Rocky Montain spotted fever usually occurs between the months of April and early September. These months are when ticks are most active. It can occur along the east coast of the United States but it is most likely to occur in the southeastern states. Cases are mostly seen in North Carolina, South Carolina, Tennessee, Georgia, Maryland, Arkansas, Virginia, and Oklahoma. Even though it is most common in the southeastern states, it was first seen in the U.S. in the Rocky Mountain region in 1873. There has been at least one case reported in almost every state in the United States. Nearly fifty percent of all reported cases occur in children.