Table. Conceptual framework for community-based prevention of RMSF listing proposed indicators and action items for communities at medium and high risk for endemic transmission*.

Core function	Recommended risk level indicators	Action	Relative cost
Healthcare system coordination and public health reporting	Presence or absence of provider education around ticks and tickborne diseases, provider understanding of diagnosing and treating tickborne diseases, diagnostic testing capacity, distance to healthcare, availability of medical transport	Implement standardized RMSF patient treatment protocol in all affected areas to include follow up contact to ensure treatment continues if the patient leaves endemic area health facilities	$
		Use RMSF patient treatment algorithm in patients experiencing with fever or a history of contact with ticks	$$
		Disseminate education on RMSF for support staff and healthcare providers	$
		Require continuing medical education for healthcare providers, including MDs in primary care, emergency care, internal care, family practice, and pediatrics, physician assistants, and nursing staff providing care; consider embedding RMSF training course into the onboarding process for new hires	$$
		Establish a clinical task force to address areas of varying needs and priorities	$
Community education and outreach	Percent of population below local poverty level, educational attainment in community; presence or absence of health education around ticks and tickborne diseases; knowledge, attitudes, and behaviors about personal and home tick prevention; percent of population with internet access	Disseminate education on RMSF for support staff and community health workers	$$
		Consider embedding RMSF training course into the onboarding process for new hires in public interfacing agencies	$
		Create an RMSF communication plan so all communities get consistent messaging	$
Animal control and veterinary programs	Wellness: presence or absence of veterinary services, availability of effective ectoparasite treatments for dogs in community, number of spayed or neutered animals, cost of effective ectoparasite treatments for dogs in community; free-roaming population status: density of free-roaming dogs, presence or absence of ordinance forbidding free roaming dogs, fencing and tethering behaviors across community; access to resources: presence or absence of animal control department, presence or absence of animal shelter space, number of low- or no-cost spay and neuter clinics	Establish animal control programs	$$$
		Establish veterinary services	$$$
Environmental tick surveillance and control	Harborage: presence or absence of municipal and community solid waste removal, landfill cost and availability; pesticide use: presence or absence of vector control program, presence or absence of certified pesticide applicators; community knowledge, Attitudes, and Practices about tickborne diseases: presence or absence of community education around ticks and tickborne diseases	Develop programs to provide regular tick control services for each home in affected areas	$$$
		Implement environmental tick surveillance to provide measurement and direction for prevention efforts	$$$
Finance and budget	Presence or absence of dedicated annual jurisdictional funding to all partners for RMSF prevention, presence or absence of personnel capable of writing and managing grants	Engage leadership to advocate for sustainable funding for all RMSF prevention partners	$
		Train personnel across all RMSF prevention partnering agencies in grant writing and management	$$

*Relative cost scale: $, lowest cost activities; $$, median cost activities; $$$, highest cost activities. RMSF, Rocky Mountain spotted fever.