Optimal control of a tick population with a view to control of Rocky Mountain Spotted Fever.

In some regions of the Americas, domestic dogs are the host for the tick vector Rhipicephalus sanguineus, and spread the tick-borne pathogen Rickettsia rickettsii, which causes Rocky Mountain Spotted Fever (RMSF) in humans. Interventions are carried out against the vector via dog collars and acaricidal wall treatments. This paper investigates the optimal control of acaricidal wall treatments, using a prior model for populations and disease transmission developed for this particular vector, host, and pathogen. It is modified with a death term during questing stages reflecting the cost of control and level of coverage. In the presence of the control, the percentage of dogs and ticks infected with Ri. rickettsii decreases in a short period and remains suppressed for a longer period, including after treatment is discontinued. Risk of RMSF infection declines by 90% during this time. In the absence of re-application, infected tick and dog populations rebound, indicating the eventual need for repeated treatment.

Alerta epidemiológico: alerta acerca do registro de casos de febre maculosa no Estado de São Paulo / Epidemiological alert: alert about the record of cases of spotted fever in the State of São Paulo

Alerta emitido pela Coordenação de Zoonoses da Gerência de Vigilância Epidemiológica de Doenças Transmissíveis (GVEDT) e o Centro de Informações Estratégicas e Resposta em Vigilância (CIEVS Goiás) da Gerência de Emergências em Saúde Pública (GESP) da Superintendência de Vigilância em Saúde (SUVISA) com o objetivo de alertar os profissionais de saúde quanto aos sinais e sintomas devido aos casos recentes de febre maculosa (FM) registrados no estado de São Paulo

Alert issued by the Zoonoses Coordination of the Communicable Diseases Epidemiological Surveillance Management (GVEDT) and the Center for Strategic Information and Surveillance Response (CIEVS Goiás) of the Public Health Emergencies Management (GESP) of the Health Surveillance Superintendence (SUVISA) in order to alert health professionals about the signs and symptoms due to recent cases of spotted fever (FM) registered in the state of São Paulo

Genetic sequencing of a 1944 Rocky Mountain spotted fever vaccine.

Rocky Mountain spotted fever (RMSF) is a rapidly progressive and often fatal tick-borne disease caused by Rickettsia rickettsii. Its discovery and characterization by Howard Ricketts has been hailed as a remarkable historical example of detection and control of an emerging infectious disease, and subsequently led to the establishment of the Rocky Mountain Laboratories (RML). Here, we examined an unopened bottle of a vaccine, labeled as containing RMSF inactivated by phenol-formalin of infected ticks, developed prior to 1944 at RML by DNA analysis using Illumina high throughput sequencing technology. We found that it contains DNA from the Rocky Mountain wood tick (Dermacentor andersoni), the vector of RMSF, the complete genome of Rickettsia rickettsii, the pathogen of RMSF, as well as the complete genome of Coxiella burnetii, the pathogen of Q-fever. In addition to genomic reads of Rickettsia rickettsii and Coxiella burnetii, smaller percentages of the reads are from Rickettsia rhipicephali and Arsenophonus nasoniae, suggesting that the infected ticks used to prepare the vaccine carried more than one pathogen. Together, these findings suggest that this early vaccine was likely a bivalent vaccine for RMSF and Q-fever. This study is the among the first molecular level examinations of an historically important vaccine.

Knowledge, Attitudes, and Practices Related to Rocky Mountain Spotted Fever in Hermosillo, México.

Rocky Mountain spotted fever (RMSF) is a serious disease in northwest Mexico, particularly in low-income communities. This study aimed to evaluate RMSF-related knowledge, attitudes, and practices in an endemic urban area with a high burden of the disease. A cross-sectional study design using a non-probabilistic household survey was conducted with 400 residents in Hermosillo, Mexico. Primary themes assessed included dog and tick-related exposure, RMSF knowledge, healthcare-seeking behavior, sociodemographic data, and household information. The majority (59%) of those surveyed had heard about RMSF, although only 36% of RMSF-aware respondents knew any RMSF symptoms. Among RMSF-aware respondents, 26% did not know or were unsure of prevention strategies. Individuals in the low socioeconomic status (SES) stratum were less likely to have heard about RMSF (odds ratio [OR]: 0.39; 95% CI: 0.25-0.59), use dog collars or any other product to avoid ticks (OR: 0.40; 95% CI: 0.17-0.99), or check their dogs for ticks (OR: 0.25; 95% CI: 0.09-0.74). The likelihood of observing high numbers of free-roaming dogs in their neighborhood was four times higher in the low SES stratum (OR: 4.19; 95% CI: 2.10-8.38) than in the high SES stratum. These findings emphasize the need for an integrative community approach to improve early recognition of symptoms and knowledge of prevention strategies, particularly in low SES neighborhoods.

In vitro acaricidal activity of different ectoparasiticide classes against Amblyomma sculptum larvae.

Zoonoses are major causes of morbidity and mortality worldwide. Among them, Brazilian Spotted Fever (BSF) is an important one that occurs in some regions of South America and can be transmitted by the "star tick" Amblyomma sculptum. Application of acaricides against the larval stage is important as strategy of population control. However, there is still a deficiency of studies on chemical control of A. sculptum and the present work aims to evaluate the in vitro acaricidal activity of cypermethrin, flumethrin, deltamethrin, fipronil, coumaphos and chlorpyrifos against A. sculptum larvae. Bioassays were performed using the larval immersion test method. A discriminatory analysis between the antiparasitic classes most used for tick control was carried out, which made it possible to determine the classes with higher potential for controlling A. sculptum larvae. Our results showed that A. sculptum larvae present highest sensitivity to the synthetic pyrethroid group, followed by the phenylpyrazole, organophosphate and macrocyclic lactone groups. These findings may support studies on improvement of tick control as in animals as in the environment.

Community-based prevention of epidemic Rocky Mountain spotted fever among minority populations in Sonora, Mexico, using a One Health approach.

BACKGROUND: Rocky Mountain spotted fever (RMSF) is a significant public health problem in Sonora, Mexico, resulting in thousands of cases and hundreds of deaths. Outbreaks of RMSF are perpetuated by heavy brown dog tick infestations in and around homes. During 2009-2015, there were 61 RMSF cases and 23 deaths in a single community of Sonora (Community A). METHODS: An integrated intervention was carried out from March-November 2016 aimed at reducing tick populations with long-acting acaricidal collars on dogs, environmental acaricides applied to peri-domestic areas and RMSF education. Tick levels were measured by inspection of community dogs to monitor efficacy of the intervention. A similar neighborhood (Community B) was selected for comparison and received standard care (acaricide treatment and education). RESULTS: The prevalence of tick-infested dogs in Community A declined from 32.5% to 8.8% (p<0.01). No new cases of RMSF were identified in this area during the subsequent 18 mo. By comparison, the percentage of tick-infested dogs in Community B decreased from 19% to 13.4% (p=0.36) and two cases were reported, including one death. CONCLUSIONS: Community-based interventions using an integrated approach to control brown dog ticks can diminish the morbidity and mortality attributable to RMSF.

In vitro acaricidal activity of different ectoparasiticide classes against Amblyomma sculptum larvae / Atividade acaricida in vitro de diferentes classes de ectoparasiticidas frente a larvas de Amblyomma sculptum

Abstract Zoonoses are major causes of morbidity and mortality worldwide. Among them, Brazilian Spotted Fever (BSF) is an important one that occurs in some regions of South America and can be transmitted by the "star tick" Amblyomma sculptum. Application of acaricides against the larval stage is important as strategy of population control. However, there is still a deficiency of studies on chemical control of A. sculptum and the present work aims to evaluate the in vitro acaricidal activity of cypermethrin, flumethrin, deltamethrin, fipronil, coumaphos and chlorpyrifos against A. sculptum larvae. Bioassays were performed using the larval immersion test method. A discriminatory analysis between the antiparasitic classes most used for tick control was carried out, which made it possible to determine the classes with higher potential for controlling A. sculptum larvae. Our results showed that A. sculptum larvae present highest sensitivity to the synthetic pyrethroid group, followed by the phenylpyrazole, organophosphate and macrocyclic lactone groups. These findings may support studies on improvement of tick control as in animals as in the environment.

Resumo As zoonoses são a maior causa de morbidade de mortalidade no mundo. A Febre Maculosa Brasileira (FMB) é uma importante zoonose que ocorre em algumas regiões da América do Sul e pode ser transmitida pelo "carrapato-estrela" Amblyomma sculptum. A aplicação de acaricidas, frente ao estágio larval, é importante como estratégia no controle da população. No entanto, ainda há uma deficiência de estudos para o controle químico de A. sculptum. Devido à necessidade de mais informações sobre o controle de A. sculptum, o presente trabalho tem como objetivo avaliar a atividade acaricida in vitro de cipermetrina, flumetrina, deltametrina, fipronil, coumafós e clorpirifós frente a larvas de A. sculptum. Os bioensaios foram realizados pelo método Teste de Imersão de Larva. Foi realizada uma análise discriminatória entre as classes antiparasitárias mais utilizadas para controle de carrapatos, possibilitando determinar classes com maior potencial para o controle de larvas de A. sculptum. Os resultados deste trabalho mostraram que as larvas de A. sculptum apresentam maior sensibilidade ao grupo dos piretroides sintéticos, seguido pelos grupos fenilpirazóis, organofosforados e lactonas macrocíclicas. Esses achados poderiam apoiar estudos visando ao controle do carrapato tanto em animais quanto no meio ambiente.

A febre maculosa brasileira e o discurso da mídia impressa: perspectivas de atores envolvidos / Brazilian spotted fever and the print media's discourse: perspectives from actors involved / La fiebre maculosa brasileña y el discurso de los medios impresos: perspectivas de los actores envueltos

A febre maculosa brasileira (FMB) é uma doença infecciosa com alta letalidade que mobiliza ações de prevenção e controle com grande impacto na opinião pública. A capivara é fundamental na epidemiologia da doença, servindo como dispersora do vetor infectado. Objetiva-se compreender e analisar o discurso da FMB entre representantes da sociedade, circulante em um meio de comunicação impresso do município de Campinas, São Paulo, Brasil. Partindo da análise exploratória dos dados e seguindo para a análise do discurso (AD), as discursividades foram observadas. Com diferentes ressonâncias, relacionavam-se aos óbitos pela doença e ao abate das capivaras, com preferência para alguns protagonistas do discurso e apagamento de outros sujeitos. Privilégios para divulgação de notícias parciais e sensacionalistas reforçaram a polarização sobre o tema. Concluiu-se que houve pouca contribuição para uma comunicação em saúde crítica e colaborativa, essencial para a consciência sanitária da população.(AU)

Brazilian Spotted Fever (BSF) is a highly lethal infectious disease that mobilizes prevention and control actions that have a large impact on public opinion. The capybara is fundamental in the epidemiology of the disease, as it serves as the spreader of the infected vector. The aim of this study is to understand and analyze the society representatives' discourse about BSF that circulates in a printed means of communication of the city of Campinas, State of São Paulo, Brazil. Starting with exploratory data analysis and moving on to discourse analysis, we investigated the discursivities: with different resonances, they were related to deaths caused by the disease and to the slaughter of capybaras. Preference was given to some protagonists of the discourse, while other subjects were obliterated. Dissemination of partial and sensational news strengthened the polarization about the theme. We concluded that there was a scarce contribution to a critical and collaborative communication in the area of health, essential for the population's sanitary awareness.(AU)

La fiebre maculosa brasileña (FMB) es una enfermedad infecciosa con alta letalidad que moviliza acciones de prevención y control con gran impacto en la opinión pública. El carpincho es fundamental en la epidemiología de la enfermedad, sirviendo como diseminador del vector infectado. El objetivo es comprender y analizar el discurso de la FMB entre representantes de la sociedad, circulante en un medio de comunicación impreso del municipio de Campinas, São Paulo, Brasil. Partiendo del análisis de exploración de los datos y continuando para el análisis del discurso, se observaron las discursividades. Con diferentes resonancias, se relacionaban a los fallecimientos por la enfermedad y a la matanza de los carpinchos. Preferencias para algunos protagonistas del discurso, apagándose otros sujetos. Privilegios para divulgación de noticias parciales y sensacionalistas reforzaron la polarización sobre el tema. Se concluyó que hubo poca contribución para una comunicación de salud crítica y colaborativa, esencial para la conciencia sanitaria de la población.(AU)

Brazilian Spotted Fever Prevention through a Nonlethal Capybara Population Control Strategy.

INTRODUCTION: Brazilian spotted fever (BSF), a lethal tick-borne Rickettsioses (2000 - 2018 >600 human deaths) involving synanthropic capybara as host. METHODS: We introduced an alternative to mitigate human-capybara conflicts and epidemiologic concerns of BSF. Complex aspects like transmission dynamics, risk areas, host mobility, and birth rate control, were considered to develop a prevention strategy using an anti-GnRH vaccine. RESULTS: The propositioned immunocontraceptive potentially remove and prevent the spread of BSF from endemic areas. CONCLUSIONS: We propose the anti-GnRH vaccine as a BSF prevention strategy based on these favorable results.

The Dynamics of Ticks and Capybaras in a Residential Park Area in Southeastern Brazil: Implications for the Risk of Rickettsia rickettsii Infection.

The bacterium Rickettsia rickettsii causes Brazilian spotted fever (BSF), a highly lethal disease that is transmitted by Amblyomma sculptum ticks in areas where capybaras (Hydrochoerus hydrochaeris) are the tick's major hosts. In this study, we evaluated the expansion of a capybara population in a residential park in São Paulo state, and the implications of such expansion to the occurrence of ticks and BSF. The capybara population was quantified during 2004-2013. In 2012, there was a BSF human case in the area, culminating in the complete fencing of the residential park and the official culling of all capybaras. Quantification of ticks in the environment was performed by dry ice traps from 2005 to 2018. Domestic dogs in 2006-2011 and capybaras in 2012 were serologically tested for the presence of anti-R. rickettsii antibodies. Our results show that capybara numbers increased ≈5 times from 2004 (41 capybaras) to 2012 (230 capybaras). Dry ice traps collected A. sculptum and Amblyomma dubitatum. The number of A. dubitatum adult ticks was generally higher than A. sculptum adults during 2005-2006; however, during 2012-2013, A. sculptum outnumbered A. dubitatum by a large difference. During 2016-2018 (after capybara culling), the number of both species fell close to zero. The low numbers of A. sculptum adult ticks during 2005-2006 coincided with relatively low capybara numbers (<80). Thereafter, in 2012, we counted the highest numbers of both A. sculptum ticks and capybaras (230 animals). All 40 canine blood samples were seronegative to R. rickettsii, in contrast to the 48.3% seropositivity (83/172) among capybaras. Our results support that the emergence of BSF in the residential park was a consequence of the increase of the local capybara population, which in turn, provided the increment of the A. sculptum population. Culling the entire capybara population eliminated the risks of new BSF cases.

Rickettsia rickettsii Whole-Cell Antigens Offer Protection against Rocky Mountain Spotted Fever in the Canine Host.

Rocky Mountain spotted fever (RMSF) is a potentially fatal tick-borne disease in people and dogs. RMSF is reported in the United States and several countries in North, Central, and South America. The causative agent of this disease, Rickettsia rickettsii, is transmitted by several species of ticks, including Dermacentor andersoni, Rhipicephalus sanguineus, and Amblyomma americanum RMSF clinical signs generally include fever, headache, nausea, vomiting, muscle pain, lack of appetite, and rash. If untreated, it can quickly progress into a life-threatening illness in people and dogs, with high fatality rates ranging from 30 to 80%. While RMSF has been known for over a century, recent epidemiological data suggest that the numbers of documented cases and the fatality rates remain high in people, particularly during the last two decades in parts of North America. Currently, there are no vaccines available to prevent RMSF in either dogs or people. In this study, we investigated the efficacies of two experimental vaccines, a subunit vaccine containing two recombinant outer membrane proteins as recombinant antigens (RCA) and a whole-cell inactivated antigen vaccine (WCA), in conferring protection against virulent R. rickettsii infection challenge in a newly established canine model for RMSF. Dogs vaccinated with WCA were protected from RMSF, whereas those receiving RCA developed disease similar to that of nonvaccinated R. rickettsii-infected dogs. WCA also reduced the pathogen loads to nearly undetected levels in the blood, lungs, liver, spleen, and brain and induced bacterial antigen-specific immune responses. This study provides the first evidence of the protective ability of WCA against RMSF in dogs.

Brazilian spotted fever prevention through a nonlethal capybara population control strategy

Abstract INTRODUCTION: Brazilian spotted fever (BSF), a lethal tick-borne Rickettsioses (2000 - 2018 >600 human deaths) involving synanthropic capybara as host. METHODS: We introduced an alternative to mitigate human-capybara conflicts and epidemiologic concerns of BSF. Complex aspects like transmission dynamics, risk areas, host mobility, and birth rate control, were considered to develop a prevention strategy using an anti-GnRH vaccine. RESULTS: The propositioned immunocontraceptive potentially remove and prevent the spread of BSF from endemic areas. CONCLUSIONS: We propose the anti-GnRH vaccine as a BSF prevention strategy based on these favorable results.

Hosts mobility and spatial spread of Rickettsia rickettsii.

There are a huge number of pathogens with multi-component transmission cycles, involving amplifier hosts, vectors or complex pathogen life cycles. These complex systems present challenges in terms of modeling and policy development. A lethal tick-borne infectious disease, the Brazilian Spotted Fever (BSF), is a relevant example of that. The current increase of human cases of BSF has been associated with the presence and expansion of the capybara Hydrochoerus hydrochaeris, amplifier host for the agent Rickettsia rickettsii and primary host for the tick vector Amblyomma sculptum. We introduce a stochastic dynamical model that captures the spatial distribution of capybaras and ticks to gain a better understanding of the spatial spread of the R. rickettsii and potentially predict future epidemic outcomes. We implemented a reaction-diffusion process in which individuals were divided into classes denoting their state with respect to the disease. The model considered bidirectional movements between base and destination locations limited by the carrying capacity of the environment. We performed systematic stochastic simulations and numerical analysis of the model and investigate the impact of potential interventions to mitigate the spatial spread of the disease. The mobility of capybaras and their attached ticks was significantly influenced by the birth rate of capybaras and therefore, disease propagation velocity was higher in places with higher carrying capacity. Some geographical barriers, generated for example by riparian reforesting, can impede the spatial spread of BSF. The results of this work will allow the formulation of public actions focused on the prevention of BSF human cases.

Th1 epitope peptides induce protective immunity against Rickettsia rickettsii infection in C3H/HeN mice.

Rickettsia rickettsii is the causative pathogen of Rocky Mountain spotted fever (RMSF). Adr2, YbgF and OmpB are protective antigens of R. rickettsii. In this study, 90 candidate peptides were selected from these antigens based on their high-affinity binding capacity for the MHC class II molecule H2 I-A or H2 I-E using bioinformatic methods. Six peptides were determined using ELISPOT assay to be immunodominant based on the IFN-γ recall responses of CD4+ T cells from mice immunized with R. rickettsii. Six nucleotide sequences encoding the immunodominant peptides were linked in series and inserted into a plasmid for expression in Escherichia coli cells, resulting in a new, recombinant polypeptide termed GWP. After immunization and challenge, the rickettsial load or histopathological lesions in the organs of mice immunized with GWP or pooled peptides was significantly lower than that in organs of mice immunized with PBS or the individual peptide OmpB399. An in vitro neutralization test revealed that sera from mice immunized with GWP, OmpB399, or pooled peptides reduced R. rickettsii adherence to, and invasion of, vascular endothelial cells. Furthermore, significantly higher levels of IgG, IgG1, or IgG2a were detected in sera from mice immunized with GWP or pooled peptides, and significantly higher levels of IFN-γ or TNF-α secreted by CD4+ T cells from R. rickettsii-infected mice were detected after immunization with GWP. Altogether, our results indicated that polypeptides, especially GWP, could induce a Th1-type immune response against R. rickettsii infection, which might contribute to the rational design of peptide-based vaccines for RMSF.

Rocky Mountain spotted fever in Mexico: past, present, and future.

Rocky Mountain spotted fever, a tick-borne zoonosis caused by Rickettsia rickettsii, is among the most lethal of all infectious diseases in the Americas. In Mexico, the disease was first described during the early 1940s by scientists who carefully documented specific environmental determinants responsible for devastating outbreaks in several communities in the states of Sinaloa, Sonora, Durango, and Coahuila. These investigators also described the pivotal roles of domesticated dogs and Rhipicephalus sanguineus sensu lato (brown dog ticks) as drivers of epidemic levels of Rocky Mountain spotted fever. After several decades of quiescence, the disease re-emerged in Sonora and Baja California during the early 21st century, driven by the same environmental circumstances that perpetuated outbreaks in Mexico during the 1940s. This Review explores the history of Rocky Mountain spotted fever in Mexico, current epidemiology, and the multiple clinical, economic, and social challenges that must be considered in the control and prevention of this life-threatening illness.

Notes from the Field: Community-Based Prevention of Rocky Mountain Spotted Fever - Sonora, Mexico, 2016.

Rocky Mountain spotted fever (RMSF), a life-threatening tickborne zoonosis caused by Rickettsia rickettsii, is a reemerging disease in Mexico (1,2). R. rickettsii is an intracellular bacterium that infects vascular endothelium and can cause multisystem organ failure and death in the absence of timely administration of a tetracycline-class antibiotic, typically doxycycline. Epidemic RMSF, as described in parts of Arizona and Mexico, is associated with massive local infestations of the brown dog tick (Rhiphicephalus sanguineus sensu lato) on domestic dogs and in peridomestic settings that result in high rates of human exposure; for example, during 2003-2012, in Arizona the incidence of RMSF in the three most highly affected communities was 150 times the U.S. national average (3,4). In 2015, the Mexico Ministry of Health (MOH) declared an epidemiologic emergency because of high and sustained rates of RMSF in several states in northern Mexico, including the state of Sonora. During 2004-2015, a total of 1,129 cases and 188 RMSF deaths were reported from Sonora (Sonora MOH, unpublished data, 2016). During 2009-2015, one impoverished community (community A) in Sonora reported 56 cases of RMSF involving children and adolescents, with a case-fatality rate of 40% (Sonora MOH, unpublished data, 2016). Poverty and lack of timely access to health services are risk factors for severe RMSF. Children are especially vulnerable to infection, because they might have increased contact with dogs and spend more time playing around spaces where ticks survive (5). In Sonora, case fatality rates for children aged <10 years can be as high as 30%, which is almost four times the aggregate case-fatality rate reported for the general population of the state (8%) (2), and 10-13 times higher than the case-fatality rate described for this age group in the United States (2.4%) (6).

High Seroprevalence for Rickettsia rickettsii in Equines Suggests Risk of Human Infection in Silent Areas for the Brazilian Spotted Fever

Equines play a role in the epidemiology of Brazilian spotted fever (BSF) since they are a primary host for the tick Amblyomma sculptum.We studied the seroprevalence for three species of Rickettsia in equines in four endemic (with human cases) and in four non-endemic areas (no human cases) in the Piracicaba River Basin, São Paulo, Brazil. A serological survey of 504 equines was performed: around 63 animals were sampled in each area and tested through indirect immunofluorescence assay for R. rickettsii, R. parkeri, and R. bellii in2012–2013. Blood samples were seropositive for 183 equines (36.3%) in which 73 (39.9%) were from non-endemic areas. In the studied sites equines were highly exposed to Rickettsia infection ranging from 6.1% to 54.7%, with Geometric Mean Titers greater in endemic area (p = 0.012). Results suggest that Rickettsia may be more widespread than the surveillance of BSF has detected. These results highlight the need to include data on the seroprevalence of sentinel animals to improve human diagnoses and surveillance in areas with no reported human cases...

Failure of a heterologous recombinant Sca5/OmpB protein-based vaccine to elicit effective protective immunity against Rickettsia rickettsii infections in C3H/HeN mice.

Spotted fever group (SFG) rickettsial species are obligate intracellular tick-borne pathogens that are responsible for important human diseases. Previous reports have demonstrated the feasibility of using recombinant surface cell antigen Sca5/OmpB to elicit protective immunity against homologous challenges using murine models of Mediterranean spotted fever and Rocky Mountain spotted fever. In addition, the feasibility of generating cross-protective immunity against related rickettsial species has also been established, but the molecular basis for these phenomena was not explored. Here, we demonstrate that vaccination of C3H/HeN mice with a recombinant OmpB domain derived from Rickettsia conorii induced high titer humoral immune responses that are capable of recognizing the native OmpB protein at the R. rickettsii outer membrane, but this immunization was not sufficient to induce effective protective immunity. In contrast, animals vaccinated with a corresponding OmpB domain derived from R. rickettsii protected animals from fatal outcomes. These results demonstrate that vaccination with nearly identical antigens may not be an effective strategy to induce wide-ranging protective immunity against related SFG Rickettsia species.

Vigilância e controle de carrapatos transmissores da Febre Maculosa Brasileira no estado de São Paulo

A febre maculosa brasileira (FMB) foi reconhecida pela primeira vez no estado de São Paulo quando da ocorrência de casos numa área de expansão urbana nos atuais bairros paulistanos de Sumaré, Perdizes e Pinheiros, em 1929. Nas décadas seguintes a ocorrência de casos nestas áreas sofreu progressivo declínio e somente a partir do final da década de 1970 e início da de 1980 é que novos casos voltaram a ser descritos na Região Metropolitana de São Paulo...