{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T05:31:36Z","timestamp":1774503096661,"version":"3.50.1"},"reference-count":18,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Japanese spotted fever (JSF) is a tick-borne rickettsiosis caused by <jats:italic>Rickettsia japonica<\/jats:italic>. Although the number of JSF cases has been increasing, exceeding 300 per year since 2017, clusters of cases are rare. Here, we report a cluster of seven JSF cases, the first nonfamilial cluster of the disease documented in the Japanese literature, and describe the management of the outbreak through prompt investigation and control-and-prevention measures performed collaboratively by members from the clinical, laboratory, and public health fields. All seven cases in the cluster had visited a cemetery in September or October of 2019. <jats:italic>R. japonica<\/jats:italic> was detected in whole-blood and\/or skin samples from six patients and in the larvae of <jats:italic>Haemaphysalis hystricis<\/jats:italic> collected in a field survey. The evidence suggested that this cluster of cases was caused by the conjunction of two circumstances within a short period of time: an increase in the number of visitors to a cemetery during a Buddhist event and an increase in the number of infectious tick larvae in the cemetery through hatching (vertical transmission from infected females). Delays in the treatment of JSF can lead to severe manifestations. Early interventions through collaborative efforts among members from the clinical, laboratory, and public health fields are important for controlling outbreaks, raising the awareness of the public, and diagnosing and treating patients.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0563","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T14:22:32Z","timestamp":1675088552000},"page":"513-517","source":"Crossref","is-referenced-by-count":2,"title":["A Cluster of Japanese Spotted Fever Cases Associated with Cemetery Visits in Wakayama City, Japan"],"prefix":"10.4269","volume":"108","author":[{"given":"Ken-ichiro","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuko","family":"Utatsu","sequence":"additional","affiliation":[{"name":"Section of Health Crisis Management, Wakayama City Public Health Center, Wakayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chisa","family":"Kanbe","sequence":"additional","affiliation":[{"name":"Section of Health Crisis Management, Wakayama City Public Health Center, Wakayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tetsuya","family":"Niu","sequence":"additional","affiliation":[{"name":"Section of Health Crisis Management, Wakayama City Public Health Center, Wakayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumio","family":"Terasoma","sequence":"additional","affiliation":[{"name":"Public Health Research Division, Wakayama Prefectural Research Center of Environment and Public Health, Wakayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Kubo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuhiro","family":"Komiya","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Emerg Infect Dis","first-page":"105","article-title":"Japanese spotted fever: report of 31 cases and review of the literature","volume":"3","author":"Mahara","year":"1997"},{"key":"b2","series-title":"Infect Agents Surveill Rep","first-page":"133","article-title":"Japanese spotted fever 1999\u20132019","volume":"41","year":"2020"},{"key":"b3","series-title":"J Infect Chemother","first-page":"83","article-title":"Clinical study of Japanese spotted fever and its aggravating factors","volume":"9","author":"Kodama","year":"2003"},{"key":"b4","series-title":"J Infect Chemother","first-page":"211","article-title":"The clinical course of 239 cases of Japanese spotted fever in Ise Red Cross Hospital, 2006\u20132019","volume":"28","author":"Sakabe","year":"2022"},{"key":"b5","series-title":"Infect Agents Surveill Rep","first-page":"109","article-title":"Scrub typhus and Japanese spotted fever in Japan 2007\u20132016","volume":"38","year":"2017"},{"key":"b6","year":"2022"},{"key":"b7","series-title":"J Vet Med Sci","first-page":"1666","article-title":"Associations between Japanese spotted fever (JSF) cases and wildlife distribution on the Boso Peninsula, central Japan (2006\u20132017)","volume":"82","author":"Matsuyama","year":"2020"},{"key":"b8","series-title":"Am J Trop Med Hyg","first-page":"336","article-title":"A cluster of cases of Rocky Mountain spotted fever in an area of Colombia not known to be endemic for this disease","volume":"101","author":"Londo\u00f1o","year":"2019"},{"key":"b9","series-title":"Vector Borne Zoonotic Dis","first-page":"143","article-title":"Clusters of Mediterranean spotted fever in Israel","volume":"7","author":"Keysary","year":"2007"},{"key":"b10","series-title":"Am J Trop Med Hyg","first-page":"835","article-title":"Case report: family cluster of Japanese spotted fever","volume":"98","author":"Matsuura","year":"2018"},{"key":"b11","series-title":"Jpn J Sanit Zool","first-page":"13","article-title":"Construction of a DNA database for ticks collected in Japan: application of molecular identification based on the mitochondrial 16S rDNA gene","volume":"65","author":"Takano","year":"2014"},{"key":"b12","series-title":"Infect Dis Clin North Am","first-page":"195","article-title":"Biology of ticks","volume":"22","author":"Anderson","year":"2008"},{"key":"b13","series-title":"Emerg Infect Dis","first-page":"810","article-title":"Acute tick-borne rickettsiosis caused by Rickettsia sibirica in the Russian Far East","volume":"10","author":"Mediannikov","year":"2004"},{"key":"b14","series-title":"Appl Environ Microbiol","first-page":"3926","article-title":"Endosymbionts of ticks and their relationship to Wolbachia spp. and tick-borne pathogens of humans and animals","volume":"63","author":"Noda","year":"1997"},{"key":"b15","series-title":"Ann Agric Environ Med","first-page":"271","article-title":"Locomotor activity of adult Dermacentor reticulatus ticks (Ixodida: Ixodidae) in natural conditions","volume":"24","author":"Buczek","year":"2017"},{"key":"b16","series-title":"J Infect Dev Ctries","first-page":"737","article-title":"Rocky Mountain spotted fever in Panama: a cluster description","volume":"5","author":"Tribaldos","year":"2011"},{"key":"b17","series-title":"Ticks Tick Borne Dis","first-page":"389","article-title":"Urban family cluster of spotted fever rickettsiosis linked to Rhipicephalus sanguineus infected with Rickettsia conorii subsp. caspia and Rickettsia massiliae","volume":"3","author":"Renvois\u00e9","year":"2012"},{"key":"b18","series-title":"Mem Inst Oswaldo Cruz","first-page":"117","article-title":"Outbreak of Rocky Mountain spotted fever in C\u00f3rdoba, Colombia","volume":"106","author":"Hidalgo","year":"2011"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/108\/3\/article-p513.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/108\/3\/article-p513.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/108\/3\/article-p513.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T13:31:31Z","timestamp":1677677491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/108\/3\/article-p513.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,1]]},"references-count":18,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.22-0563","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,1]]}}}