Oster C N, Burke D S, Kenyon R H, Ascher M S, Harber P, Pedersen C E
N Engl J Med. 1977 Oct 20;297(16):859-63. doi: 10.1056/NEJM197710202971604.
Nine patients with laboratory-acquired Rocky Mountain spotted fever were seen during the period 1971 to 1976. Investigation of each case revealed either definite or probable exposure to an aerosol containing infectious rickettsiae; in no case was there evidence of parenteral exposure either by accidental self-inoculation or by tick bite. These illnesses are believed to represent infection acquired via the respiratory route. This report emphasizes the aerosol hazard of Rickettsia rickettsii in the laboratory and discusses the possibility of respiratory transmission of Rocky Mountain spotted fever in nature. The illness occurred only in personnel who had received either no vaccination or the primary series of the commercial (Lederie) vaccine against this infection. Other personnel who had received the primary series with multiple booster vaccinations demonstrated increased immunity as measured by humoral antibody titers and rickettsial antigen-induced lymphocyte transformation; no cases of clinical disease developed in these multiply-vaccinated personnel.
1971年至1976年期间，共发现9例实验室获得性落基山斑疹热患者。对每例病例的调查均显示，患者明确或可能接触了含有传染性立克次体的气溶胶；在任何病例中，均未发现有因意外自我接种或蜱叮咬而导致肠道外接触的证据。这些疾病被认为是通过呼吸道途径获得的感染。本报告强调了实验室中里氏立克次体的气溶胶危害，并讨论了落基山斑疹热在自然界中通过呼吸道传播的可能性。发病者均为未接种疫苗或未完成针对该感染的商用（Lederie）疫苗基础免疫接种的人员。其他完成基础免疫接种并多次接种加强针的人员，通过体液抗体滴度和立克次体抗原诱导的淋巴细胞转化检测显示免疫力增强；这些多次接种疫苗的人员均未出现临床疾病病例。
