In 1969, there was more than a 50% increase in the reported incidence of tick-borne typhus in the United States. This dramatic increase caps a ten-year trend of an ever-increasing number of cases of this disease. Virginia led the states in the major endemic area of the nation, the Piedmont plateau of the Southeast, with 91 reported cases. Yearly fluctuations may be attributable to climatic conditions influencing the relative number of ticks, but the long-term trend of increasing human morbidity is promoted by the apparently inexorable forces of population growth and land-use changes. More attention to precautionary measures by the public, as well as a heightened awareness of physicians, in major endemic states may prevent some deaths. Treatment should not await serological confirmation.
Peters AH. Tick-Borne Typhus (Rocky Mountain Spotted Fever): Epidemiologic Trends, With Particular Reference to Virginia. JAMA. 1971;216(6):1003–1007. doi:10.1001/jama.1971.03180320047009
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