Alabama Department of Public Health
Alabama Emergency Response Technology (ALERT) 
Health Alert Network (HAN)
June 26, 2025
Consider Vector-borne Disease Testing in Patients with Exposure to Ticks, Fleas, and Lice

The Alabama Department of Public Health (ADPH) is issuing this Health Advisory to inform healthcare providers and local public health officials of a potential increase in certain vector-borne diseases that are of growing regional concern. These conditions are caused by ticks, fleas, and lice, which are parasitic arthropods that can significantly impact both human and animal health. Bites can cause intense itching, allergic reactions, secondary bacterial infections due to scratching, and serious illnesses including, but  not limited to:

• Alpha-gal Syndrome
• Borrelia miyamotoi
• Orientia tsutsugamushi
• Rickettsia prowazekii
• Rickettsia typhi
• Tick-Borne Relapsing Fever

Background
According to CDC, an increase is occurring nationwide in the incidence or geographic distribution of the pathogens causing these vector-borne conditions. These illnesses are often underdiagnosed due to limited awareness and may require specific testing not available through commercial laboratories.

Recommendations for Clinicians

• Include these lesser-known vector-borne conditions in the differential diagnosis for patients with unexplained febrile illness, rash, headache, myalgias, or neurologic symptoms, particularly during vector-active months (spring through fall).
• Ask about travel history, outdoor activities, and tick, flea, and lice exposure in both domestic and international contexts.
• Contact ADPH for assistance with testing options when commercial testing is unavailable or limited.
• Initiate empirical treatment where appropriate (e.g., doxycycline for suspected rickettsial infection) without waiting for lab confirmation.
• Report suspected or confirmed cases of these conditions to ADPH even if they are not reportable. Please submit a REPORT for Reportable Disease/Conditions as a case of public health importance with detailed information on the illness.

For more information, visit:

CDC Alpha Gal Syndrome
CDC Borrelia miyamotoi 
CDC Orientia tsutsugamushi  
CDC Rickettsia prowazekii
CDC Rickettsia typhi
CDC Tick-Borne Relapsing Fever