Community-based prevention of epidemic Rocky Mountain spotted fever among minority populations in Sonora, Mexico, using a One Health approach

Rocky Mountain spotted fever is a neglected tropical disease in Latin America

Rocky Mountain spotted fever (RMSF), a severe and extraordinarily lethal infectious disease, has emerged as a widespread public health crisis among predominantly vulnerable populations in several countries of Latin America, particularly evident in northern Mexico. Historically, RMSF has gained less attention than many other tropical infectious diseases, resulting in insufficient allocations of resources and development of capabilities for its prevention and control in endemic regions. We argue that RMSF fulfills accepted criteria for a neglected tropical disease (NTD). The relative neglect of RMSF in most Latin American countries contributes to disparities in morbidity and mortality witnessed in this region. By recognizing RMSF as an NTD, an increased public policy interest, equitable and more appropriate allocation of resources, scientific interest, and social participation can ameliorate the impact of this potentially treatable disease, particularly in vulnerable populations.

A mutation associated with resistance to synthetic pyrethroids is widespread in US populations of the tropical lineage of Rhipicephalus sanguineus s.l

The brown dog tick, Rhipicephalus sanguineus sensu lato (s.l.), is an important vector for Rickettsia rickettsii, causative agent of Rocky Mountain spotted fever. Current public health prevention and control efforts to protect people involve preventing tick infestations on domestic animals and in and around houses. Primary prevention tools rely on acaricides, often synthetic pyrethroids (SPs); resistance to this chemical class is widespread in ticks and other arthropods. Rhipicephalus sanguineus s.l. is a complex that likely contains multiple unique species and although the distribution of this complex is global, there are differences in morphology, ecology, and perhaps vector competence among these major lineages. Two major lineages within Rh. sanguineus s.l., commonly referred to as temperate and tropical, have been documented from multiple locations in North America, but are thought to occupy different ecological niches. To evaluate potential acaricide resistance and better define the distributions of the tropical and temperate lineages throughout the US and in northern Mexico, we employed a highly multiplexed amplicon sequencing approach to characterize sequence diversity at: 1) three loci within the voltage-gated sodium channel (VGSC) gene, which contains numerous genetic mutations associated with resistance to SPs; 2) a region of the gamma-aminobutyric acid-gated chloride channel gene (GABA-Cl) containing several mutations associated with dieldrin/fipronil resistance in other species; and 3) three mitochondrial genes (COI, 12S, and 16S). We utilized a geographically diverse set of Rh sanguineus s.l. collected from domestic pets in the US in 2013 and a smaller set of ticks collected from canines in Baja California, Mexico in 2021. We determined that a single nucleotide polymorphism (T2134C) in domain III segment 6 of the VGSC, which has previously been associated with SP resistance in Rh. sanguineus s.l., was widespread and abundant in tropical lineage ticks (>50 %) but absent from the temperate lineage, suggesting that resistance to SPs may be common in the tropical lineage. We found evidence of multiple copies of GABA-Cl in ticks from both lineages, with some copies containing mutations associated with fipronil resistance in other species, but the effects of these patterns on fipronil resistance in Rh. sanguineus s.l. are currently unknown. The tropical lineage was abundant and geographically widespread, accounting for 79 % of analyzed ticks and present at 13/14 collection sites. The temperate and tropical lineages co-occurred in four US states, and as far north as New York. None of the ticks we examined were positive for Rickettsia rickettsii or Rickettsia massiliae.

Clinical and laboratory features of rickettsioses in Yucatan, Mexico

Rickettsia species are obligate intracellular bacteria that can cause mild to severe human disease. Based on phylogeny, clinical symptoms, and antigenic properties, rickettsiae are classified into four groups. Infections by these agents are characterized by clinical symptoms ranging from self-limited to severe and even fatal febrile illnesses, depending on the Rickettsia spp. involved, the patient's predisposition, and timely medical care. The present study aimed to characterize rickettsial diseases in Yucatan according to clinical and laboratory features appearing in medical records corresponding to 427 samples taken between 2015 and 2018. A study was conducted over the period 2015-2018 on 427 samples. Clinical and laboratory features were documented from the patients' medical records. For molecular diagnosis, blood was collected in 3.8 % sodium citrate as anticoagulant, and DNA was extracted. Single-step and nested PCR amplification was performed using genus-specific primers for the rickettsial 17kDa and ompB genes. The amplicons obtained were purified and sequenced. A total of 22.7 % (97/427) positive cases of Rickettsia spp. were identified by PCR from 14.15 % (15/106) of the municipalities in Yucatan. 75.2 % (73/97) of the cases were from the city of Merida during the autumn (September-December). The age groups with the highest frequency of confirmed cases were pediatric (5-14 years) (57.7 %) and adults (25-49 years) (42.2 %). There were six fatal cases in children, one associated with R. typhi and five with R. rickettsii. In non-fatal cases, 32.9 % (32/97) corresponded to the spotted fever group (SFG), and 60.8 % (59/97) to the typhus group (TG). Significant differences in signs, and laboratory data, were observed between the pediatric and adult populations. For the treatment of patients, oral and intravenous doxycycline was used in severe hospitalized cases. Typhus group and spotted fever group Rickettsiae are endemic pathological agents found in urban and rural areas of our region. Molecular identification allows for greater diagnostic accuracy and timely treatment and consequently a better prognosis. It is necessary to implement or reinforce measures focused on the dissemination of knowledge regarding rickettsial diseases and their prevention.

Optimal control of a tick population with a view to control of Rocky Mountain Spotted Fever

In some regions of the Americas, domestic dogs are the host for the tick vector Rhipicephalus sanguineus, and spread the tick-borne pathogen Rickettsia rickettsii, which causes Rocky Mountain Spotted Fever (RMSF) in humans. Interventions are carried out against the vector via dog collars and acaricidal wall treatments. This paper investigates the optimal control of acaricidal wall treatments, using a prior model for populations and disease transmission developed for this particular vector, host, and pathogen. It is modified with a death term during questing stages reflecting the cost of control and level of coverage. In the presence of the control, the percentage of dogs and ticks infected with Ri. rickettsii decreases in a short period and remains suppressed for a longer period, including after treatment is discontinued. Risk of RMSF infection declines by 90% during this time. In the absence of re-application, infected tick and dog populations rebound, indicating the eventual need for repeated treatment.

POTENTIAL SHARED DISEASE RISK AMONG DOGS AND COYOTES (CANIS LATRANS) EXEMPLIFIED BY THE ECOLOGY OF RICKETTSIOSIS IN A ROCKY MOUNTAIN SPOTTED FEVER-EPIDEMIC REGION IN NORTHERN MEXICO

Rocky Mountain spotted fever (RMSF), caused by the bacterium Rickettsia rickettsii, is a re-emerging tick-borne zoonosis in North America, with hundreds of human fatalities in multiple outbreaks in northern Mexico and the southwestern US in the past few decades. Free-roaming dogs are key because they are reservoirs for the pathogen and the main hosts of the brown dog tick (Rhipicephalus sanguineus), which vectors RMSF in this region. Because coyotes (Canis latrans) can be infected with R. rickettsii and infested with Rh. sanguineus, we hypothesized that space sharing among dogs and coyotes could enhance disease risks. In summer 2021, we captured and sampled 11 coyotes at two sites in Baja California, Mexico, near population centers with human cases of RMSF, and fitted seven individuals with GPS logging collars. We also tested tissue samples, sera, and ectoparasites for DNA of R. rickettsii with PCR and used serology to detect antibodies to R. rickettsii. Finally, we deployed an array of cameras to document dog-coyote interactions. Mean home range size was 40.37 km2. Both GPS and camera data showed considerable home range overlap both between individual coyotes and between coyotes and dogs. Coyotes were active in areas where dogs occur including the domestic interface surrounding human settlements. Although none of our samples were positive for R. rickettsii on PCR, 72.7% (8/11) of the samples were seropositive with titers ≥64. Our data confirm shared space use and risk of shared parasites and disease between coyotes and dogs.

Rickettsial antibodies and Rickettsia bellii detection in lagomorphs and their ectoparasites in Northern Baja California, Mexico

Lagomorphs-principally rabbits and hares-have been implicated as hosts for vectors and reservoirs for pathogens associated with multiple rickettsial diseases. Western North America is home to diverse rickettsial pathogens which circulate among multiple wild and domestic hosts and tick and flea vectors. The purpose of this study was to assess lagomorphs and their ectoparasites in 2 locations in northern Baja California, Mexico, for exposure to and infection with rickettsial organisms. In total, 55 desert cottontail rabbits (Sylvilagus audubonii) (Baird) and 2 black-tailed jackrabbits (Lepus californicus) (Gray) were captured. In Mexicali, ticks were collected from 44% (14/32) of individuals, and were exclusively Haemaphysalis leporispalustrisNeumann (Acari: Ixodidae); in Ensenada, ticks were collected from 70% (16/23) individuals, and 95% were Dermacentor parumapertus. Euhoplopsyllus glacialis affinisBaker (Siphonaptera: Pulicidae) fleas were collected from 72% of rabbits and 1 jackrabbit from Mexicali, while the few fleas found on hosts in Ensenada were Echidnophaga gallinaceaWestwood (Siphonaptera: Pulicidae) and Cediopsylla inaequalis(Siphonaptera: Pulicidae). Rickettsia bellii was the only rickettsial organism detected and was identified in 88% of D. parumapertus and 67% of H. leporispalustris ticks from Ensenada. A single tissue sample from a jackrabbit was positive for R. belli (Rickettsiales: Rickettsiaceae). Hosts in Ensenada had a significantly higher prevalence of rickettsial antibodies than hosts in Mexicali (52.3% vs. 21.4%). Although R. bellii is not regarded as pathogenic in humans or other mammals, it may contribute to immunity to other rickettsiae. The marked difference in distribution of ticks, fleas, and rickettsial exposure between the 2 locations suggests that disease transmission risk may vary markedly between communities within the same region.

Detection of Rickettsia amblyommatis and Rickettsia bellii in ticks collected from pet dogs in peri-urban and rural areas in Yucatan, Mexico

Rickettsia species are bacteria that may cause multiple diseases in animals and humans, via transmission through multiple arthropod vectors. Routine surveillance of Rickettsia spp. within vectors is critical to determine their presence and risk to mammalian hosts within human populations. Therefore, to better characterize the circulating Rickettsia species in an understudied region we targeted pet dogs to survey. Ticks were collected from pet dogs in three populations of the Yucatan where we tested for the presence of Rickettsia spp. by PCR in metagenomic DNA. In these ticks removed from pet dogs we detected Rickettsia amblyommatis and Rickettsia bellii in Amblyomma auriculatum, Amblyomma ovale and Amblyomma mixtum ticks obtained in a rural community in the Mexican state of Yucatan. This is the first report detecting both species for this state in Mexico, underpinning the importance of more routine surveillance.

Perception of risk among children: Exploring the risk of TB-rickettsial disease based on the children's drawing pictures in a Mayan community of Yucatan

Background

It is important to work on designs of health promotion strategies that involve educational interventions about the risk factors associated to TB-rickettsiosis (Tick-Borne rickettsiosis). Children's drawings provide a window into their thoughts and feelings. The aim was to analyze children's risk perceptions regarding by the presence of ticks in a rural community in southeast Mexico.

Methods

The main framework used was a social cognitive perspective under the Health Belief Model. Study was carried out in rural elementary schools and included a drawing contest. A total of 224 children (8-12 years old) participated. Drawings were coded and classified; descriptive trend analysis was performed using counts and percentages. The qualitative data was analyzed by researcher experts in TB- rickettsiosis and using Atlas ti V.8.

Results

Results are presented in seven categories that consider environmental elements, actors, and cognitive aspects. The environmental context, 99.1% of the drawings represent sites outside the home (92% include vegetation with the presence of ticks in their immediate external environment). In the actors' category, 69.6% included people carrying out activities (prevention and risk). As for the cognitive aspects, 70% included domestic pets and 13.4% farmyards animals.

Conclusion

The children expressed their ideas about risk factors and preventive measures against TB-rickettsiosis with a self-care approach. They acquired knowledge about preventive strategies and clinical symptoms. It is necessary to evaluate what happens after an intervention and how they implement in their lives what they have learned.

Tick-borne pathogens detected in sheltered dogs during an epidemic of Rocky Mountain spotted fever, a One Health challenge

OBJECTIVE

To assess exposure to and infection with 3 pathogens (Rickettsia rickettsii, Anaplasma platys, and Ehrlichia canis) vectored by brown dog ticks (Rhipicephalus sanguineus) in sheltered dogs at the western US-Mexico border.

ANIMALS

239 dogs in shelters in San Diego and Imperial counties, US, and Mexicali and Tijuana, Mexico.

PROCEDURES

Each dog had blood drawn and basic demographic data collected. PCR was performed to determine active infection with Rickettsia spp, E canis, and A platys. Serology was performed to determine exposure to Rickettsia, Anaplasma, and Ehrlichia species.

RESULTS

2 of 78 (2.6%) dogs sampled in Tijuana were actively infected with R rickettsii. A single brown dog tick collected from a dog in Tijuana was PCR-positive for R rickettsii. Infection with E canis and A platys ranged across shelters from 0% to 27% and 0% to 33%, respectively. Dogs in all 4 locations demonstrated exposure to all 3 pathogens, though Rickettsia and Ehrlichia seropositivity was highest in Mexicali (81% and 49%, respectively) and Anaplasma seropositivity was highest in Tijuana (45%).

CLINICAL RELEVANCE

While infection and exposure were highest in sheltered dogs in the southern locations, dogs in all locations demonstrated exposure to all pathogens, demonstrating the potential for emergence and spread of zoonotic pathogens with significant public health consequences in southern California and northern Baja California. In addition, veterinarians and shelter staff should be aware that Ehrlichia or Anaplasma infection may co-occur with Rocky Mountain spotted fever, which is a human health risk.

Brown Dog Tick (Rhipicephalus sanguineus Sensu Lato) Infection with Endosymbiont and Human Pathogenic Rickettsia spp., in Northeastern México

Of the documented tick-borne diseases infecting humans in México, Rocky Mountain spotted fever (RMSF), caused by the Gram-negative bacterium Rickettsia rickettsii, is responsible for most fatalities. Given recent evidence of brown dog tick, Rhipicephalus sanguineus s.l., as an emerging vector of human RMSF, we aimed to evaluate dogs and their ticks for rickettsiae infections as an initial step in assessing the establishment of this pathosystem in a poorly studied region of northeastern México while evaluating the use of dogs as sentinels for transmission/human disease risk. We sampled owned dogs living in six disadvantaged neighborhoods of Reynosa, northeastern México to collect whole blood and ticks. Of 168 dogs assessed, tick infestation prevalence was 53%, composed of exclusively Rh. sanguineus s. l. (n = 2170 ticks). Using PCR and sequencing, we identified an overall rickettsiae infection prevalence of 4.1% (n = 12/292) in ticks, in which eight dogs harbored at least one infected tick. Rickettsiae infections included Rickettsia amblyommatis and Rickettsia parkeri, both of which are emerging human pathogens, as well as Candidatus Rickettsia andeanae. This is the first documentation of pathogenic Rickettsia species in Rh. sanguineus s.l. collected from dogs from northeastern México. Domestic dog infestation with Rickettsia-infected ticks indicates ongoing transmission; thus, humans are at risk for exposure, and this underscores the importance of public and veterinary health surveillance for these pathogens.

Modeling of Control Efforts against Rhipicephalus sanguineus, the Vector of Rocky Mountain Spotted Fever in Sonora Mexico

Rocky Mountain spotted fever (RMSF) is a significant health problem in Sonora, Mexico. The tick vector, Rhipicephalus sanguineus, feeds almost exclusively on domestic dogs that, in this region, also serve as the reservoir for the tick-borne pathogen, Rickettsia rickettsii. A process-based mathematical model of the life cycle of R. sanguineus was developed to predict combinations of insecticidal dog collars and long-lasting insecticidal wall treatments resulting in suppression of indoor tick populations. Because of a high burden of RMSF in a rural community near the Sonora state capital of Hermosillo, a test area was treated with a combination of insecticidal dog collars and long-lasting insecticidal wall treatments from March 2018 to April 2019, with subsequent reduction in RMSF cases and deaths. An estimated 80% of the dogs in the area had collars applied and 15% of the houses were treated. Data on tick abundance on walls and dogs, collected during this intervention, were used to parameterize the model. Model results show a variety of treatment combinations likely to be as successful as the one carried out in the test community.

Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico-United States Border, 2009-2019

Longevity, high prevalence, and multifocal distribution of this disease pose unprecedented public health challenges.

Epidemic levels of Rocky Mountain spotted fe­­­ver (RMSF) have persisted in Mexicali, Mexico, since the initial outbreak was first reported in December 2008. We compared clinical and epidemiologic data of cases in Mexicali during 2009–2019 between patients with an IgG titer reactive with Rickettsia rickettsii bacteria by indirect immunofluorescence antibody (IFA) assay and those who demonstrated DNA of R. rickettsii in a whole blood sample when tested by PCR. We identified 4,290 patients with clinical and epidemiologic features compatible with RMSF; of these, 9.74% tested positive by IFA and 8.41% by PCR. Overall, 140 patients died (11-year case-fatality rate 17.97%). Substantial differences in the frequency of commonly recognized clinical characteristics of RMSF were identified between PCR-positive and IFA-positive cases. The Mexicali epidemic is unique in its size and urban centralization. Cases confirmed by PCR most accurately reflect the clinical profile of RMSF.

Knowledge, Attitudes, and Practices Related to Rocky Mountain Spotted Fever in Hermosillo, México

Rocky Mountain spotted fever (RMSF) is a serious disease in northwest Mexico, particularly in low-income communities. This study aimed to evaluate RMSF-related knowledge, attitudes, and practices in an endemic urban area with a high burden of the disease. A cross-sectional study design using a non-probabilistic household survey was conducted with 400 residents in Hermosillo, Mexico. Primary themes assessed included dog and tick-related exposure, RMSF knowledge, healthcare-seeking behavior, sociodemographic data, and household information. The majority (59%) of those surveyed had heard about RMSF, although only 36% of RMSF-aware respondents knew any RMSF symptoms. Among RMSF-aware respondents, 26% did not know or were unsure of prevention strategies. Individuals in the low socioeconomic status (SES) stratum were less likely to have heard about RMSF (odds ratio [OR]: 0.39; 95% CI: 0.25-0.59), use dog collars or any other product to avoid ticks (OR: 0.40; 95% CI: 0.17-0.99), or check their dogs for ticks (OR: 0.25; 95% CI: 0.09-0.74). The likelihood of observing high numbers of free-roaming dogs in their neighborhood was four times higher in the low SES stratum (OR: 4.19; 95% CI: 2.10-8.38) than in the high SES stratum. These findings emphasize the need for an integrative community approach to improve early recognition of symptoms and knowledge of prevention strategies, particularly in low SES neighborhoods.

An exploratory analysis of demography and movement patterns of dogs: New insights in the ecology of endemic Rocky Mountain-Spotted Fever in Mexicali, Mexico

An outbreak of Rocky Mountain spotted fever (RMSF) transmitted by the brown dog tick (Rhipicephalus sanguineus sensu lato) has emerged as a major human and animal health concern in Mexicali, Mexico. Due to high rates of brown dog tick infestation, susceptibility, and association with humans, dogs serve as sentinels and have a key role in the ecology of RMSF. A cross-sectional household questionnaire study was conducted in six rural and urban locations to characterize dog ecology and demography in RMSF high-and low-risk areas of Mexicali. In addition, we tracked movement patterns of 16 dogs using a GPS data logger. Of 253 households, 73% owned dogs, and dog ownership tended to be higher in high-risk areas, with a mean dog:human ratio of 0.43, compared with 0.3 in low-risk areas. Dogs in high-risk areas had higher fecundity and roamed more, but the dog density and numbers of free-roaming dogs were comparable. There was a higher proportion of younger dogs and lower proportion of older dogs in high-risk areas. The high proportion of immunologically naïve puppies in high risk areas could result in a lack of herd immunity leading to a more vulnerable dog and human population. The marked increase of space use of free-roaming dogs in high-risk areas suggests that unrestrained dogs could play an important role in spreading ticks and pathogens. As means to limit RMSF risk, practical changes could include increased efforts for spay-neuter and policies encouraging dog restraint to limit canine roaming and spread of ticks across communities; due to dog density is less impactful such policies may be more useful than restrictions on the number of owned dogs.