Partnering with tribes to improve American Indian health

The Rocky Mountain spotted fever (RMSF) Rodeo project

In 2003, a case of Rocky Mountain spotted fever (RMSF) was confirmed by the Centers for Disease Control and Prevention (CDC) as the cause of death of a 1-year-old American Indian child in Arizona in an area not previously known to have RMSF. A bacterial illness spread by the bite of an infected tick, RMSF can lead to death in more than 20% of cases when left untreated. Upon investigation, it was discovered that a new tick was spreading RMSF in Arizona. This tick–the brown dog tick–lives, eats, and breeds on dogs, bringing ticks out of the woods and into people’s homes. Cases in Arizona have reached epidemic proportions, with more than 300 cases and 20 deaths reported between 2002 and 2014. Children have been particularly affected, representing more than half of all cases and deaths from this terrible disease.

Because this type of tick lives in and around homes, prevention of RMSF had to go above and beyond bug spray and tick checks. CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) and the National Center for Environmental Health (NCEH) joined forces with tribal and local health departments, the Indian Health Service, Arizona Department of Health Services, and other public and private partners to design a new tick control strategy. A pilot project, the RMSF Rodeo, started in 2012 and used long-lasting tick collars on dogs, monthly environmental pesticide applications, and community-based education about tick control and pet health.

The RMSF Rodeo achieved rapid and dramatic control of tick populations–the number of dogs with ticks went from 63% to less than 1% in the first year, with efforts sustained in the second year with the tick collar alone. No deaths have occurred in the Rodeo community since the start of the projects, and cases in people have been reduced by 43%. Based on the overwhelming success of the initial RMSF Rodeo, the tribe decided to expand the key aspects of the project (including monthly pesticide application and use of the long-lasting collar) reservation-wide. The success has motivated other highly impacted tribes to implement similar prevention programs. Expansion of this prevention program is critical to continue to reduce the number of RMSF cases in people and save lives.

The Rodeo project serves as a model for other local communities seeking to reduce RMSF transmitted by the brown dog tick, and is now reaching across the US-Mexico border. In 2015, the government of Mexico declared RMSF to be a public health emergency. There have been a high number of cases reported, particularly among children, in some areas of Northern Mexico. NCEZID has formed collaborations with the Ministry of Health, state health departments, and academic institutions in Mexico to better define the burden of disease, increase diagnostic capacity, and create lasting prevention programs to reduce disability and death in Mexican communities.