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  1. 1. Lyme Disease and other tick-borne Diseases Hunterdon County Department of Health 2006
  2. 3. What Is Lyme Disease? <ul><li>Bacterial Infection </li></ul><ul><li>Primarily transmitted by ‘Black-legged’ (Deer Tick) </li></ul><ul><li>Affects both animals and humans </li></ul><ul><li>Hunterdon remains in top 5 counties for incidence </li></ul>
  3. 4. Mouthparts of a tick (barbed hypostome in center anchors tick as it feeds)              
  4. 5. Reported Lyme Disease Cases Number of Confirmed Lyme Disease Cases by Report Year – Hunterdon County, 1988 to 2008
  5. 6. Typical Seasonal Distribution of Reported Lyme Disease Cases
  6. 7. LYME cases by Age
  7. 8. <ul><li>“ Family Portrait” </li></ul>
  8. 9. Engorged Nymphal Tick
  9. 10. Tick Facts... <ul><li>Ticks must be attached 36 - 48 hours to transmit bacteria </li></ul><ul><li>In Hunterdon, ~20% of nymphal ticks carry bacteria </li></ul><ul><li>Nymphal ticks cause majority of Lyme cases </li></ul><ul><li>Most cases ‘caught’ around the home </li></ul><ul><li>Nymphal ticks most active late May thru July </li></ul><ul><li>Adult ticks most active late Oct. and early November. </li></ul>
  10. 11. Wood Tick <ul><li>Larger than Deer Tick </li></ul><ul><li>Does NOT transmit Lyme </li></ul>
  11. 13. Adult Deer Tick                                                                   
  12. 14. <ul><li>Three Active Stages </li></ul><ul><li>Need ‘host’ at each stage </li></ul><ul><li>(Such as mouse, other animal or person) </li></ul><ul><li>Not born with bacteria </li></ul><ul><li>Do NOT fly or jump </li></ul><ul><li>Attach as host passes by </li></ul><ul><ul><li>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. </li></ul></ul>                  
  13. 15.                                                                                         
  14. 16. Common Tick Habitats <ul><li>Tall grassy areas </li></ul><ul><li>Leaf litter </li></ul><ul><li>Ground cover </li></ul><ul><li>Low bushes / shrubs </li></ul><ul><li>Need moisture to survive </li></ul>
  15. 17. Signs and Symptoms of Lyme Disease
  16. 18. Clinical Manifestations <ul><li>Early Lyme (Days to month after bite) </li></ul><ul><li>-- Erythema Migrans (‘Bull’s Eye Rash’) </li></ul><ul><li>-- +/- Flu-like symptoms </li></ul><ul><li>Early Disseminated Lyme / Late Lyme </li></ul><ul><li>-- Neurologic or cardiac abnormalities </li></ul><ul><li>-- Musculoskeletal symptoms </li></ul><ul><li>-- Migratory arthritis </li></ul>
  17. 21. Recommendations for Testing <ul><li>No blood test if rash present </li></ul><ul><li>Two-test approach </li></ul><ul><li>ELISA test </li></ul><ul><li>Western Immunoblot for positive or equivocal ELISA </li></ul>
  18. 22. TREATMENT <ul><li>Doxycycline, amoxicillin, and ceftin </li></ul><ul><li>Usually treated for 4-6 weeks. </li></ul><ul><li>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. </li></ul>
  19. 23. Personal Protection Measures to Reduce Your Risks
  20. 24. <ul><li>Before going out... </li></ul><ul><li>Wear light-colored clothing </li></ul><ul><li>Tuck shirt into pants and pants into socks </li></ul><ul><li>Wear ‘closed’ shoes </li></ul>
  21. 25. <ul><li>Perform </li></ul><ul><li>Frequent Tick </li></ul><ul><li>Checks…. </li></ul>… while in tick habitats AND when returning home
  22. 26. <ul><li>Avoid ‘tick-friendly’ habitats when possible </li></ul><ul><li>Keep to center of path </li></ul>
  23. 27. Tick Repellents for Personal Use <ul><li>30% - 40% DEET content most effective for ticks </li></ul><ul><li>Use on skin or clothing </li></ul><ul><li>Target shoes, pant legs </li></ul><ul><li>Not for children < 3 yrs </li></ul><ul><li>See guidelines for children </li></ul><ul><li>FOLLOW DIRECTIONS CAREFULLY </li></ul>
  24. 28. Tick Repellents for Personal Use <ul><li>Permethrin-containing products </li></ul><ul><li>USE ON CLOTHING ONLY </li></ul><ul><li>Insecticide </li></ul><ul><li>FOLLOW DIRECTIONS CAREFULLY </li></ul>
  25. 29. Using ‘Host Reduction’ to Reduce Risks for Lyme Disease
  26. 30. <ul><li>Move birdfeeders and firewood away from family activity area (like picnic and/or play area) </li></ul><ul><li>Avoid common ‘host habitats’ </li></ul>
  27. 31. Modifying Your Habitat to Reduce Risks for Lyme Disease
  28. 32. <ul><li>VS. </li></ul>
  29. 33. <ul><li>Keep grass short </li></ul><ul><li>Prune trees and shrubbery </li></ul><ul><li>Remove old leaf piles </li></ul><ul><li>Allow sunlight! </li></ul>Remember: Ticks need moisture to survive
  30. 34. <ul><li>Properly timed and targeted pesticide use is an effective means of tick control </li></ul><ul><li>Late May : granular </li></ul><ul><li>Late September : liquid </li></ul>
  31. 35. <ul><li>Tick Repellents </li></ul><ul><li>Keep off the furniture! </li></ul><ul><li>Signs of Lyme in pets </li></ul>
  32. 36. Proper Tick Removal <ul><li>Use fine-point tweezers </li></ul><ul><li>Grasp CLOSE TO SKIN </li></ul><ul><li>Pull gently </li></ul><ul><li>Wash area with soap, water and antiseptic </li></ul>
  33. 37. Remember… <ul><li>It’s not the tick you remove that is likely to give you Lyme Disease, it’s the one you never find! </li></ul><ul><li>… In fact, if an attached tick is found and removed, your chances of developing Lyme disease is just 1-3% </li></ul>
  34. 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.
  35. 39. Symptoms <ul><li>Person may be asymptomatic or may have mild to severe symptoms. </li></ul><ul><li>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. </li></ul><ul><li>As many as half of all patients require hospitalization. 2-3% of patients die from the infection. </li></ul>
  36. 40. Treatment <ul><li>Treatment should be initiated immediately when there is suspicion of Ehrlichiosis. Treatment should not be delayed until lab confirmation is obtained. </li></ul><ul><li>100 mg. Doxycycline twice daily for a minimum of 7 days. Severe cases may require longer treatment. </li></ul>
  37. 41. Babesiosis <ul><li>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. </li></ul>
  38. 42. Symptoms <ul><li>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. </li></ul>
  39. 43. Treatment <ul><li>Clindamycin + quinine or atovaquone plus azithromycin for 7 days. </li></ul>
  40. 44. Health Department Educational Activities <ul><li>Tick ID cards and Lyme Disease Alert notices to parents </li></ul><ul><li>County employee Lyme awareness spring program </li></ul><ul><li>Public presentations to community groups/businesses </li></ul>
  41. 45. More Educational Activities <ul><li>Youth camp counselor training </li></ul><ul><li>On-line education program for teachers </li></ul><ul><li>Press releases and PSA announcements </li></ul><ul><li>Public health updates to physicians </li></ul><ul><li>General information/referral/mailings </li></ul><ul><li>GIS mapping of cases </li></ul>
  42. 46. Health Department website: www.co.hunterdon.nj.us/health/lymeinfo.htm Or Call: 908-788-1351 or 908-806-4570
  43. 47. References <ul><li>Centers for Disease Control and Prevention (CDC) </li></ul><ul><li>American Lyme Disease Foundation— </li></ul><ul><li>www.aldf.com </li></ul>