Colorado Tick Fever in the United States, 2013-2022

Colorado tick fever (CTF) virus is an arbovirus maintained in an enzootic cycle between Rocky Mountain wood ticks (Dermacentor andersoni) and rodent species in the western United States. Individuals with CTF typically present with symptoms including fever, headache, myalgia, and lethargy, with a biphasic illness frequently occurring. We reviewed data on CTF cases reported to the national U.S. arboviral disease surveillance system and identified through testing at the CDC to characterize the epidemiology of CTF from 2013-2022. During this period, 148 CTF cases were identified, all likely infected in an endemic area in one of six states (Montana, Wyoming, Oregon, Colorado, Utah, Idaho). A median of 11 cases (range: 5-37) were identified per year, with an average annual national incidence of 0.04 cases per million population. The median age of cases was 55 years (range: 1-84 years), and 96 (65%) were male. Most (n = 145; 98%) cases acquired infection from April through July. The hospitalization rate was 16% (16 of 102 cases with data), and no deaths were reported. These findings substantiate the continued circulation of CTF virus in the western United States, highlighting the importance of implementing approaches to ensure CTF awareness for medical providers and providing education on tick bite prevention strategies for residents and visitors to risk areas.