title: Tick-Borne Relapsing Fever Outbreak Among a High School Football Team at an Outdoor Education Camping Trip, Arizona, 2014.
abstract: During August 2014, five high school students who had attended an outdoor education camp were hospitalized with a febrile illness, prompting further investigation. Ten total cases of tick-borne relapsing fever (TBRF) were identified-six cases confirmed by culture or visualization of spirochetes on blood smear and four probable cases with compatible symptoms (attack rate: 23%). All patients had slept in the campsite's only cabin. Before the camp, a professional pest control company had rodent proofed the cabin, but no acaricides had been applied. Cabin inspection after the camp found rodents and Ornithodoros ticks, the vector of TBRF. Blood samples from a chipmunk trapped near the cabin and from patients contained Borrelia hermsii with identical gene sequences (100% over 630 base pairs). Health departments in TBRF endemic areas should consider educating cabin owners and pest control companies to apply acaricides during or following rodent proofing, because ticks that lack rodents for a blood meal might feed on humans.
authors.affiliation: Arizona Department of Health Services, Phoenix, Arizona. Epidemic Intelligence Service, Atlanta, Georgia. jjones10@cdc.gov.
authors.forename: Jefferson M
authors.initials: JM
authors.lastname: Jones
authors.affiliation: Northern Arizona University, Flagstaff, Arizona.
authors.forename: Carter R
authors.initials: CR
authors.lastname: Hranac
authors.affiliation: Coconino County Public Health Services District, Flagstaff, Arizona.
authors.forename: Mare
authors.initials: M
authors.lastname: Schumacher
authors.affiliation: Flagstaff Medical Center, Flagstaff, Arizona.
authors.forename: Kim
authors.initials: K
authors.lastname: Horn
authors.affiliation: Flagstaff Medical Center, Flagstaff, Arizona.
authors.forename: Darlene M
authors.initials: DM
authors.lastname: Lee
authors.affiliation: Flagstaff Medical Center, Flagstaff, Arizona.
authors.forename: Joel
authors.initials: J
authors.lastname: Terriquez
authors.affiliation: Translational Genomics Research Institute, Flagstaff, Arizona.
authors.forename: David M
authors.initials: DM
authors.lastname: Engelthaler
authors.affiliation: Coconino County Public Health Services District, Flagstaff, Arizona.
authors.forename: Marie
authors.initials: M
authors.lastname: Peoples
authors.affiliation: Coconino County Public Health Services District, Flagstaff, Arizona.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Corrigan
authors.affiliation: Centers for Disease Control Division of Vector-Borne Disease, Fort Collins, Colorado.
authors.forename: Adam
authors.initials: A
authors.lastname: Replogle
authors.affiliation: Flagstaff Medical Center, Flagstaff, Arizona.
authors.forename: Nina
authors.initials: N
authors.lastname: Souders
authors.affiliation: Arizona Department of Health Services, Phoenix, Arizona.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Komatsu
authors.affiliation: Northern Arizona University, Flagstaff, Arizona.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Nieto
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001130:Arizona / Q000453:epidemiology; D001898:Borrelia / Q000235:genetics; D002165:Camping; D004196:Disease Outbreaks; D005538:Football; D006801:Humans; D008297:Male; D026861:Ornithodoros / Q000382:microbiology; D010802:Phylogeny; D012061:Relapsing Fever / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D012377:Rodentia / Q000469:parasitology