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What You Should Know About Lyme Disease and Other
Tick-Borne Diseases
Minnesota Department of HealthDisease Prevention & Control
625 Robert St NPO Box 64975
Saint Paul, MN 55164(651) 201-5414
Revised October 2009
Goal
“Minnesota residents and visitors will take action to prevent exposure to ticks which may carry Borrelia burgdorferi; will know the signs and symptoms of Lyme disease and other tick-borne diseases; and if present, will seek early diagnosis and treatment.”
1995 Minnesota Lyme Disease Public Education Plan
Goals of presentation
• Be aware of Lyme disease and other tick-borne diseases
• Recognize basic signs and symptoms • Seek early diagnosis and treatment• Know whether you live, work or play in
endemic areas• Practice prevention activities• Know whom to contact for more
information
LYME DISEASE
Borrelia burgdorferi, the bacteria that cause Lyme disease
History
1975 Juvenile cases of arthritis found in Connecticut
Disease named Lyme disease
1985 Lyme disease became reportable in Minnesota
Lyme DiseaseSigns & Symptoms
3 to 30 days after deer tick bite• Rash (often “bulls-eye”)• Fever• Chills• Headache• Muscle and joint pain• Fatigue
Erythema migrans (EM) rash characteristic of Lyme disease
Lyme disease rashwithout central clearing
Lyme DiseaseSigns & Symptoms
Days to weeks after illness onset• Multiple rashes• Facial paralysis on one side• Fever, stiff neck, headache• Weakness, numbness, arm/leg pain• Irregular heart beat• Persistent weakness and fatigue
Multiple Rashes
• Reaction as bacteria move through body
• Not caused by multiple tick bites
Multiple Rashes
• This is another example of a multiple rash.
Lyme DiseaseSigns & Symptoms
Weeks to months after illness onset• Fatigue• Chronic arthritis• Nervous system problems
Joint swelling and pain may occur weeks to months after onset of illness if left untreated.
Joint Swelling
Diagnosis of Lyme Disease
• Physical examination• History of possible exposure to
deer ticks• Blood tests may be performed
– A screening test is done first, followed by a confirmatory test for antibodies to Lyme disease bacteria
Remember
Early recognition of signs and symptoms of Lyme disease is very important for prompt diagnosis and treatment.
Treatment
• Lyme disease can be treated• Antibiotics are used to treat
Lyme disease• Talk to your doctor about
specific treatment
Questions aboutDiagnosis or Treatment
of Lyme Disease?
Call your doctor
or
Minnesota Department of Health at 651-201-5414
TICKSBlacklegged Tick
(deer tick)(spreads Lyme disease)
American dog tick(wood tick)
(does not spread Lyme disease)
adult male adult female
Blacklegged ticks have three life stages
Blacklegged Ticks (Deer Ticks)
Nymph
Adult(female)
Larva
Blacklegged Tick Larvae
• Size of period at end of sentence
• Initially does not have Lyme disease bacteria, so does not transmit the bacteria to a host
• May get the bacteria from a host who has the bacteria
Lyme disease researchers often live-trap small mammals to collect blacklegged ticks.
Collecting ImmatureBlacklegged Ticks
Immature blacklegged ticks can be infected by feeding on mice that are carrying Lyme disease bacteria.
Transmission can also occur from the ticks to mice.
Natural Host forImmature Blacklegged Ticks
Blacklegged Tick Nymph
Blacklegged Tick Nymph
• Size of a poppy seed
• Transmits most cases of disease because they are so difficult to detect
• Seeks a blood meal from mid-May to mid-July
Adult female
Blacklegged Tick Adults
Adultmale
Blacklegged Tick Engorgement
Male and Female Adult Blacklegged Tick
• Feed and mate on large animals in the fall or early spring
• After feeding, females lay eggs, then die• Ticks that did not feed or mate go
dormant
EGGS
Eggs laid,adults die
MEAL 1• Mouse• Bird
SPRING
WINTER
SUMMER
FALL
Larvae molt into nymph
stage
Nymphs molt into
adults
MEAL 3• Person• Deer• Dog
ADULTS
MEAL 3* For adults
that did not feed in fall• Person• Deer• Dog
Nymphs dormant
LARVAE
MEAL 2(peak feeding
time May-mid July)• Person• Mouse• Dog
NYMPHS
Two-Year Life Cycle of Blacklegged Tick
Blacklegged Tick Habitat
Trails and Edge Habitat
• Blacklegged ticks live in woody, brushy areas that provide food and cover for hosts such as mice and deer
• Exposure to these ticks can be greatest along trails and edges of woods
Blacklegged ticks search for a host from the tips of low-growing vegetation, generally climbing onto a person or animal near ground level.
Blacklegged Tick Questing
Blacklegged Tick Feeding
To Get Lyme Disease
• Blacklegged tick must be infected with Lyme disease bacteria
• Only the nymphs and adult females can transmit the Lyme disease bacteria
• Tick must be attached 24 - 48 hours before it passes bacteria to host
Lyme Disease Cases by State, 2002 (n = 23,763)2002 Lyme Disease Cases by State as Reported to CDC
n=23,763
3989
37219
26118075535852
46312349
194
D.C.25
259
137
82
2
79
26
26
21
25
28
1112
5
3
41
47
1090
867
42
1
2
6
7
0
139
1
1
4
0
11
4
5
4
4
12
97
0 3
26
738
2002 Lyme Disease Cases by State as Reported to CDCn=23,763
3989
37219
26118075535852
46312349
194
D.C.25
259
137
82
2
79
26
26
21
25
28
1112
5
3
41
47
1090
867
42
1
2
6
7
0
139
1
1
4
0
11
4
5
4
4
12
97
0 3
26
738
Minnesota Department of HealthMay 2008
Wadena
Hennepin
Murray
Pine
Aitkin
CassHubbard
Wilkin
Itasca
St. Louis
Cook
Wash-ing-ton
Lake
Le Sueur
Rice Goodhue
NoblesRock Jackson Martin Faribault FreebornMower
Fillmore Houston
WinonaOlmsted
DodgeSteeleWasecaBlue EarthWatonwanCottonwoodPipestone
Nicollet
Wabasha
DakotaScott
Chisago
Isanti
Brown
Sibley
Carver
WrightMeeker
Kandiyohi
Renville
Redwood
Sherburne
LyonLincoln
Yellow Medicine
Lac Qui Parle
Swift
Big Stone
PopeStevensTraverse
Chippewa
Stearns
Benton
Carlton
Kanabec
MilleLacs
Crow Wing
Morrison
Todd
DouglasGrant
Ottertail
BeckerClay
ClearWater
MahnomenNorman
Red Lake
PenningtonPolk
Beltrami
Marshall
Koochiching
Lakeof theWoods
RoseauKittson
McLeod
Ram- sey
Anoka
Lyme Disease Areas of Highest Riskin Minnesota
Tick-borne disease risk in Minnesota is highest in forested areas within the shaded zones.
Blacklegged ticks may also be found at lower levels in some forested areas outside this zone.
Reported Cases of Lyme Disease in Minnesota, 1986-2008 (n = 9,726)
94 83 83107
67 80
196147
202 204252 256 261
283
465 463
866
475
1,023
917 913
1,239
1,050
0
100
200
300
400
500
600
700
800
900
1,000
1,100
1,200
1,300
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Nu
mb
er o
f C
ase
s
0
200
400
600
800
1000
1200
1400
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Nu
mb
er o
f C
ases
Metro AreaGreater Minnesota
Reported Cases of Lyme Disease in Minnesota by Location of Residence,
1998-2007 (n=6,905)
AnokaWashingtonRamseyDakotaHennepinScottCarverTotal
County
187183
383218
65
469
No. of Cases
Reported Cases of Lyme Disease byCounty of Exposure, Twin Cities
Metropolitan Area, 1998-2007
1. Crow Wing2. Cass3. Pine4. Aitkin5. Anoka6. Washington7. Houston8. Morrison9. Hubbard10. Itasca
WisconsinOther
County 966 (20%) 370 (8%) 302 (6%) 207 (4%) 187 (4%) 183 (4%) 125 (3%) 124 (3%) 103 (2%) 103 (2%)
940 (20%) 1,120 (24%)
4,730
No. (%) of Cases
Total Cases with Known Exposure
Top Ten Counties of Exposure for Reported Cases of Lyme Disease,
1998-2007
0% 0% 0% 0%
4%
22%
41%
19%
9%
4%
1% 0%0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Month
Per
cen
t o
f C
ases
Reported Cases of Lyme Diseaseby Month of Onset, Minnesota,
1999-2008 (n = 6,277*)
* Excluding 1,415 cases without erythema migrans or with unknown onset dates
24%
11%
8%
9%
16% 16%
10%
6%
0%
5%
10%
15%
20%
25%
0-12 13-19 20-29 30-39 40-49 50-59 60-69 70+
Age at Time of Onset
Per
cen
tReported Cases of Lyme Disease
by Age at Onset, Minnesota,1999-2008 (n=7,610*)
* Excluding cases with unknown age at time of onset
Reported Cases of Lyme Disease in Minnesota by Sex, 1999-2008
2,960 (38%)
Female
4,732 (62%)
Male
7,692
Total
Human AnaplasmosisSigns and Symptoms
• Fever (over 102 degrees)
• Chills and shaking
• Severe headache
• Muscle aches
618 14
3036
79
93
149
76
139
186176
322
278
0
50
100
150
200
250
300
350
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Nu
mb
er o
f C
ase
s
Reported Cases of Human Anaplasmosisin Minnesota by Year, 1995-2008
(n = 1,602)
5%
2%3%
7%
16%
22%
20%
25%
0%
5%
10%
15%
20%
25%
30%
0-12 13-19 20-29 30-39 40-49 50-59 60-69 70+
Age at Time of Onset
Per
cen
tReported Cases of Human Anaplasmosisby Age at Onset, Minnesota, 1999-2008
(n = 1,530)
* Excluding cases with unknown age
Human AnaplasmosisSex Distribution, 1999-2008
Male Female Total
980 (64%) 554 (36%) 1,534
0% 0% 0%2%
10%
30%
27%
10%
6%8%
5%
1%0%
5%
10%
15%
20%
25%
30%
35%
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Month
Per
cen
t o
f C
ases
Reported Cases of Human Anaplasmosis by Month of Onset, Minnesota,
1999-2008 (n = 1,519*)
* Excluding 15 cases with unknown onset
Hennepin
Murray
Pine
Aitkin
CassHubbard
Wilkin
Itasca
St. Louis
Cook
Wash-ing-ton
Lake
Le Sueur
Rice Goodhue
NoblesRock Jackson Martin Faribault FreebornMower
Fillmore Houston
WinonaOlmsted
DodgeSteeleWasecaBlue EarthWatonwanCottonwoodPipestone
Nicollet
Wabasha
DakotaScott
Chisago
Isanti
Brown
Sibley
Carver
WrightMeeker
Kandiyohi
Renville
Redwood
Sherburne
LyonLincoln
Yellow Medicine
Lac Qui Parle
Swift
Big Stone
PopeStevensTraverse
Chippewa
Stearns
Benton
Carlton
Kanabec
MilleLacs
Crow Wing
Morrison
Wadena
Todd
DouglasGrant
Ottertail
BeckerClay
ClearWater
MahnomenNorman
Red Lake
PenningtonPolk
Beltrami
Marshall
Koochiching
Lakeof theWoods
RoseauKittson
McLeod
Ram- sey
Anoka
Cases with unknown exposure = 266
Cases with known exposure = 1,057
Minnesota = 722 Wisconsin = 99Other State = 7
7
41 155
229
15
6
99
14
5
123965
368
2
10
100
7
1
3
5
1
* Includes confirmed and probable cases
7
4
1
2
31
112
1
2
1
1
1
Reported Cases of Human Anaplasmosisin Minnesota by County of Exposure,
1995-2007(n = 1,323)
1
2
4
1
1
1
Babesiosis Signs & Symptoms
• High fever• Chills• Headache• Muscle aches• Fatigue• Loss of appetite
Summary of Tick-Borne Diseases,Minnesota, 1999-2008
(n = 9,333)
7,692 (82%)
1534 (16%)
107(1%)0
2000
4000
6000
8000
Lyme disease Humananaplasmosis
Babesiosis
Nu
mb
er
of
Ca
ses
Prevention Actions• Campers, hikers, hunters, people in outdoor
occupations, and people who live near the woods may be at risk in the counties known to have blacklegged ticks.
• Know whether you live, work or play in an area that has blacklegged ticks
• Take precautions when in blacklegged tick habitat, especially from May through July
• Remember, preventing exposure to blacklegged ticks requires diligence
Lyme Disease Vaccine
• Discontinued in 2002
Use repellents (DEET or permethrin), according to label directions.
Tucking pants into socks creates a barrier to ticks.
Wearing light-colored clothing helps to more easily spot ticks.
Prevention
It is a good idea to check yourself and your children for ticks after spending time in a wooded or brushy area.
Checking for Ticks
Check your dog or cat for ticks before bringing them inside.
There is a Lyme disease vaccine for dogs, but it does not prevent them from bringing ticks into the home.
Pets
Avoid Deer Tick Bites
• Be aware of high-risk times and places
• Walk in the center of trails to avoid picking up ticks from brush
• Wear long pants, light-colored clothing, and repellent
If you live in area with ticks, they are usually located around the fringe of your yard and a wooded area.
Avoiding Blacklegged Ticks at Home
Ticks have barbed mouth parts. This means that ticks attached to the skin should be pulled out slowly and steadily.
Removing Attached Ticks
To Remove a Deer Tick
• Use tick forceps or tweezers• Grasp the tick close to the skin• Pull outward S-L-O-W-L-Y, gently,
and steadily• Do not squeeze the tick• Use an antiseptic on the bite
Important Messages
• Know whether you live, work or play in an area that has deer ticks
• Take preventive actions
• Seek early diagnosis and treatment
Whom to Contact
Minnesota Department of Health
651-201-5414
Metropolitan Mosquito Control District
651-645-9149
Minnesota Department of Health’sLyme Disease Web Site
www.health.state.mn.us
Scroll down to “Diseases and Conditions” and click on “Diseases A to Z”
Click on “Lyme Disease”