identify additional cases, determine the cause, and prevent further infections. A total of 11 cases (six confirmed and five probable) were identified.
authors.forename: Jefferson M
authors.initials: JM
authors.lastname: Jones
authors.forename: Mare
authors.initials: M
authors.lastname: Schumacher
authors.forename: Marie
authors.initials: M
authors.lastname: Peoples
authors.forename: Nina
authors.initials: N
authors.lastname: Souders
authors.forename: Kimberly
authors.initials: K
authors.lastname: Horn
authors.forename: Lisa
authors.initials: L
authors.lastname: Fox
authors.forename: Michele
authors.initials: M
authors.lastname: Scott
authors.forename: Shane
authors.initials: S
authors.lastname: Brady
authors.forename: Joli
authors.initials: J
authors.lastname: Weiss
authors.forename: Ken
authors.initials: K
authors.lastname: Komatsu
authors.forename: Nathan
authors.initials: N
authors.lastname: Nieto
mesh_terms: D000293:Adolescent; D000328:Adult; D001130:Arizona / Q000453:epidemiology; D001898:Borrelia / Q000302:isolation & purification*; D002165:Camping; D004196:Disease Outbreaks; D006801:Humans; D012061:Relapsing Fever / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D012574:Schools