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Ehrlichia chaffeensis Seroprevalence Among Children in the Southeast and South-Central Regions of the United States
Gary S. Marshall, MD;
Richard F. Jacobs, MD;
Gordon E. Schutze, MD;
Helene Paxton, MS;
Steven C. Buckingham, MD;
John P. DeVincenzo, MD;
Mary Anne Jackson, MD;
Venusto H. San Joaquin, MD;
Steven M. Standaert, MD;
Charles R. Woods, MD;
for the Tick-Borne Infections in Children Study Group
Arch Pediatr Adolesc Med. 2002;156:166-170.
Background The reported annual incidence of human monocytic ehrlichiosis, which
is due to infection with Ehrlichia chaffeensis, is
as high as 5.5 per million in some states, but serosurveys suggest much higher
infection rates in some populations.
Objective To estimate the prevalence of E chaffeensis
infection among children aged 1 to 17 years living in the southeast and south-central
United States.
Design Cross-sectional serosurvey.
Setting Seven academic pediatric medical centers in the southeastern and south-central
United States.
Patients Nineteen hundred ninety-nine children (approximately 300 at each center)
having their blood drawn for any reason.
Main Outcome Measure The presence of antibody at 2 different cutoff titers to E chaffeensis, as detected by indirect immunofluorescence assay.
Results Overall, 250 children (13%) had E chaffeensis
antibody titers of 1:80 or higher and 61 (3%) had titers of 1:160 or higher.
Age-adjusted seroprevalence rates varied widely between sites. At 1:80 or
higher, the highest rate was in Winston-Salem, NC (22%), and the lowest was
in Louisville, Ky (2%). At 1:160 or higher, the highest rate was in Kansas
City, Mo (9%), and the lowest was in Oklahoma City, Okla (<1%). In univariate
analyses, no associations were found between seroprevalence at either cutoff
value and sex, race, source of specimen, or residence demographics. However,
age was a significant predictor of seroprevalence at both cutoff values. In
multiple logistic regression analysis, study site and age remained strong
predictors of seroprevalence, but living in a nonurban ZIP code was not significantly
related.
Conclusion Infection with E chaffeensis, or related ehrlichiae,
may be more common in children than previously recognized.
From the Divisions of Pediatric Infectious Diseases, University of
Louisville School of Medicine, Louisville, Ky (Dr Marshall), and the University
of Arkansas for Medical Sciences, Little Rock (Drs Jacobs and Schutze); PanBio
InDx, Inc, Baltimore, Md (Ms Paxton); the Divisions of Pediatric Infectious
Diseases, University of Tennessee Health Sciences Center, Memphis (Drs Buckingham
and DeVincenzo), the University of Missouri, Kansas City (Dr Jackson), and
the University of Oklahoma Health Sciences Center, Oklahoma City (Dr San Joaquin);
Department of Preventive Medicine, Vanderbilt University School of Medicine,
Nashville, Tenn (Dr Standaert); and Division of Pediatric Infectious Diseases,
Wake Forest University School of Medicine, Winston-Salem, NC (Dr Woods).
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