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Ehrlichiosis in a golf-oriented retirement community
S M Standaert1, J E Dawson, W Schaffner
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA.
The New England Journal of Medicine
|August 17, 1995
Summary
An Ehrlichia chaffeensis outbreak in a Tennessee retirement community was linked to Lone Star ticks and proximity to a wildlife area. High tick concentrations during outdoor activities can lead to arthropod-borne zoonoses.
Area of Science:
- Epidemiology
- Infectious Diseases
- Zoonoses
Background:
- Ehrlichiosis, caused by Ehrlichia chaffeensis, typically presents sporadically with low incidence.
- The Lone Star tick (Amblyomma americanum) is the primary vector.
- An unusual outbreak occurred in a Tennessee retirement community in June 1993.
Purpose of the Study:
- To investigate the cause of an ehrlichiosis outbreak in a golf-oriented retirement community.
- To identify risk factors associated with Ehrlichia chaffeensis infection in the affected community.
Main Methods:
- A case-control study involving medical history review, serologic testing, and PCR for E. chaffeensis.
- Household surveys in the affected community (A) and a control community (B).
- Tick surveillance in both communities.
Main Results:
- Eleven symptomatic ehrlichiosis cases were identified, 10 in community A (attack rate 330/100,000).
- Serologic evidence of E. chaffeensis infection was higher in community A (12.5%) than community B (3.3%).
- Risk factors included tick bites, wildlife exposure, golfing, retrieving balls from rough, and lack of insect repellent use. Thousands of Lone Star ticks were found in community A.
Conclusions:
- Proximity to a wildlife reserve significantly increased E. chaffeensis infection rates in community A.
- High tick concentrations and outdoor recreational activities can precipitate outbreaks of tick-borne zoonoses.