Editing Rocky Mountain spotted fever (section)

==Epidemiology==
[[File:Rickettsiosis-incidence-map.jpg|thumb|upright=1.4|US distribution of spotted fever rickettsiosis, of which RMSF is a type, in 2014]]
There are between 500 and 2500 cases of Rocky Mountain spotted fever reported in the United States per year,<ref>{{cite web|title=Rocky Mountain Spotted Fever – Statistics and Epidemiology|url=https://www.cdc.gov/rmsf/stats/index.html|website=Centers for Disease Control|access-date=26 May 2016}}</ref> and in only about 20% can the tick be found.{{Citation needed|date=May 2011}}

Host factors associated with severe or fatal Rocky Mountain spotted fever include advanced age, male sex, African or Caribbean background, long-term excessive alcohol use and [[glucose-6-phosphate dehydrogenase]] (G6PD) deficiency. Deficiency of G6PD is a genetic condition affecting about 12 percent of the Afro-American male population. Deficiency in this enzyme is associated with a high proportion of severe cases of Rocky Mountain spotted fever.<ref>{{Cite journal|last1=Walker|first1=D. H.|last2=Hawkins|first2=H. K.|last3=Hudson|first3=P.|date=March 1983|title=Fulminant Rocky Mountain spotted fever. Its pathologic characteristics associated with glucose-6-phosphate dehydrogenase deficiency|journal=Archives of Pathology & Laboratory Medicine|volume=107|issue=3|pages=121–125|issn=0003-9985|pmid=6687526}}</ref> This is a rare clinical complication that is often fatal within five days of the onset of the disease.<ref>{{Cite journal |last=Chapman |first=Alice |date=2006-03-16 |title=Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichioses, and Anaplasmosis --- United States A Practical Guide for Physicians and Other Health-Care and Public Health Professionals |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm |access-date=2024-06-20 |journal=MMWR. Recommendations and Reports |volume=55 |issue=RR-4 |pages=1–27 |pmid=16572105 |publisher=CDC}}</ref>

In the early 1940s, outbreaks were described in the Mexican states of [[Sinaloa]], [[Sonora]], [[Durango]], and [[Coahuila]] driven by dogs and [[Rhipicephalus sanguineus|''Rhipicephalus sanguineus'' sensu lato]], the brown dog tick.<ref name=Al2017/> Over the ensuing 100 years case fatality rates were 30%–80%. In 2015, there was an abrupt rise in Sonora cases with 80 fatal cases. From 2003 to 2016, cases increased to 1394 with 247 deaths.<ref name=Al2017/>