Bowhay Thomas R, Rubach Matthew P, Mendes Ângelo J F, Nicholson William L, Perniciaro Jamie L, Maze Michael J, Moorthy Ganga S, Halliday Jo E B, Allan Kathryn J, Mmbaga Blandina T, Saganda Wilbrod, Lwezaula Bingileki F, Kazwala Rudovick R, Cleaveland Sarah, Sharples Katrina J, Maro Venance P, Crump John A
Centre for International Health, University of Otago, Dunedin, New Zealand.
Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Open Forum Infect Dis. 2024 Nov 13;11(12):ofae664. doi: 10.1093/ofid/ofae664. eCollection 2024 Dec.
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.
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.
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).
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.
撒哈拉以南非洲地区关于斑点热群立克次体病（SFGR）的危险因素存在知识空白。我们试图确定坦桑尼亚乞力马扎罗地区的SFGR危险因素。
我们招募了2012年2月至2014年5月在莫希的2家医院就诊的发热患者。采用标准化的临床和危险因素调查问卷。SFGR暴露定义为免疫荧光抗体效价倒数≥64，急性SFGR定义为配对血清之间效价升高≥4倍。采用逻辑回归确定关联。
在提供≥1份血清样本的1190名参与者中，中位年龄为21.8岁（范围0.3 - 100.2岁），646名（54.3%）为女性，650名（54.6%）有SFGR暴露。在731名有配对血清的参与者中，67名（9.2%）有急性SFGR。多变量分析显示，0 - 2岁年龄组急性SFGR的几率更高（较年长年龄组的调整优势比[aORs]，<0.36；P <.011），农村居民（aOR，4.1；P =.007），以及日最高气温<26°C的地区（较高温度组的aORs，<0.42；P <.035）。在花园工作的人（aOR，1.8；P =.010）和接触过狗的人（aOR，1.5；P =.010）中SFGR暴露的几率更高。0 - 2岁年龄组（较年长年龄组的aORs，>1.5；P <.026）、女性（aOR，0.62；P <.001）以及来自查加部落的人（aOR，0.68；P =.003）中SFGR暴露的几率较低。
年龄<2岁者、农村居民以及居住在温度较低地区的人患SFGR的几率增加。我们的结果确定了需要进一步研究蜱暴露情况并进行针对性预防干预的人群。
