Lyme Disease and other tick-borne Diseases

1. Lyme Disease and other tick-borne Diseases Hunterdon County Department of Health 2006

3. What Is Lyme Disease? • Bacterial Infection • Primarily transmitted by ‘Black-legged’ (Deer Tick) • Affects both animals and humans • Hunterdon remains in top 5 counties for incidence

4. Mouthparts of a tick(barbed hypostome in centeranchors tick as it feeds)

5. Reported Lyme Disease CasesNumber of Confirmed Lyme Disease Cases by Report Year – Hunterdon County, 1988 to 2008

6. TypicalSeasonalDistributionof Reported Lyme Disease Cases

7. LYME cases by Age

8. “Family Portrait”

9. Engorged Nymphal Tick

10. Tick Facts... • Ticks must be attached 36 - 48 hours to transmit bacteria • In Hunterdon, ~20% of nymphal ticks carry bacteria • Nymphal ticks cause majority of Lyme cases • Most cases ‘caught’ around the home • Nymphal ticks most active late May thru July • Adult ticks most active late Oct. and early November.

11. Wood Tick • Larger than Deer Tick • Does NOT transmit Lyme

13. Adult Deer Tick

14. Three Active Stages • Need ‘host’ at each stage (Such as mouse, other animal or person) • Not born with bacteria • Do NOT fly or jump • Attach as host passes by • White-footed mice serve as the principal reservoirs of infection on which many larval and nymphal ticks feed and become infected with the LD spirochete.

16. Common Tick Habitats • Tall grassy areas • Leaf litter • Ground cover • Low bushes / shrubs • Need moisture to survive

17. Signs and Symptoms of Lyme Disease

18. Clinical Manifestations • Early Lyme (Days to month after bite) -- Erythema Migrans (‘Bull’s Eye Rash’) -- +/- Flu-like symptoms • Early Disseminated Lyme / Late Lyme -- Neurologic or cardiac abnormalities -- Musculoskeletal symptoms -- Migratory arthritis

21. Recommendations for Testing • No blood test if rash present • Two-test approach • ELISA test • Western Immunoblot for positive or equivocal ELISA

22. TREATMENT • Doxycycline, amoxicillin, and ceftin • Usually treated for 4-6 weeks. • A recent study of in the New England Journal of Medicine indicates that a four-week course of oral doxycycline is just as effective in treating late LD, and much less expensive, than a similar course of intravenous Ceftriaxone (Rocephin) unless neurological or severe cardiac abnormalities are present.

23. Personal Protection Measures to Reduce Your Risks

24. Before going out... • Wear light-colored clothing • Tuck shirt into pants and pants into socks • Wear ‘closed’ shoes

25. Perform Frequent Tick Checks…. …while in tick habitats AND when returning home

26. Avoid ‘tick-friendly’ habitats when possible • Keep to center of path

27. Tick Repellents for Personal Use • 30% - 40% DEET content most effective for ticks • Use on skin or clothing • Target shoes, pant legs • Not for children < 3 yrs • See guidelines for children • FOLLOW DIRECTIONS CAREFULLY

28. Tick Repellents for Personal Use • Permethrin-containing products • USE ON CLOTHING ONLY • Insecticide • FOLLOW DIRECTIONS CAREFULLY

29. Using ‘Host Reduction’ to Reduce Risks for Lyme Disease

30. Move birdfeeders and firewood away from family activity area (like picnic and/or play area) • Avoid common ‘host habitats’

31. Modifying Your Habitat to Reduce Risks for Lyme Disease

32. VS.

33. Keep grass short • Prune trees and shrubbery • Remove old leaf piles • Allow sunlight! Remember: Ticks need moisture to survive

34. Properly timed and targeted pesticide use is an effective means of tick control Late May: granular Late September: liquid

35. Tick Repellents • Keep off the furniture! • Signs of Lyme in pets

36. Proper Tick Removal • Use fine-point tweezers • Grasp CLOSE TO SKIN • Pull gently • Wash area with soap, water and antiseptic

37. Remember… It’s not the tick you remove that is likely to give you Lyme Disease, it’s the one you never find! …In fact, if an attached tick is found and removed, your chances of developing Lyme disease is just 1-3%

38. Ehrlichiosis A disease caused by bacteria in the genus Ehrlichia. 2 types have been identified in the U.S.: HME and HGE. Transmitted by the deer tick. It is considered an acute infection without chronic long-term consequences. The severity of the disease varies from person to person. May be life-threatening or fatal for elderly and others with compromised immune systems.

39. Symptoms • Person may be asymptomatic or may have mild to severe symptoms. • Initial symptoms include fever, headache, malaise, and muscle aches. Other symptoms include nausea, vomiting, diarrhea, cough, and joint pains. May also have a rash. Severe complications include prolonged fever, renal failure, seizures, or coma. • As many as half of all patients require hospitalization. 2-3% of patients die from the infection.

40. Treatment • Treatment should be initiated immediately when there is suspicion of Ehrlichiosis. Treatment should not be delayed until lab confirmation is obtained. • 100 mg. Doxycycline twice daily for a minimum of 7 days. Severe cases may require longer treatment.

41. Babesiosis • Babesiosis is a malaria-like illness caused by a protozoan parasite (Babesia microti in the U.S.) that is primarily transmitted by the black-legged deer tick.

42. Symptoms • May be asymptomatic; symptoms include fever, chills, sweating, muscle aches, fatigue, and hemolytic anemia. Symptoms typically occur after an incubation period of 1-4 weeks, and can last several weeks. Disease is more severe in the elderly and immunosuppressed individuals.

43. Treatment • Clindamycin + quinine or atovaquone plus azithromycin for 7 days.

44. Health Department Educational Activities • Tick ID cards and Lyme Disease Alert notices to parents • County employee Lyme awareness spring program • Public presentations to community groups/businesses

45. More Educational Activities • Youth camp counselor training • On-line education program for teachers • Press releases and PSA announcements • Public health updates to physicians • General information/referral/mailings • GIS mapping of cases

46. Health Department website:www.co.hunterdon.nj.us/health/lymeinfo.htm Or Call: 908-788-1351 or 908-806-4570

47. References • Centers for Disease Control and Prevention (CDC) • American Lyme Disease Foundation— www.aldf.com