Epidemiology of Rocky Mountain Spotted Fever

This essay will explore various aspects related to the epidemiology of Rocky Mountain spotted fever (RMSF). It will seek to determine the nature and extent of the problem, as well as strategic points of control. Additionally, this essay will identify the design and implementation of control strategies, as well as evaluate them. Overall, the reader is meant to gain a greater understanding of the diverse characteristics of epidemiology and the way they correlate to community nursing. By analyzing the epidemiology of RMSF, the reader should be able to apply an epidemiological analysis to other diseases and determine a proper course of action in relation to prevention, maintenance, and eradication. RMSF can be a life-threatening disease that causes damage to the body’s blood vessels, tissues, and organs. Once the blood vessels are damaged, the body triggers an inflammatory response that causes a surge of microembolic clots to coagulate in the damaged blood vessels, leading to hypoxia and even death if not treated. According to Anikwe, Davis, and Waters (2013), “RMSF is a potentially lethal Gram-negative, tick-borne infection caused by the Rickettsia rickettsii bacteria that’s prevalent in South, North, and Central America” (p. 19). However, in the United States, sixty percent of new cases in 2012 were in Arkansas, Missouri, North Carolina, Oklahoma, and Tennessee (Anikwe et al., p. 19). In the aforementioned states, the incidence rates are around sixty-three cases per one million people every year.
The reason the rates are so high is because of the increased number of vectors in those states. The epidemiological triangle for RMSF is as follows: the host is anybody who is bitten by a tick and infected with the bacteria, the agent is the Rickettsia rickettsii bacteria, and the environment exists both internally and externally. Internally, the environment is the circulatory system, where the bacteria migrates, reproduces, and colonizes. Externally, the environment is an area that has an increased number of ticks, such as wooded or grassy areas. However, methods are outlined in the article that equips the population with ways in which to avoid contracting RMSF.
Primary prevention focuses on education and strategies to prevent contact with vectors. For example, people should wear long-sleeved clothing, pants, and closed-toe footwear that are all light in color. They should also do routine skin assessments when coming in from outside. Pets should also be checked for ticks. Furthermore, exposure to wooded or grassy areas should be limited during warmer months like July and August. Secondary prevention focuses on screening and diagnostic testing should anyone suffer a tick bite. Examples include a skin biopsy, a skin swab, tick pathology, serum antibody titer, and/or a physical exam. Tertiary prevention focuses on treatment. For example, Anikwe’s article says:
“The CDC recommends doxycycline as a front-line antibiotic choice for RMSF. The typical dose of doxycycline is 100 mg every 12 hours; children older than age 8 and weighing more than 100 lb (45 kg) typically receive 4mg/kg every 12 hours. Children under age 8 shouldn’t be prescribed doxycycline because it can cause a permanent yellow stain to the child’s teeth. If patients are allergic to doxycycline, pregnant, or have severe liver or kidney disease, the healthcare team should consider chloramphenicol as an alternative” (p. 21).
In relation to the epidemiological triangle, primary prevention informs the potential hosts (the population) about the external environment (wooded or grassy areas) and ways to avoid tick exposure. Secondary prevention reveals if the agent (the Rickettsia rickettsii bacteria) exists within the internal environment (the circulatory system). Finally, tertiary prevention concentrates on treating the infection in the host caused by the agent. By employing these levels of prevention, the long-term goal is to decrease the morbidity and mortality rates in compliance with the goals of Healthy People 2020.
Anikwe et al. does a wonderful job of educating the reader on prevention strategies, but he also describes signs and symptoms that are indicative of RMSF. According to Anikwe et al., “Initial symptoms that mimic the flu begin 2 to 14 days after the initial tick bite. In approximately 90% of all RMSF cases, the patient’s temperature will exceed 102˚ F (38.8˚ C)… A 1 to 5 mm petechial skin rash is the hallmark sign of RMSF that’s typically seen on the wrists, palms of the hands, and soles of the feet” (p. 20). Furthermore, the article gave a brief description of the various diagnostic tests used to determine if a person has RMSF. All of the educational data gives the reader a strong foundational knowledge of what to look for, what to expect if he or she has it, and how he or she can be treated. Furthermore, the article enforced prevention strategies through education using the “3 P’s” strategy. This strategy reiterates the importance of prevention when it comes to people, pets, and property. The article did not outline cultural and/or lifestyle characteristics that would increase an individual’s risk of contracting the disease. However, after understanding the education and prevention strategies, groups at risk would include: children, pet owners, farmers, hunters, and other individuals whose occupations or hobbies bring them in contact with large wooded or grassy areas.
Expected outcomes related to RMSF include increased education and awareness, decreased prevalence and incidence rates, early recognition and screening, prompt treatment, and decreased morbidity and mortality rates. Due to the recentness of the article, the expected outcomes cannot be evaluated at this time. One potential problem is the lack of public awareness of the information prevented in the article. Since most of the information is presented to health care workers, it is their duty to educate and relay information to their patients. Outcomes could be achieved more quickly if quality information was presented in common locations and media easily accessed by the public, rather than in periodicals that are specific to the health care industry.
Overall, the epidemiology of RMSF proves that the disease is quite preventable as long as proper prevention methods are utilized. The foundational knowledge that the reader is left with upon completing the article is enough to understand the basics of epidemiology in relation to RMSF. By understanding the relationship between the agent, environment, and host, the reader is better able to recognize methods of prevention, screening, and treatment.
In relation to community nursing, it is important for health care professionals to increase the awareness of RMSF, especially during summer months, to at-risk populations in areas where incidence and prevalence rates are high. By raising public awareness and keeping the focus on health promotion and prevention, community nurses can effectively contribute to the decrease of incidence and prevalence rates, as well as morbidity and mortality rates. This truly shows how important epidemiology is in relation to community nursing and the overall health of the population. If this focus is applied to several diseases and the at-risk populations, long-term goals can be more readily achieved, making the expected outcomes of Healthy People 2020 a reality in our nation.

Works Referenced
Anikwe, F., Davis, C. & Waters, J. (2013, July). How to spot rocky mountain spotted fever.
Nursing Made Incredibly Easy, 11(4), 19-24.
Harkness, G., & DeMarco, R. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins.