Page 82 - Journal of Special Operations Medicine - Fall 2016

children under the age of 8 years and pregnant women,
for whom doxycycline is usually contraindicated because COL Burnett is currently Chief of Pediatric Infectious Dis-
of concerns of tooth staining. The recommended dos- eases at Tripler Army Medical Center in Hawaii, and is the
age is 100mg twice a day either orally or intravenously, Pediatric Subspecialties Consultant to the US Army Surgeon
and 2.2mg/kg of body weight twice a day for children General. He is board certified in Pediatrics and Pediatric In-
weighing less than approximately 45kg (100 lb). The fectious Diseases. He has served overseas in Korea, Germany,
recommended length of treatment is at least 3 days after Kosovo, Iraq, Afghanistan, Kuwait, and as the JSOTF-P Sur-
the resolution of fever and until clinical improvement is geon in the Philippines. He is a graduate of the University of
Wisconsin-Madison, and the Medical College of Wisconsin.
noted, which is typically at least 1 week of therapy. Lim-
ited studies performed do not recommend prophylactic
treatment for those who have had recent tick bites but Keywords: Rocky Mountain spotted fever; disease, rickett-
who are not ill. sial, tick-borne; Rickettsia rickettsii

Vaccination Rash of RMSF
There is no vaccination available for the prevention of
RMSF.

Importance in a Deployed Setting
RMSF is a risk to military forces who train and deploy
to wooded areas of the Americas. Wearing permethrin-
treated uniforms and using N,N-diethyl-meta-toluamide
(DEET)-containing insect repellents is key to the pre-
vention of this potentially catastrophic disease. Recog-
nition that this disease can be seen outside of the Rocky Source: Hardin Library for the Health Sciences, University of Iowa
Mountain region of the United States—and most often, http://hardinmd.lib.uiowa.edu/cdc/1962.html
it is—is paramount to the initiation of prompt appropri-
ate treatment that can be life-saving. Annual reported incidence (per million population) for RMSF
in the United States for 2010. (NN= Not notifiable)

Disclaimer
The views expressed in this publication are those of the
author and do not reflect the official policy or position
of the Department of the Army, Department of Defense,
or the US Government.

Disclosure
The author has nothing to disclose

Bibliography Source: Centers for Disease Control and Prevention
http://www.cdc.gov/rmsf/stats/
Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and man-
agement of tickborne rickettsial diseases: Rocky Mountain This figure shows the annual reported incidence of RMSF cases by
spotted fever and other spotted fever group rickettsioses, state in 2010 per million persons. RMSF was not notifiable in Alaska
ehrlichioses, and anaplasmosis—United States. MMWR Re- and Hawaii in 2010. The incidence rate was zero for Connecticut,
Kansas, Massachusetts, Nevada, South Dakota, Vermont and West
comm Rep. 2016;65(No. RR-2):1–44. Virginia. Incidence ranged between 0.2 to 1.5 cases per million per-
Centers for Disease Control and Prevention. Rocky Mountain sons for California, Colorado, Florida, Kentucky, Louisiana, Michi-
spotted fever (RMSF). https://www.cdc.gov/rmsf/index.html. gan, Minnesota, New Hampshire, New Mexico, North Dakota, Ohio,
Oregon, Pennsylvania, Texas, Utah, Washington and Wisconsin. An-
nual incidence ranged from 1.5 to 19 cases per million persons in
Alabama, Arizona, the District of Columbia, Georgia, Idaho, Illinois,
Indiana, Iowa, Maine, Maryland, Mississippi, Montana, Nebraska,
New Jersey, New York, Rhode Island, South Carolina, Virginia and
Wyoming. The highest incidence rates, ranging from 19 to 63 cases
per million persons were found in Arkansas, Delaware, Missouri,
North Carolina, Oklahoma, and Tennessee.

64 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2016