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Kidd L. Emerging Spotted Fever Rickettsioses in the United States. Vet Clin North Am Small Anim Pract 2022; 52:1305-1317. [DOI: 10.1016/j.cvsm.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kjemtrup AM, Padgett K, Paddock CD, Messenger S, Hacker JK, Feiszli T, Melgar M, Metzger ME, Hu R, Kramer VL. A forty-year review of Rocky Mountain spotted fever cases in California shows clinical and epidemiologic changes. PLoS Negl Trop Dis 2022; 16:e0010738. [PMID: 36108065 PMCID: PMC9514610 DOI: 10.1371/journal.pntd.0010738] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 09/27/2022] [Accepted: 08/12/2022] [Indexed: 01/05/2023] Open
Abstract
Rocky Mountain spotted fever (RMSF) is a life-threatening tick-borne disease documented in North, Central, and South America. In California, RMSF is rare; nonetheless, recent fatal cases highlight ecological cycles of the two genera of ticks, Dermacentor and Rhipicephalus, known to transmit the disease. These ticks occur in completely different habitats (sylvatic and peridomestic, respectively) resulting in different exposure risks for humans. This study summarizes the demographic, exposure, and clinical aspects associated with the last 40 years of reported RMSF cases to the California Department of Public Health (CDPH). Seventy-eight RMSF cases with onsets from 1980 to 2019 were reviewed. The incidence of RMSF has risen in the last 20 years from 0.04 cases per million to 0.07 cases per million (a two-fold increase in reports), though the percentage of cases that were confirmed dropped significantly from 72% to 25% of all reported cases. Notably, Hispanic/Latino populations saw the greatest rise in incidence. Cases of RMSF in California result from autochthonous and out-of-state exposures. During the last 20 years, more cases reported exposure in Southern California or Mexico than in the previous 20 years. The driver of these epidemiologic changes is likely the establishment and expansion of Rhipicephalus sanguineus sensu lato ticks in Southern California and on-going outbreaks of RMSF in northern Mexico. Analysis of available electronically reported clinical data from 2011 to 2019 showed that 57% of reported cases presented with serious illness requiring hospitalization with a 7% mortality. The difficulty in recognizing RMSF is due to a non-specific clinical presentation; however, querying patients on the potential of tick exposure in both sylvatic and peridomestic environments may facilitate appropriate testing and treatment.
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Affiliation(s)
- Anne M. Kjemtrup
- California Department of Public Health, Sacramento, California, United States of America
- * E-mail:
| | - Kerry Padgett
- California Department of Public Health, Richmond, California, United States of America
| | | | - Sharon Messenger
- California Department of Public Health, Richmond, California, United States of America
| | - Jill K. Hacker
- California Department of Public Health, Richmond, California, United States of America
| | - Tina Feiszli
- California Department of Public Health, Richmond, California, United States of America
| | - Michael Melgar
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Marco E. Metzger
- California Department of Public Health, Ontario, California, United States of America
| | - Renjie Hu
- California Department of Public Health, Ontario, California, United States of America
| | - Vicki L. Kramer
- California Department of Public Health, Sacramento, California, United States of America
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Stanley H, Rhodes DVL. Presence of Rickettsia Species in Ticks Collected from Companion Animals in Northeastern Georgia, United States. Vet Sci 2021; 8:vetsci8030037. [PMID: 33652620 PMCID: PMC7996843 DOI: 10.3390/vetsci8030037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/30/2023] Open
Abstract
Tick-borne diseases are a major threat to both humans and their pets; therefore, it is important to evaluate the prevalence of pathogens carried by ticks on companion animals. In this study, attached and unattached Ixodid ticks were removed from companion animals by a veterinary practice in Hall County, Georgia. DNA was extracted from unengorged adult ticks and each was screened for the presence of Rickettsia spp. by polymerase chain reaction (PCR) and sequenced to determine the species present. Two hundred and four adult hard-bodied ticks were identified to species and Rickettsia spp. were found in 19.6% (n = 38) of the 194 analyzed DNA extracts. Rickettsia montanensis was found in Dermacentor variablis (14.7%; n = 25), Amblyomma maculatum (33.3%; n = 2), and Rhipicephalus sanguineus s.l. ticks (25%; n = 4). One Amblyomma americanum tick contained Rickettsia amblyommatis, while Rickettsia felis was found in one Dermacentor variablis tick, serving as the first report of Rickettsia felis in a tick in this region and within this tick vector. This study suggests that there is a risk of companion animals contracting a species of Rickettsia from a tick bite in northeastern Georgia, indicating a need for more investigation and highlighting the importance of tick prevention on pets.
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Estrada I, Balagot C, Fierro M, Kriner P, Iniguez-Stevens E, Kjemtrup A, Foley J. Spotted fever group rickettsiae canine serosurveillance near the US-Mexico border in California. Zoonoses Public Health 2019; 67:148-155. [PMID: 31769616 DOI: 10.1111/zph.12666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/07/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Dogs are vulnerable to pathogens transmitted by brown dog ticks. An epidemic of Rocky Mountain spotted fever (RMSF) is underway in Mexicali, a Mexican city bordering California affecting people and dogs; several human cases have been reported in California residents who travelled to Mexico. To evaluate risks of RMSF, we conducted seroprevalence surveys in Imperial County in 2016 and 2017 using dogs as sentinels. METHODS Blood was collected from 752 dogs and was tested for antibodies against R. rickettsii, E. canis and A. phagocytophilum (as a proxy for A. platys). Samples were considered seropositive to spotted fever group rickettsia (SFGR) if the R. rickettsia titre was ≥1:64 and seropositive to E. canis and A. phagocytophilum if the titre was ≥1:32. Owners provided information on dog age, exposure risks, health status and tick prevention. We assessed associations between SFGR seropositivity and driving distance to the nearest US-Mexico border crossing station, whether proximity to a border crossing increased likelihood of taking dogs across the border, and whether distance to the border was associated with seropositivity. Logistic regression was performed to assess relationships between the titre classes and other predictor variables. RESULTS 12.2% of dogs were seropositive against SFGR. Dogs close to the border were significantly more likely to be taken across the border and to be seropositive. Risk factors that increased seropositivity included owners seeing ticks on the dog (OR = 1.9), being an adult dog, travel to Mexico (OR = 3.0) and living in a rural area (OR = 4.0). There was statistically significant co-exposure to SFGR and Anaplasma spp. CONCLUSION Surveillance for brown dog tick-vectored pathogens can help identify dogs and people at risk for RMSF. Tick prevention, particularly in dogs, and surveillance of tick-borne pathogens can help prevent the spread of rickettsioses and other diseases in this dynamic border region.
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Affiliation(s)
- Irais Estrada
- Epidemiology, Imperial County Public Health Department, El Centro, CA, USA
| | - Caroline Balagot
- Office of Binational Border Health, California Department of Public Health, San Diego, CA, USA
| | - Marian Fierro
- Epidemiology, Imperial County Public Health Department, El Centro, CA, USA
| | - Paula Kriner
- Epidemiology, Imperial County Public Health Department, El Centro, CA, USA
| | | | - Anne Kjemtrup
- Vector-Borne Disease Section, Infectious Disease Branch, California Department of Public Health, Sacramento, CA, USA
| | - Janet Foley
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA
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Pieracci EG, De La Rosa JDP, Rubio DL, Perales MES, Contreras MV, Drexler NA, Nicholson WL, De La Rosa JJP, Chung IH, Kato C, Barton Behravesh C, Enríquez MAG, Roldan JFG, Villarino ME. Seroprevalence of spotted fever group rickettsiae in canines along the United States-Mexico border. Zoonoses Public Health 2019; 66:918-926. [PMID: 31441594 DOI: 10.1111/zph.12642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/14/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
Portions of northern Mexico are experiencing a re-emergence of Rocky Mountain spotted fever (RMSF), a tickborne disease caused by Rickettsia rickettsii, a member of the spotted fever group of rickettsiae (SFGR). Infection with R. rickettsii can result in serious and life-threatening illness in people and dogs. Canine seroprevalence has been used as a sentinel for human RMSF in previous studies. This study aims to quantify SFGR seroprevalence in canines in three northern Mexican states and identify risk factors associated with seropositivity. A total of 1,136 serum samples and 942 ticks were obtained from dogs participating in government sterilization campaigns and from animal control facilities in 14 Mexican cities in three states. SFGR antibodies were detected using indirect immunofluorescence antibody assays at titre values ≥1/64. Six per cent (69 dogs) showed antibodies to SFGR, with the highest seroprevalence reported in Baja California (12%), Coahuila (4%) and Sonora (4%). Dogs from Baja California had three times higher odds of having SFGR antibodies compared to dogs from Sonora (OR = 3.38, 95% CI, 1.81-6.37). Roughly one quarter (25%) of surveyed dogs were parasitized by ticks (Rhipicephalus sanguineus sensu lato) at the time of sample collection. A portion of collected ticks were tested for rickettsial DNA using polymerase chain reaction. Positive samples were then sequenced, showing evidence of SFGR including R. massiliae, R. parkeri and R. rickettsii. Dogs that spent the majority of time on the street, such as free-roaming or community-owned dogs, showed a greater risk of tick infestation, seropositivity, bearing seropositive ticks, and may play a pivotal role in the spread of SFGR among communities. Estimating the seroprevalence of SFGR in the canine population can help public health campaigns target high-risk communities for interventions to reduce human RMSF cases.
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Affiliation(s)
- Emily G Pieracci
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia
| | | | - Daniel Luna Rubio
- Programa de Zoonosis y Rickettsiosis, de Isesalud en el Estado de Baja California, Tijuana, Mexico
| | | | | | - Naomi A Drexler
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - William L Nicholson
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Ida H Chung
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Cecilia Kato
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Casey Barton Behravesh
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Jesús Felipe González Roldan
- Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaria de Salud, Ciudad de Mexico, Mexico
| | - Margarita E Villarino
- US-Mexico Unit, Division of Global Migration and Quarantine, NCEZID, CDC, Atlanta, Georgia
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Kidd L, Qurollo B, Lappin M, Richter K, Hart JR, Hill S, Osmond C, Breitschwerdt EB. Prevalence of Vector-Borne Pathogens in Southern California Dogs With Clinical and Laboratory Abnormalities Consistent With Immune-Mediated Disease. J Vet Intern Med 2017; 31:1081-1090. [PMID: 28558145 PMCID: PMC5508353 DOI: 10.1111/jvim.14735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/24/2017] [Accepted: 04/12/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Studies investigating the prevalence of vector-borne pathogens in southern California dogs are limited. Occult infections might be misdiagnosed as idiopathic immune-mediated disease. HYPOTHESIS/OBJECTIVES (1) To determine the prevalence of vector-borne pathogens in southern California dogs with compatible clinical findings using PCR and serologic panels and (2) to determine whether testing convalescent samples and repeating PCR on acute samples using the same and different gene targets enhance detection. ANIMALS Forty-two client-owned dogs with clinical signs of vector-borne disease presenting to specialty practices in San Diego County. METHODS Combined prospective and retrospective observational study. Forty-two acute and 27 convalescent samples were collected. Acute samples were prospectively tested for antibodies to Rickettsia, Ehrlichia, Bartonella, Babesia, Borrelia, and Anaplasma species. PCR targeting Ehrlichia, Babesia, Anaplasma, hemotropic Mycoplasma, and Bartonella species was also performed. Retrospectively, convalescent samples were tested for the same organisms using serology, and for Ehrlichia, Babesia, Anaplasma, and Bartonella species using PCR. Acute samples were retested using PCR targeting Ehrlichia and Babesia species. RESULTS Evidence of exposure to or infection with a vector-borne pathogen was detected in 33% (14/42) of dogs. Ehrlichia and Babesia species were most common; each was identified in 5 dogs. Convalescent serologic testing, repeating PCR, and using novel PCR gene targets increased detection by 30%. CONCLUSIONS AND CLINICAL IMPORTANCE Repeated testing using serology and PCR enhances detection of infection by vector-borne pathogens in dogs with clinical signs of immune-mediated disease. Larger prevalence studies of emerging vector-borne pathogens in southern California dogs are warranted.
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Affiliation(s)
- L Kidd
- Western University of Health Sciences College of Veterinary Medicine, Pomona, CA
| | - B Qurollo
- Vector Borne Disease Diagnostic Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - M Lappin
- Center for Companion Animal Studies, Colorado State University College of Veterinary Medicine, Fort Collins, CO
| | - K Richter
- Veterinary Specialty Hospital, San Diego, CA
| | - J R Hart
- Veterinary Specialty Hospital, San Diego, CA
| | - S Hill
- Veterinary Specialty Hospital, San Diego, CA
| | - C Osmond
- California Veterinary Specialists, Carlsbad, CA
| | - E B Breitschwerdt
- Vector Borne Disease Diagnostic Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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The Eco-epidemiology of Pacific Coast Tick Fever in California. PLoS Negl Trop Dis 2016; 10:e0005020. [PMID: 27706171 PMCID: PMC5051964 DOI: 10.1371/journal.pntd.0005020] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/02/2016] [Indexed: 11/21/2022] Open
Abstract
Rickettsia philipii (type strain “Rickettsia 364D”), the etiologic agent of Pacific Coast tick fever (PCTF), is transmitted to people by the Pacific Coast tick, Dermacentor occidentalis. Following the first confirmed human case of PCTF in 2008, 13 additional human cases have been reported in California, more than half of which were pediatric cases. The most common features of PCTF are the presence of at least one necrotic lesion known as an eschar (100%), fever (85%), and headache (79%); four case-patients required hospitalization and four had multiple eschars. Findings presented here implicate the nymphal or larval stages of D. occidentalis as the primary vectors of R. philipii to people. Peak transmission risk from ticks to people occurs in late summer. Rickettsia philipii DNA was detected in D. occidentalis ticks from 15 of 37 California counties. Similarly, non-pathogenic Rickettsia rhipicephali DNA was detected in D. occidentalis in 29 of 38 counties with an average prevalence of 12.0% in adult ticks. In total, 5,601 ticks tested from 2009 through 2015 yielded an overall R. philipii infection prevalence of 2.1% in adults, 0.9% in nymphs and a minimum infection prevalence of 0.4% in larval pools. Although most human cases of PCTF have been reported from northern California, acarological surveillance suggests that R. philipii may occur throughout the distribution range of D. occidentalis. Rickettsia philipii, a spotted fever group rickettsia, is the etiologic agent of Pacific Coast tick fever, an emerging tick-borne disease transmitted by the Pacific Coast tick (Dermacentor occidentalis). The Pacific Coast tick’s range, and thus potential for exposure to R. philipii, includes most of California, southern Oregon, and northern Baja California, Mexico. This study describes the clinical manifestations of the 14 human cases reported to date in California and the known acarological risk factors for encountering PCTF. While Rickettsia rickettsii, the agent of Rocky Mountain spotted fever (RMSF) is genetically similar to R. philipii, PCTF is a milder disease than RMSF; the two diseases share key clinical features such as headache and fever but differ in that PCTF presents with a localized eschar (necrotic wound) but without a petechial rash. Most case-patients have illness onset dates in the summer (peak: July and August) which is coincident with the activity period of immature D. occidentalis. Results from this study support the premise that larval and nymphal D. occidentalis are the vectors of PCTF to humans in California. While only three ticks have tested positive for R. rickettsii over decades of surveillance in California, the prevalence of R. philipii in D. occidentalis ticks averages 0.4% in larvae, 0.9% in nymphs, and 2.1% in adult ticks, indicating a higher risk of acquiring PCTF than RMSF statewide.
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A cluster of Rickettsia rickettsii infection at an animal shelter in an urban area of Brazil. Epidemiol Infect 2014; 143:2446-50. [PMID: 25483025 DOI: 10.1017/s0950268814003161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rickettsia rickettsii infection is being increasingly recognized as an important cause of fatal acute illness in Brazil, where this tick-borne disease is designated Brazilian spotted fever (BSF). In this study we report five fatal cases of BSF in employees of an animal shelter in an urban area in the municipality of Rio de Janeiro in southeast Brazil after a natural disaster on 11 January 2011. Four of the cases occurred from 27 January to 11 April 2011, while the fifth fatal case was identified in April 2012. Three cases were confirmed by molecular analysis and two by epidemiological linkage. An investigation of BSF was performed in the animal shelter, and blood samples were collected from 115 employees and 117 randomly selected dogs. The presence of high levels (1024-4096) of antibodies against spotted fever group rickettsiae was found in three (2·6%) employees and 114 (97·5%) dogs. These findings emphasize the need to consider BSF as a possible cause of undifferentiated febrile illness, especially dengue and leptospirosis, in patients occupationally exposed to dogs heavily infested by ticks, mainly working at kennels and animal shelters that have inadequate space for the animals housed and frequently providing an environment conducive to exposure to pathogens such as R. rickettsii.
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Drexler N, Miller M, Gerding J, Todd S, Adams L, Dahlgren FS, Bryant N, Weis E, Herrick K, Francies J, Komatsu K, Piontkowski S, Velascosoltero J, Shelhamer T, Hamilton B, Eribes C, Brock A, Sneezy P, Goseyun C, Bendle H, Hovet R, Williams V, Massung R, McQuiston JH. Community-based control of the brown dog tick in a region with high rates of Rocky Mountain spotted fever, 2012-2013. PLoS One 2014; 9:e112368. [PMID: 25479289 PMCID: PMC4257530 DOI: 10.1371/journal.pone.0112368] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/30/2014] [Indexed: 11/26/2022] Open
Abstract
Rocky Mountain spotted fever (RMSF) transmitted by the brown dog tick (Rhipicephalus sanguineus sensu lato) has emerged as a significant public health risk on American Indian reservations in eastern Arizona. During 2003–2012, more than 250 RMSF cases and 19 deaths were documented among Arizona's American Indian population. The high case fatality rate makes community-level interventions aimed at rapid and sustained reduction of ticks urgent. Beginning in 2012, a two year pilot integrated tick prevention campaign called the RMSF Rodeo was launched in a ∼600-home tribal community with high rates of RMSF. During year one, long-acting tick collars were placed on all dogs in the community, environmental acaricides were applied to yards monthly, and animal care practices such as spay and neuter and proper tethering procedures were encouraged. Tick levels, indicated by visible inspection of dogs, tick traps and homeowner reports were used to monitor tick presence and evaluate the efficacy of interventions throughout the project. By the end of year one, <1% of dogs in the RMSF Rodeo community had visible tick infestations five months after the project was started, compared to 64% of dogs in Non-Rodeo communities, and environmental tick levels were reduced below detectable levels. The second year of the project focused on use of the long-acting collar alone and achieved sustained tick control with fewer than 3% of dogs in the RMSF Rodeo community with visible tick infestations by the end of the second year. Homeowner reports of tick activity in the domestic and peridomestic setting showed similar decreases in tick activity compared to the non-project communities. Expansion of this successful project to other areas with Rhipicephalus-transmitted RMSF has the potential to reduce brown dog tick infestations and save human lives.
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Affiliation(s)
- Naomi Drexler
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
- * E-mail:
| | - Mark Miller
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, Georgia, United States of America
| | - Justin Gerding
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, Georgia, United States of America
| | - Suzanne Todd
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, United States of America
| | - Laura Adams
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, United States of America
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - F. Scott Dahlgren
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
| | - Nelva Bryant
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
| | - Erica Weis
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
- Inter-Tribal Council of Arizona Inc., Tribal Epidemiology Center, Phoenix, Arizona, United States of America
| | - Kristen Herrick
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - Jessica Francies
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - Kenneth Komatsu
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - Stephen Piontkowski
- Indian Health Service, Office of Environmental Health and Engineering, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Jose Velascosoltero
- Indian Health Service, Office of Environmental Health and Engineering, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Timothy Shelhamer
- Indian Health Service, Office of Environmental Health and Engineering, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Brian Hamilton
- Indian Health Service, Infection Control Nurse, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Carmen Eribes
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Anita Brock
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Patsy Sneezy
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Cye Goseyun
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Harty Bendle
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Regina Hovet
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Velda Williams
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Robert Massung
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
| | - Jennifer H. McQuiston
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
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