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Lyme Disease and other tick-borne Diseases

Hunterdon County Department of

Health 2006

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What Is Lyme Disease?

Bacterial InfectionPrimarily transmitted by ‘Black-legged’

(Deer Tick)Affects both animals and humansHunterdon remains in top 5 counties for

incidence

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Mouthparts of a tick(barbed hypostome in center

anchors tick as it feeds)

            

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

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Typical Seasonal Distribution of Reported Lyme Disease Cases

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LYME cases by Age

1918

1 1

16

23

30

13

10

5

13

17

39

35

50

40

34

60

0

10

20

30

40

50

60

Num

ber

of

Cas

es

UnknownAge

2 - 9 20 - 29 40 - 49 60 +

Male

Female

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“Family Portrait”

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Engorged Nymphal Tick

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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.

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Wood Tick

Larger than Deer Tick

Does NOT transmit Lyme

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Adult Deer Tick

                                                                 

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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.

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Common Tick Habitats

Tall grassy areas

Leaf litterGround coverLow bushes /

shrubsNeed moisture

to survive

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Signs and Symptoms of Lyme Disease

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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

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Recommendations for Testing

No blood test if rash presentTwo-test approachELISA testWestern Immunoblot for positive or

equivocal ELISA

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TREATMENT

Doxycycline, amoxicillin, and ceftinUsually 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.

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Personal Protection Measures to Reduce Your

Risks

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Before going out... Wear light-colored

clothing Tuck shirt into pants

and pants into socks

Wear ‘closed’ shoes

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Perform Frequent Tick

Checks….

…while in tick habitats AND

when returning home

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Avoid ‘tick-friendly’ habitats when possible

Keep to center of path

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Tick Repellents for Personal Use

30% - 40% DEET content most effective for ticks

Use on skin or clothingTarget shoes, pant legsNot for children < 3 yrsSee guidelines for childrenFOLLOW DIRECTIONS

CAREFULLY

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Tick Repellents for Personal Use

Permethrin-containing products

USE ON CLOTHING ONLY

InsecticideFOLLOW

DIRECTIONS CAREFULLY

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Using ‘Host Reduction’ to Reduce Risks for Lyme Disease

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Move birdfeeders and firewood away from family activity area (like picnic and/or play area)

Avoid common ‘host habitats’

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Modifying Your Habitat to Reduce Risks for Lyme

Disease

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VS.

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Keep grass shortPrune trees and

shrubbery Remove old leaf pilesAllow sunlight!

Remember:

Ticks need moisture

to survive

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Properly timed and targeted pesticide use is an effective

means of tick control

Late May: granular

Late September: liquid

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Tick RepellentsKeep off the

furniture!Signs of Lyme in

pets

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Proper Tick Removal

Use fine-point tweezers

Grasp CLOSE TO SKIN

Pull gentlyWash area with

soap, water and antiseptic

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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%

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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.

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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.

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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.

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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.

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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.

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Treatment

Clindamycin + quinine or atovaquone plus azithromycin for 7 days.

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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

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More Educational Activities

Youth camp counselor trainingOn-line education program for teachersPress releases and PSA

announcements Public health updates to physiciansGeneral information/referral/mailingsGIS mapping of cases

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Health Department website:www.co.hunterdon.nj.us/health/lymeinfo.htm

Or Call: 908-788-1351 or 908-806-4570

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References

Centers for Disease Control and Prevention (CDC)

American Lyme Disease Foundation—

www.aldf.com