Lyme Disease and other tickborne Diseases

1
Lyme Disease and other tick-borne Diseases
Hunterdon County Department of Health
2006
2
(No Transcript)
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
Typical Seasonal Distribution of 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

12
(No Transcript)
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.
15
(No Transcript)
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 (Bulls Eye Rash)
• -- /- Flu-like symptoms
• Early Disseminated Lyme / Late Lyme
• -- Neurologic or cardiac abnormalities
• -- Musculoskeletal symptoms
• -- Migratory arthritis

19
(No Transcript)
20
(No Transcript)
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
• 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

• Its not the tick you remove that is likely to
  give you Lyme Disease, its 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 websitewww.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