Rocky Mountain spotted fever in New York State

Clinical and laboratory data provided in 214 Rocky Mountain spotted fever (RMSF) case reports received by the New York State Department of Health during 1977-1988 were analyzed to determine recent trends of this disease observed infrequently, but continuously, in New York State residents. Age, sex, geographic exposure, onset, symptoms, laboratory test, treatment, and hospitalization data are presented. Despite a 69% decrease of disease incidence from 1977 (0.368 cases per 10(5) population) to 1980 (0.114 cases per 10(5) population), case incidence rates in New York State since 1980 have averaged 0.118 cases/10(5) population with a 5.2% case fatality rate. RMSF was reported more frequently in males (58.9%) and in the total 10-19-year-old age group (28%) than in any other age group. Of 156 reports including confirming laboratory data, 60.3% relied upon the microimmunofluorescence or indirect immunofluorescent antibody procedure, as opposed to 32.7% with Proteus-OX, 4.5% with complement fixation, or 1.9% with latex agglutination, microagglutination, or indirect hemagglutination procedures. Of 164 reports providing therapy data, 79% included the use of tetracyclines alone or in combination with other drugs, as opposed to 21% using chloramphenicol or other drugs. Of 44 patients in the 1-9-year-old age group, 32 (73%) received tetracyclines for RMSF therapy despite risks of staining the permanent teeth. One hundred and thirty patients (61%) required hospitalization, with the highest rate in the 30-39-year-old age group (19/24 = 79%).