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A study of Rickettsia rickettsii was conducted in Rowan, Cabarrus, and Granville counties, North Carolina in an attempt to define the prevalence of endemic infection in this area. Serum samples were obtained from 1,976 healthy persons and tested by indirect hemagglutination for detectable antibodies to R. rickettsii. Of this group, 568 (28.7%) had detectable antibody (greater than or equal to 1:8), 80 (4%) had titers greater than or equal to 1:64, and 1,408 (70%) had no detectable antibody (less than or equal 1:8). Indirect immunofluorescence testing for antibody was also performed for 315 (15%) of the serum samples, of which 301 (95%) had undetectable titers and 14 (5%) had detectable titers ranging from 1:8 to greater than or equal to 1:64. Serological reactivity by indirect hemagglutination was detected in persons in the absence of known Rocky Mountain spotted fever. The study failed to show a good correlation of either the height of the geometric mean titer or percentage of seropositive persons with the previously determined age-related rates of acquisition of the disease. These data suggest that the antibodies measured may not be specific for R. rickettsii or that the antibody levels wane with time or both. It is probable that unrecognized infection occurs, but the true incidence or prevalence cannot be determined by available serological tests.
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