Lyme Disease

1. Lyme Disease Maduabuchi Prince Gabriel PhD Epidemiology Walden University PUBH 8165 Environment Health Instructor: Dr. Donald Goodwin. Winter Quarter, 2011. The target audience: General Public & Public Health Student

2. Objectives Of the Presentation • Define Lyme disease and the vector that causes Lyme disease. • Review the significance, prevalence, incidence, statistics and the effect of Lyme disease. • We will evaluate how Lyme disease is screened. • Ways to stop transmission .

3. Objectives Of the Presentation cont. • Prevention, control and eradication of the Ixodesscapularis and Ixodepacificus that causes Lyme Disease. • We will look at some recent development and policies on the prevention of this disease, and eradication of the, host, vector, and Lyme disease. • Finally, Provide more reading materials.

4. Definitions and overview • What is Lyme disease. Lyme disease is a vector borne disease, caused by a spirochete bacteria called Borreliaburgdorferi. • What are the signs and symptoms of Lyme disease. The first signs and symptoms of Lyme disease is a red rash called erythemamigrans, flu like symptoms, and joint pain. American Lyme Disease Foundation, (2006); Center for Disease Control, (2011).

5. Erythemamigrans Google images, (2011).

6. What vector causes Lyme disease • Deer tick or Blacklegged tick. The scientific name is Ixodes scapularis. When the Ixodes scapularis have a blood meal on its host, they will leave them infected with Borrelia burgdorferi after 36-48hours of engorging. • The infected nymphal is the main cause of Lyme disease than the adult blacklegged tick. • If the tick is removed before the first 36hours, then the individual will not be infected by the disease. American Lyme Disease Foundation, (2006)

7. Picture of Ixodesscapularis (Deer tick) on human body Google images, (2011).

8. Picture of Ixodesscapularis. This tick is very tiny in size. Minnesota Department of Health, (2011)

9. Three host life cycle of Ixodesscapularis Image scratched by Maduabuchi Gabriel with information from the Stafford, (2007) .

10. Explanation to the three host life cycle of Ixodesscapularis • The tick have four stages in their life cycle, egg, larva, nymph and the adult (male and female). • The larvae and the nymphs changes to another stage after digesting a blood meal by shedding the molting or the cuticles. • The Larvae feeds on an animal and drop to the ground and molts to a nymph. First host. Stafford, (2007)

11. Explanation to the three host life cycle of Ixodesscapularis cont. • The nymph feeds on small mammals and birds, engorged drop to the ground and molt to an adult. Second host. • The adult tick feeds on medium and large mammals (third host) and the female tick will produce one single batch of eggs and die. Stafford, (2007)

12. 3D Illustration of B.burgdorferi Google Images, (2011)

13. Areas with Lyme disease Center For Disease Control, (2009)

14. Significance and prevalence of Lyme disease. • Most frequently reported vector borne disease in the US. • Northeastern and North Central states of the United States more at risk. American Lyme Disease Foundation, (2006).

15. Statistics : 1st five state with highest incidence rate in 2009. • In 2009, Delaware had highest incidence of Lyme disease. • Connecticut the second • New Hampshire the third. • Massachusetts the fourth. • Maine was the fifth state. Center for Disease Control, (2010).

16. Incidence of Lyme disease • During 1992-2006 there was a total of 248,074 cases of Lyme disease reported to CDC in the 50 states, District of Columbia and the US territories. • Out of these total number, 93% of the total reported was from Connecticut, Delaware, Massachusetts, Maryland, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin. • The highest incidence was among children 5-14years of age, 53% of the cases reported was among male. Center for Disease Control, (2006).

17. Where do you find the vectors • In the woods • Around deer. • In homes closes to bushes. • Leaves around the home. • Piles of woods. • Untrimmed trees around the home.

18. Control of transmission: • Non human host-mice, deer, birds. • Vectors: Deer tick (Ixodesscapularis). • Vector controlling agents: insecticides, incent repellants. Steeve, Coburn & Glickstein, (2004 p 1100)

19. Tick management strategies for the control of Ixodesscapularis. • Personal protection: prevention of tick bites, tick checks after visiting the woods and bushes, and tick removal. • Landscape management: cutting of the grasses, tick safe landscape modification to make it unsuitable for ticks. • Management of host abundance: fencing, host reduction and destruction of the host habitats. • Host targeted Acaricides: the treatment of the host like the white footed mice, chipmunks or deer through passive tropical applications. • Biological or natural control: use of fungal pathogens and biopesticides to control tick. Stafford, (2007)

20. Personal protection to prevent Lyme disease. • Wearing long sleeve and long pants in wooded areas. • Use of Insect repellants. • Shower immediately coming out from the woods • Self checks after visiting the woods. • Call your doctor for check up for un-usual Rash. Center for Disease Control, (2006).

21. Environmental prevention for Lyme disease. • Clearing the surroundings. Keeping the lawns mowed, and removing things from the edge of the lawn. • Removing brushes and leaves around stonewalls and wood piles. • Discouraging rodents activities. • Keep dogs cats and other mammal pets away from the woods to reduce them bringing tick back to the house. • Fencing homes to exclude deer and planting plants that do not attract Deer. • Using pesticide :DEET or permethrin-based mosquito and tick repellants should be used in the yard when working in the lawns. American Academy of Pediatrician, (2000); Stafford, (2007)

22. Clinically treatment of Lyme disease. • You can treat Lyme disease clinically by the use of antibiotics after diagnosis through laboratory test. Antibiotics can also be used as a prophylaxes to prevent Lyme disease. Wormser, et al. (2006)

23. Laws and policies about Lyme disease. • Lyme disease is a reportable disease. By this I mean that when you are infected by Lyme disease, the hospital where you are diagnosed with the disease will report the incidence to the health department and then this will be reported to center for Disease control. Center for Disease Control, (2006).

24. Recommendations and conclusion • More work is needed on better vaccines and insecticides to be used to prevent the disease and eradicate the vectors. The last vaccine that was in use for Lyme disease was discontinued in 2002 due to lack of demand for the vaccine. • Education and information is the key. Pass on information to your friends, colleagues and family members on the need to prevent tick bite especially the blacked legged tick and ways to prevent its spread. Stafford, (2007)

25. Reference: American Academy of Pediatricians, (2000) Prevention of Lyme disease. Pediatrics, 105, 142-147 http://pediatrics.aappublications.org/cgi/reprint/105/1/142 American Lyme Association , (2006) Lyme disease. Retrieved January 15, 2011 from http://www.aldf.com/lyme.shtml Center For Disease Control, (2010) reported cases of Lyme disease United States 2009. Retrieved January, 15th from http://www.cdc.gov/ncidod/dvbid/lyme/ld_Incidence.htm Center For Disease Control, (2006) Lyme disease I Incidence. Retrieved January, 15th from Http://www.cdc.gov/ncidod/dvbid/lyme/ld_MeanAnnualIncidence.htm Google Images, (2011) Images of tick and ErythemaMigrans Retrieved January, 15th 2011 from http://www.google.com/images?hl=en&source=imghp&biw=1596&bih=695&q=lyme+disease&gbv=2&aq=0&aqi=g10&aql=&oq=Lyme

26. Reference cont. Minnesota Department of Health, (2010). Blacklegged tick . Retrieved February, 5th 2011 from http://www.health.state.mn.us/divs/idepc/dtopics/tickborne/ticks.html Stafford, K. C. (2007). Tick management handbook. Produced by The Connecticutt Agricultural experimental station. Retrieved February, 6th 2011 from: http://www.ct.gov/caes/lib/caes/documents/publications/bulletins/b1010.pdf Steers, A., Coburn J., & Glickstein, L. (2004) The emergency of Lyme disease. The Journal of clinical investigation, 115(8), 1093-1101. Retrieved January, 15, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC385417/pdf/JCI0421681.pdf Wormser, G. P., Dattwayler, R. J., Shapiro, E. D., Halperin, J. J., Steere, A. C., Klempner, M. S.,… Nadelman R.O., (2006) The Clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the infectious disease society of America. Clinical Infectious Disease, 43, 1089-1134. Retrieved January, 15, 2011 from http://cid.oxfordjournals.org/content/43/9/1089.full.pdf+html

27. Resources on Lyme disease from CDC • NEW Free Lyme Disease Continuing Medical Education for Clinicians • Brochures and educational materials • Protect Yourself from Tick-Borne Diseases.( PDF - 1 page, 782KB) • Lyme Disease: A Public Information Guide( 16 pages, 4.94MB) • Tickborne Diseases in Massachusetts, a physicians’ reference manual(26 pages, 2MB) • Tick Management Handbook: An integrated guide for homeowners, pest control operators, and public health officials for the prevention of tick-associated diseases. ( 84 pages, 8,800KB) (From Connecticut Agricultural Experiment Station, New Haven CT) • Lyme Disease: The Facts, the Challenge(29 pages, 407KB) (From U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health) • Information about repellents: • Insect repellent use and safety , Insect repellent protection times

28. More Resources From CDC • Prevention • How Can We Prevent Lyme Disease?Edward B. Hayes, M.D., and Joseph Piesman, D.Sc.(Access granted courtesy of New England Journal of Medicine) • Ecology and transmission • Surveillance for Lyme Disease --- United States, 1992--2006MMWR,October 3, 2008 / 57(SS10);1-9 • Lyme Disease --- United States, 2003--2005June 15, 2007 / 56(23);573-576 • Case definition and report forms • Lyme Disease Surveillance Case Definition (revised Jan 2008) • Lyme Disease Surveillance Case Report Form-For Public Health Officials Use ( 2 pages, 737 KB)

29. Other helpful Resources • American Lyme disease foundation. http://www.aldf.com/lyme.shtml

30. Questions • ANY QUESTION ??????