2189. Improving Surveillance of Rocky Mountain Spotted Fever (RMSF): Implementation of a Multidisciplinary Process

Background Several Arizona tribal lands are highly endemic for the potentially deadly tickborne disease Rocky Mountain spotted fever (RMSF). In 2017, state public health officials were concerned with the underreporting of RMSF in our rural American Indian (AI) community. Surveillance of RMSF using serologic methods requires two samples—a baseline (acute) titer and a second (convalescent) titer two to 4 weeks later. Patient return rates are low, leading to poor understanding of disease burden. Our hospital serves a predominantly AI population that is spread across a large geographic area, with limited access to reliable transportation. Methods We established a model (Figure 1) for improved RMSF surveillance with a multidisciplinary team comprising clinicians, pharmacists, laboratorians, community health representatives (CHRs), environmental health, clinical care coordinators (CCCs), and public health nurses. The success and sustainability of the system depends on multiple departments sharing the workload. Results As a result of the model, we identified 22 cases of RMSF in 2018, including one death (Figure 2). Testing in the community increased over 9-fold and the total number of titers sent to state lab increased over 13-fold from 2017 to 2018. The system facilitated laboratory follow-up resulting in 61% of samples sent as pairs (acute + convalescent), compared with 36% of samples paired in 2017 (Figure 3). Conclusion This multidisciplinary process led to improved case identification, improved testing efficiency and sustainable surveillance for RMSF. There was a marked increase in RMSF cases detected at our site, an increase in the number of samples tested and the percent of paired samples obtained during 2018. Beyond this relative improvement, the success rate in paired titers is now the highest in Arizona State, where approximately 40% of samples are paired. There is a need for practical and integrated systems to more accurately test and track cases of RMSF in highly endemic, rural areas. Working together across departments was crucial to address challenges and provide solutions, and led to the success of the model. This process provides a model framework for inter-departmental collaboration and develops a unique system to improve both patient care and education to healthcare workers and the community. Disclosures All authors: No reported disclosures.