Abstract
Rickettsial diseases have a diversity of epidemiologic characteristics reflective of the variety of ecologic situations in which the obligate intracellular bacteria are transmitted to humans. For the spotted fever group (SFG) rickettsiae, Rickettsia typhi. R. tsutsugamushi, Coxiella burnetii, and the human ehrlichial agent, humans are a dead-end host who plays no role in the maintenance of the organism in nature. All rickettsioses exist as zoonoses. Moreover, all rickettsiae are found in infected arthopods, which generally serve as the natural hosts and can transmit the infection to the next generation of ticks, mites, chiggers, or fleas. From our anthropocentric viewpoint, Q fever aerosol infection from parturient animals and Brill-Zinsser disease ignited epidemics of louse-borne epidemic typhus are exceptions. However, silent cycles of C. burnetii in ticks and R. prowazekii in the flying squirrel flea may have maintained these agents in transovarial or enzootic cycles for eons before humans and their domestic animals arrived on the scene. Thus, the epidemiology of rickettsial diseases must be recognized as an unfortunate aberration of the rickettsial economy.
Several excellent reviews of rickettsial ecology contain a wealth of useful information (2, 8, 55, 70, 84).
Similar content being viewed by others
References
AggerW.A. and SongsiridejY. (1985): Epidemic typhus acquired in Wisconsin - Wis. Med. J. 84: 27–30.
AzadA.F. (1988): Relationship of vector biology and epidemiology of louse- and flea-borne rickettsioses In: Biology of Rickettsial Diseases Vol. II, CRC Press, Boca Raton, pp. 51–61.
BaneguraF.K., MunubeG.M.R., SenyakazanaA.G. and NzaroE. (1983): An epidemic of typhus in Ankole, Uganda, 1975–1976 - East African Med. J. 60: 55–59.
BarandaJ.M., CarrencejaJ.C. and ErrastiC.A. (1985): Q fever in the Basque Country: 1981–1984 - Rev. Infect. Dis. 7: 700–701.
BernardK.W., HelmickC.G., KaplanJ.E. and WinklerW.G. (1982): Surveillance of Rocky Mountain spotted fever in the United States, 1978–1980 - J. Infect. Dis. 146: 297–299.
BrownA.E., MeekS.R., ManeechaiN. and LewisG.E. (1988): Murine typhus among Khmers living at an evacuation site on the Thai-Kampuchean border -Am. J. Trop. Med. Hyg. 38: 168–171.
BrownG.W., ShiraiA., JegathesanM., BurkeD.S., TwartzJ.C., SaundersJ.P. and HuxsollD.L. (1984): Febrile illness in Malaysia: An analysis of 1,629 hospitalized patients - Am. J. Trop. Med. Hyg. 33: 311–315.
BurgdorferW. (1988): Ecological and epidemiological considerations of Rocky Mountain spotted fever In: Biology of Rickettsial Diseases Vol. II, CRC Press, Boca Raton, pp. 33–50.
BurgdorferW. and BrintonL.P. (1975): Mechanisms of transovarial infection of spotted fever rickettsiae in ticks - Ann. N.Y. Acad. Sci. 266: 61–72.
BurgdorferW., CooneyJ.C., MavrosA.J., JellisonW.L. and MaserC. (1980): The role of cottontail rabbits (Sylvilagus spp.) in the ecology of Rickettsia rickettsii in the United States - Am. J. Trop. Med. Hyg. 29: 686–690.
BurgdorferW., FriedhoffK.T. and LancasterJ.L. Jr. (1966): Natural history of tickborne spotted fever in the USA - Bull. W.H.O. 35: 149–153.
CampbellR.W., AbeywickremaP. and FentonC. (1979): Queensland tick typhus in Sydney: a new endemic focus - Med. J. Aust. 1: 350–351.
Centers for Disease Control (1982): Epidemic typhus associated with flying squirrels — United States -M.M.W.R. 31: 555–561.
Centers for Disease Control (1988): Rocky Mountain spotted fever — United States, 1987 - M.M.W.R. 37: 388–389.
Centers for Disease Control (1988): Human ehrlichiosis - United States - M.M.W.R. 37: 270–277.
Centers for Disease Control (1990): Rocky Mountain spotted fever and human ehrlichiosis - United States, 1989 - M.M.W.R. 39: 281–284.
D'AngeloL.J., BregmanD.J. and WinklerW.G. (1982): Rocky Mountain spotted fever in the United States: Use of age-specific incidence to determine public health policy for a vector-borne disease - So. Med. J. 75: 3–5.
DawsonJ.E., FishbeinD.B., EngT.R., RedusM.A. and GreeneN.R. (1990): Diagnosis of human ehrlichiosis with the indirect fluorescent antibody test: Kinetics and specificity - J. Infect. Dis. 162: 91–95.
ElliotL.B., FournierP.V. and TeltowG.J. (1990): Rickettsia in Texas - Ann. N.Y. Acad. Sci. 590: 221–226.
EngT.R., FishbeinD.B., DawsonJ.E., GreeneC.R. and RedusM. (1990): Surveillance of human ehrlichiosis in the United States: 1988 - Ann. N.Y. Acad. Sci. 590: 306–307.
FanM.Y., WalkerD.H., LiuQ.H., LiH., BaiH.C., ZhangJ.K., LenzB. and CaiH. (1987): Rickettsial and serologic evidence for prevalent spotted fever rickettsiosis in Inner Mongolia - Am. J. Trop. Med. Hyg. 36: 615–620.
FanM.Y., WalkerD.H., YuS.R. and LiuQ.H. (1987): Epidemiology and ecology of rickettsial diseases in the People's Republic of China - Rev. Infect. Dis. 9: 823–840.
FanM.Y., WangJ.G., JiangY.X., ZongD.G., LenzB. and WalkerD.H. (1987): Isolation of a spotted fever group rickettsia from a patient and related ecologic investigations in Xinjiang Uygur Autonomous Region of China - J. Clin. Microbiol. 25: 628–632.
FanM.Y., YuX.J. and WalkerD.H. (1988): Antigenic analysis of Chinese strains of spotted fever group rickettsiae by protein immunoblotting - Am. J. Trop. Med. Hyg. 39: 497–501.
Farhang-AzadA. and EmalaM.A. (1987): Suppression of Rickettsia typhii transmission in fleas maintained on murine typhus-immune rats - Am. J. Trop. Med. Hyg. 37: 629–635.
Farhang-AzadA. and TraubR. (1985): Transmission of murine typhus rickettsiae by Xenopsylla cheopis, with notes on experimental infection and effects of temperature - Am. J. Trop. Med. Hyg. 34: 555–563.
Farhang-AzadA., TraubR. and BaqarS. (1985): Transovarial transmission of murine typhus rickettsiae in Xenopsylla cheopis fleas - Science 227: 543–545.
Farhang-AzadA., TraubR., SofiM. and WissemanC.L. Jr. (1984): Experimental murine typhus infection in the cat flea, Ctenocephalides felis (Siphonaptera: Pulicidae) - J. Med. Entomol. 21: 675–680.
FishbeinD.B., FrontiniM.G., GilesR. and VernonL.L. (1990): Fatal cases of Rocky Mountain spotted fever in the United States, 1981–1988 - Ann. N.Y. Acad. Sci. 590: 246–247.
FishbeinD.B., KaplanJ.E., BernardK.W. and WinklerW.G. (1984): Surveillance of Rocky Mountain spotted fever in the United States, 1981–1983 - J. Infect. Dis. 150: 609–611.
Fishbein D.B., Kaplan J.E., Bernard K.W. and Winkler W.G. (1984): Surveillance of Rocky Mountain spotted fever - M.M.W.R. 33: 15SS–18SS.
FishbeinD.B., KempA., DawsonJ.E., GreeneN.R., RedusM.A. and FieldsD.H. (1989): Human ehrlichiosis: Prospective active surveillance in febrile hospitalized patients - J. Infect. Dis. 160: 803–809.
FishbeinD.B., SawyerL.A., HollandC.J., HayesE.B., OkoroanyanwuW., WilliamsD., SikesR.K., RisticM. and McDadeJ.E. (1987): Unexplained febrile illnesses after exposure to ticks - Infection with an Ehrlichia -J.A.M.A. 257: 3100–3104.
FunatoT., KitamuraY., KawamuraA. and UchidaT. (1988): Rickettsiosis of spotted fever group encountered in Muroto area of Shikoku, Japan –Clinical and epidemiological features of 23 cases - J. Jpn. Assoc. Infect. Dis. 62: 783–791.
GageK.L., BurgdorferW. and HoplaC.E. (1990): Hispid cotton rats (Sigmodon hispidus) as a source for infecting immature Dermacentor variabilis (Acari: Ixodidae) with Rickettsia rickettsii - J. Med. Entomol. 27: 615–619.
GonzalesJ.P., FisetP., GeorgesA.J., SaluzzoJ.R. and WissemanC.L. Jr. (1985): Approche serologique sur l'incidence des rickettsioses en Republique Centrafricaine - Bull. Soc. Path. Ex. 78: 153–156.
GrossE.M., ArbefY., BearmanJ.E., YagupskyP., CoharK., TorokV. and GoldwasserR.A. (1984): Spotted fever and murine typhus in the Negev desert region of Israel, 1981 - Bull. W.H.O. 62: 301–306.
GrossE.M. and YagupskyP. (1987): Israeli rickettsial spotted fever in children - Acta Trop. 44: 91–96.
HarkessJ.R., EwingS.A., CrutcherJ.M., KudlacJ., McKeeG. and IstreG.R. (1989): Human ehrlichiosis in Oklahoma - J. Infect. Dis. 159: 576–579.
HelmickC.G., BernardK.W. and D'AngeloL.J. (1984): Rocky Mountain spotted fever: Clinical, laboratory, and epidemiological features of 262 cases - J. Infect. Dis. 150: 480–488.
IshikuraM., WatanabeM., MoritaO. and UetakeH. (1985): Epidemiological studies on the background of the endemic occurrence of tsutsugamushi disease in Toyama Prefecture - Microbiol. Immunol.29: 859–872.
KaihoI., TokiedaM., OhtawaraM., UchiyamaT. and UchidaT. (1988): Occurrence of rickettsiosis of spotted fever group in Chiba Prefecture of Japan -Jpn. J. Med. Sci. Biol. 41: 9–71.
KaplanJ.E. and NewhouseV.F. (1984): Occurrence of Rocky Mountain spotted fever in relation to climatic, geophysical, and ecologic variables - Am. J. Trop. Med. Hyg. 33: 1281–1282.
LambertM., DugernierT., BigaignonG., RahierJ. and PiotP. (1984): Mediterranean spotted fever in Belgium - Lancet 2: 1038.
LangeJ.V., WalkerD.H. and WesterT.B. (1982): Documented Rocky Mountain spotted fever in wintertime - J.A.M.A. 247: 2403–2404.
LangleyJ.M., MarrieT.J., CovertA., WaagD.M. and WilliamsJ.C. (1988): An urban outbreak of Q fever following exposure to a parturient cat - N. Engl. J. Med. 319: 354–356.
LinnemannC.C.Jr., SchaefferA.E., BurgdorferW., HutchinsonL. and PhilipR.N. (1980): Rocky Mountain spotted fever in Clermont County, Ohio — II. Distribution of population and infected ticks in an endemic area - Am. J. Epidemiol. 111: 31–36.
LiuQ.H., WalkerD.H. and ZhouG.F. (1990): Serologic survey for antibodies to Rickettsia sibirica in Inner Mongolia, People's Republic of China -Ann. N.Y. Acad. Sci. 590: 237–242.
MaedaK., MarkowitzN., HawleyR.C., RisticM., CoxD. and McDadeJ.E. (1987): Human infection with Ehrlichia canis, a leukocytic rickettsia - N. Engl. J. Med. 316: 853–856.
MagnarelliL.A., AndersonJ.F., PhilipR.N., BurgdorferW. and ChappellW.A. (1983): Rickettsiae-infected ticks (acari: Ixodidae) and seropositive mammals at a focus for Rocky Mountain spotted fever in Connecticut, USA - J. Med. Entomol. 20: 151–156.
MansuetoS., TringaliG. and WalkerD.H. (1986): Widespread, simultaneous increase in the incidence of spotted fever group rickettsioses - J. Infect. Dis. 154: 539–540.
MansuetoS., VitaleG., MiceliM.D., TringaliG.QuartararoP., PiconeD.M. and OcchinoC. (1984): A sero-epidemiological survey of asymptomatic cases of boutonneuse fever in Western Sicily - Trans. Royal Soc. Trop. Med. Hyg. 78: 16–18.
MarrieT.J., SchlechW.E.III, WilliamsJ.C. and YatesL. (1986): Q fever pneumonia associated with exposure to wild rabbits - Lancet 1: 427–429.
MarrieT.J. and YatesL. (1990): Incidence of Q fever: Pilot studies in two areas in Nova Scotia - Ann. N.Y. Acad. Sci. 590: 275–280.
McDadeJ.E. and NewhouseV.F. (1986): Natural history of Rickettsia rickettsii - Ann. Rev. Microbiol. 40: 287–309.
MeiklejohnG., ReimerL.G., GravesP.S. and HelmickC. (1981): Cryptic endemic of Q fever in a medical school - J. Infect. Dis. 144: 107–113.
NewhouseV.F., ChoiK., HolmanR.C., ThackerS.B., D'AngeloL.J. and SmithJ.D. (1986): Rocky Mountain spotted fever in Georgia, 1961–75: Analysis of social and environmental factors affecting occurrence -Public Health Rep. 101: 419–428.
NormentB.R. and BurgdorferW. (1985): Susceptibility of small mammals to nonvirulent spotted fever group rickettsiae - J. Med. Entomol. 22: 200–203.
NormentB.R. and BurgdorferW. (1984): Susceptibility and reservoir potential of the dog to spotted fever-group rickettsiae - Am. J. Vet. Res. 45: 1706–1710.
OkadaT., TangeY. and KobayashiY. (1990): Causative agent of spotted fever group rickettsiosis in Japan - Infect. Immun. 58: 887–892.
OlsonJ.G., BourgeoisA.L. and FangR.C.Y. (1982): Population indices of chiggers (Leptotrombidium deliense) and incidence of scrub typhus in Chinese military personnel, Pescadores Islands of Taiwan, 1976–77 - Trans. Royal Soc. Trop. Med. Hyg. 76: 85–88.
PetersenL.R., SawyerL.A., FishbeinD.B., KelleyP.W., ThomasR.J., MagnarelliL.A., RedusM. and DawsonJ.E. (1989): An outbreak of ehrlichiosis in members of an army reserve unit exposed to ticks - J. Infect. Dis. 159: 562–568.
PhilipR.N. and CasperE.A. (1981): Serotypes of spotted fever group rickettsiae isolated from Dermacentor andersoni (Stiles) ticks in Western Montana - Am. J. Trop. Med. Hyg. 30: 230–238.
PhilipR.N., CasperE.A., AnackerR.L., CoryJ., HayesS.F., BurgdorferW. and YunkerC.E. (1983): Rickettsia bellii sp. nov.: a tick-borne rickettsia, widely distributed in the United States, that is distinct from the spotted fever and typhus biogroups - Int. J. Syst. Bacteriol. 33: 94–106.
PretzmanC., DaughertyN., PoetterK. and RalphD. (1990): The distribution and dynamics of rickettsia in the tick population of Ohio - Ann. N.Y. Acad. Sci. 590: 227–236.
RaoultD., LenaD., PerrimontH., GallaisH., WalkerD.H. and CasanovaP. (1986): Haemolysis with Mediterranean spotted fever and glucose-6 phosphate dehydrogenase deficiency - Trans. Royal Soc. Trop. Med. Hyg. 80: 961–962.
RaoultD., NicolasD., DeMiccoP., GallaisH. and CasanovaP. (1985): Aspects epidemiologiques de la fievre boutonneuse Mediterraneenne en Corse du Sud - Bull. Soc. Path. Ex. 78: 446–451.
RaoultD., TogaB., ChaudetH. and Chiche-PorticheC. (1987): Rickettsial antibody in southern France: antibodies to Rickettsia conorii and Coxiella burnetii among urban, suburban and semi-rural blood donors -Trans. Royal Soc. Trop. Med. Hyg. 81: 80–81.
RauchA.M., TannerM., PacerR.E., BarrettM.J., BrokoppC.D. and SchonbergerL.B. (1987): Sheep-associated outbreak of Q fever, Idaho - Arch. Intern. Med. 147: 341–344.
RehacekJ. and TarasevichI.V. (1988): In: Acari-Borne Rickettsiae & Rickettsioses in Eurasia, Veda Publishing House of the Slovak Academy of Sciences, Bratislava.
RichardusJ.H., DumasA.M., HuismanJ. and SchaapG.J.P. (1985): Q fever in infancy: a review of 18 cases -Pediatr. Infect. Dis. 4: 369–373.
SalgoM.P., TelzakE.E., CurrieB., PerlmanD.C., LitmanN., LeviM., NathensonG., BenachJ.L., AlHafidhR. and CaseyJ. (1988): A focus of Rocky Mountain spotted fever within New York City - New Engl. J. Med. 318: 1345–1348.
SarovB., GalilA., SikulerE., YagupskyP., SaahA., GiladA., NagganL. and SarovI. (1990): Prospective study on symptomatic versus asymptomatic infections and serological response to spotted fever group rickettsiae in two rural sites in the Negev (Southern Israel) - Ann. N.Y. Acad. Sci. 590: 243–245.
SawyerL.A., FishbeinD.B. and McDadeJ.E. (1987): Q fever: Current concepts - Rev. Infect. Dis. 9: 935–946.
Segura-PortaF., Font-CreusB., Espejo-ArenasE. and Bella-CuetoF. (1989): New trends in Mediterranean spotted fever - Eur. J. Epidemiol. 5: 438–443.
SextonD.J., KingG. and Dwyer B. (1990): Fatal Queensland tick typhus - J. Infect. Dis. 162: 779–780.
SimorA.E., BruntonJ.L., SalitI.E., VellendH., Ford-JonesL. and SpenceL.P. (1984): Q fever: hazard from sheep used in research - Can. Med. J. 130: 1013–1016.
SolimanA.K., BotrosB.A.M., KsiazekT.G., HoogstraalH., HelmyI. and MorrillJ.C. (1985): Seroprevalence of Rickettsia typhi and Rickettsia conorii infection among rodents and dogs in Egypt -J. Trop. Med. Hyg. 92: 345–349.
TaylorJ.P., BetzT.G., FishbeinD.B., RobertsM.A., DawsonJ. and RisticM. (1988): Serological evidence of possible human infection with Ehrlichia in Texas -J. Infect. Dis. 158: 217–220.
TaylorJ.P., BetzT.G. and RawlingsJ.A. (1986): Epidemiology of murine typhus in Texas, 1980 through 1984 - J.A.M.A. 255: 2173–2176.
TaylorJ.P., IstreG.R. and McChesneyT.C. (1988): The epidemiology of Rocky Mountain spotted fever in Arkansas, Oklahoma, and Texas, 1981 through 1985 -Am. J. Epidemiol. 127: 1295–1301.
TaylorJ.P., TannerW.B., RawlingsJ.A., BuckJ., ElliottL.B., DewlettH.J., TaylorB. and BetzT.G. (1985): Serological evidence of subclinical Rocky Mountain spotted fever infections in Texas - J. Infect. Dis. 151: 367–369.
TinelliM., MaccabruniA., MicheloneG. and ZambelliA. (1989): Mediterranean spotted fever in Lombardy: an epidemiological, clinical and laboratory study of 76 cases in the years 1977–1986 - Eur. J. Epidemiol. 5: 516–520.
TraubR., WissemanC.L.Jr. and Farhang-AzadA. (1978): The ecology of murine typhus: a critical review - Trop. Dis. Bull. 75: 238–317.
TringaliG., IntonazzoV., PernaA.M., MansuetoS., Vitale and WalkerD.H. (1986): Epidemiology of boutonneuse fever in Western Sicily: Distribution and prevalence of spotted fever group rickettsial infection in dog ticks (Rhipicephalus sanguineus) -Am. J. Epidemiol. 123: 721–727.
UchidaT., UchiyamaT. and KoyamaA.H. (1988): Isolation of spotted fever group rickettsiae from humans in Japan - J. Infect. Dis. 158: 664–665.
UchidaT., TashiroF., FunatoT. and KitamuraY. (1986): Isolation of a spotted fever group rickettsia from a patient with febrile exanthematous illness in Shikoku, Japan - Microbiol. Immunol. 30: 1323–1326.
UchidaT., YuX.J., UchiyamaT. and WalkerD.H. (1989): Identification of a unique spotted fever group rickettsia from humans in Japan - J. Infect. Dis. 159: 1122–1126.
VitaleG., Di StefanoR., DamianiG. and MansuetoS. (1989): Characterization of Sicilian strains of spotted fever group rickettsiae by using monoclonal antibodies - J. Clin. Microbiol. 27: 1081–1085.
WalkerD.H. (1990): The role of host factors in the severity of spotted fever and typhus rickettsioses -Ann. N.Y. Acad. Sci. 590: 10–19.
WalkerD.H. (1989): The rickettsia-host interaction In: Intracellular Parasitism - Boca Raton, CRC Press, Inc., pp. 79–92.
WalkerD.H., LiuQ.H. and FengH.M. (1990): Update on rickettsiae and rickettsial diseases in China - Rev. Infect. Dis. 12: 562–563.
WangJ.G. and WalkerD.H. (1987): Identification of spotted fever group rickettsiae from human and tick sources in the People's Republic of China - J. Infect. Dis. 156: 665–669.
WilfertC.M., MacCormackJ.N., KleemanK., PhilipR.N., AustinE., DickinsonV. and TurnerL. (1984): Epidemiology of Rocky Mountain spotted fever as determined by active surveillance - J. Infect. Dis. 150: 469–479.
YagupskyP., SarovB., NagganL., SarovI., AvyK. and GoldwasserR. (1990): The prevalence of IgG antibodies to spotted-fever group rickettsiae among urban and rural dwelling children in Southern Israel -Scand. J. Infect. Dis. 22: 19–23.
YamamotoS., KawabataN., UchiyamaT. and UchidaT. (1987): Evidence for infections caused by spotted fever group rickettsia in Kyushu, Japan - Jpn. J. Med. Sci. Biol. 40: 75–78.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Walker, D.H., Fishbein, D.B. Epidemiology of rickettsial diseases. Eur J Epidemiol 7, 237–245 (1991). https://doi.org/10.1007/BF00145672
Issue Date:
DOI: https://doi.org/10.1007/BF00145672