Content Information
A. Purpose of Surveillance and Reporting
- To identify where RMSF occurs in Iowa, and to recognize changes in disease incidence in the state.
- To focus preventive education, and to target tick control measures.
B. Laboratory and Healthcare Provider Reporting Requirements
Iowa Administrative Code 641-1.3(139) stipulates that the laboratory and the healthcare provider must report. After completing the investigation and gathering the information to complete the report form, enter the information into the Iowa Disease Surveillance System (IDSS), or FAX the report form with supporting laboratory documentation as follows: The reporting number for IDPH Center for Acute Disease Epidemiology (CADE) is (800) 362-2736; fax number (515) 281-5698, or mail (in an envelope marked “Confidential”) to the Iowa Department of Public Health, CADE mailing address:
Iowa Department of Public Health, CADE
Lucas State Office Building, 5th Floor
321 E. 12th St.
Des Moines, IA 50319-0075
Laboratory Testing Services Available
The University of Iowa State Hygienic Laboratory (SHL) tests single serum samples for R. rickettsii utilizing Indirect Fluorescence Antibody tests. Laboratory confirmation involves a single IFA serological titer of ³1:64. The State Hygienic Laboratory will identify ticks potentially carrying R. rickettsii. For more information on either sera or tick specimen submission, call the SHL at (319) 335-4500.
C. Local Public Health Agency Follow-Up Responsibilities
Case Investigation
The LPHA is responsible for completing the case report form in IDSS by interviewing the case and others who may be able to provide pertinent information. Much of the information required on the form can be obtained from the case’s healthcare provider or the medical record.
Use the following guidelines in completing the IDSS form:
- Accurately record demographic information, occupation, whether hospitalized (including location and associated dates), date of symptom onset, symptoms, laboratory information, treatment information, healthcare provider information, and disease outcome (e.g., recovered, died).
- Exposure history: Use the incubation period range for Rocky Mountain spotted fever (3-14 days). Specifically, focus on the period beginning a minimum of 3 days prior to onset and ending no more than 14 days before onset for the following exposures:
- Determine if a tick bit the case. If yes, record information about the duration of tick attachment, date(s) and geographic location(s) where the bite occurred.
- Travel history: Determine the geographic area(s) visited by the case.
- If the patient was diagnosed at the same time with another tick-borne disease (such as Lyme disease, ehrlichiosis, or babesiosis) please refer to other chapters in this manual and complete the appropriate IDSS case report forms.
- If several unsuccessful attempts have been made to obtain case information (the case or healthcare provider does not return calls or respond to a letter, or the case refuses to divulge information or is too ill to be interviewed), complete the IDSS form with as much information as possible. Make notations in IDSS “Notes” why any information is incomplete. If unable to get information, in IDSS select the appropriate reason under the Event tab in the Event Exception field.
If assistance is needed, contact CADE at (800) 362-2736; epidemiologists are available to answer questions about completing a case investigation.
Institution of disease control measures is an integral part of case investigation. It is the LPHA responsibility to understand, and, if necessary, institute the control guidelines listed in the Controlling Spread tab.