Novel Tickborne Disease and Tickborne Disease Incidence,

Kansas, 2012-2014

Daniel Neises, MPHSenior Epidemiologist

Bureau of Epidemiology and Public Health Informatics

Learning Objectives

• List the two most prevalent tickborne diseases in Kansas

• Identify the areas of the state where most of these infections occur.

Ixodes Species Life Cycle

Tickborne Disease Incidence, Kansas, 2012-2014

DiseaseConfirmed and Probable Cases

Spotted Fever Rickettsiosis 423Ehrlichiosis/Anaplasmosis 118Tularemia* 77Lyme Disease 73Bourbon virus 1

*Transmitted by ticks as well as deer flies, rabbits, and other animals

Species Tick Vector Geographic Distribution

Rickettsia rickettsii

Dermacentor variabilis (American dog tick)

East of the Rocky Mountains and limited areas on the Pacific Coast.

Rickettsia parkeri

Amblyomma maculatum (Gulf Coast tick)

Eastern and southern U.S., particularly along the coast

Rickettsia species 364D

Dermacentor occidentalis (Pacific Coast tick)

Northern California, Pacific Coast

Spotted Fever Rickettsiosis

Rocky Mountain Spotted Fever

• Characterized by acute onset of fever– Headache, myalgia,

malaise, nausea/vomiting

– Macular or maculopapular rash 4-7 days following onset (~80% patients)• Often on palms and soles

Ehrlichiosis/Anaplasmosis

• Similar diseases– Anaplasmosis used to be considered a type of

ehrlichiosis• Ehrlichia chaffeensis and Ehrlichia ewingii bacteria• Anaplasma phagocytophilum bacteria

• Characterized by acute onset of fever with:– Headache, myalgia, malaise– Anemia, leukopenia, thrombocytopenia, or elevated

hepatic transaminases– Nausea, vomiting, or rash may be present

Rocky Mountain Spotted Fever

Incidence per 100,000 population, 2012-2014*

*Mapped by county of exposure, not residence

Ehrlichiosis

Incidence per 100,000 population, 2012-2014*

*Mapped by county of exposure, not residence

Anaplasmosis

Incidence per 100,000 population, 2012-2014*

*Mapped by county of exposure, not residence

Tickborne Rickettsial Diseases, Confirmed and Probable Cases

2010 2011 2012 2013 20140

20

40

60

80

100

120

140

160

180

Spotted Fever Rickettsiosis

Ehrlichiosis/Anaplasmosis

Year

Case

s

Tickborne Rickettsial Diseases by Hospitalization Status

2012 2013 2014 2012 2013 2014Ehrlichiosis/Anaplasmosis Spotted fever rickettsiosis

0

20

40

60

80

100

120

140

160

180

TotalHospitalized

Case

s

Heartland Virus

• 2012, NW Missouri (Heartland Regional Medical Center in St. Joseph)– 2 patients hospitalized with fever, headache, fatigue

and diarrhea– A virus analysis = novel, genetically unique phlebovirus.– Likely transmitted by Lone Star tick

• As of May 2014– 10 cases identified among residents of Missouri,

Oklahoma, and Tennessee– 2 deaths

Bourbon Virus

• Late Spring 2014, KU Med Center– Previously healthy man from Bourbon County– History of tick bite, fever, fatigue, thrombocytopenia and

leukopenia – Given doxycycline for presumed tickborne illness– Multiorgan failure developed, and he died 11 days after

illness onset– Testing results for known tickborne pathogens were negative

• Tested for antibodies against Heartland virus, indicated presence of another virus

• Virus identified as a novel Thogotovirus, “Bourbon Virus”

Bourbon Virus

• Planned tick and human studies

KDHE Resources

• Disease statistics– kdheks.gov/epi/statistics.htm

• Epidemiology Hotline– Infectious Disease Epidemiologists available to

answer questions, provide recommendations

1-877-427-7317epihotline@kdheks.gov