Only occurs in the western hemisphere and is the most common spotted fever rickettsiosis. More than 5000 cases of spotted fever rickettsiosis were reported in the US in 2018. It is unclear how many of these cases were RMSF as cases are reported under the category of spotted fever rickettsiosis.[4] While the incidence has generally increased over time, the case fatality rate has decreased (approximately 0.5% in 2020). However, this includes data on less severe spotted fevers; clinical reviews suggest 5% to 10% of RMSF cases are fatal.[5]

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