Risk Factors for Spotted Fever Group Rickettsioses in Kilimanjaro Region, Tanzania.

BACKGROUND

Knowledge gaps exist on risk factors for spotted fever group rickettsioses (SFGR) in sub-Saharan Africa. We sought to identify SFGR risk factors in Kilimanjaro Region, Tanzania.

METHODS

We recruited febrile patients presenting at 2 hospitals in Moshi from February 2012 through May 2014. Standardized clinical and risk factor questionnaires were administered. SFGR exposure was defined as a immunofluorescence antibody reciprocal titer ≥64, and acute SFGR as a ≥4-fold rise between paired sera. Logistic regression was used to identify associations.

RESULTS

Of 1190 participants providing ≥1 serum sample, the median age was 21.8 (range, 0.3-100.2) years, 646 (54.3%) were female, and 650 (54.6%) had SFGR exposure. Of 731 participants with paired sera, 67 (9.2%) had acute SFGR. On multivariable analysis, odds of acute SFGR were higher in the age group 0-2 years (adjusted odds ratios [aORs] for older age groups, <0.36; < .011), rural residence (aOR, 4.1; = .007), and areas with maximum daily temperature <26°C (aORs for higher temperature groups, <0.42; < .035). Odds of SFGR exposure were higher in those working in the garden (aOR, 1.8; = .010) and seeing a dog (aOR, 1.5; = .010). Odds of SFGR exposure were lower in the age group 0-2 years (aORs for older age groups, >1.5; < .026), female sex (aOR, 0.62; < .001), and being from the Chaga tribe (aOR, 0.68; = .003).

CONCLUSIONS

Those aged <2 years, rural residents, and persons residing in areas with cooler temperatures had increased odds of SFGR. Our results identify groups for further research on tick exposure and for targeted prevention interventions.