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