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!The purpose of the Tick and Mosquito-borne Educational Toolkit is to provide local health departments, nongovernmental organizations, and local authorities working in the Ho-chunk nation and La Crosse, Monroe, Vernon, Crawford, Trempealeau, Pierce, Dunn, St. Croix, La Fayette, Jackson, Houston, and Winona County with up-to-date educational material and standards for preventing and controlling vector-borne diseases. The documents outline the burden of the diseases, transmission, symptoms, and treatments for the diseases, along with specific guidelines on the prevention and control of these diseases. This toolkit aims to provide up-to-date information on the major tick and mosquito-borne threats faced by the population. The list of diseases has been selected on the basis of the burden of morbidity and mortality and includes Lyme disease, Anaplasmosis, Ehrlichiosis, Babesiosis, Rocky Mountain Spotted Fever, Powassan Virus, West Nile Virus, La Crosse Virus, Eastern Equine Virus, Western Equine Virus, and St. Louis Encephalitis. The Educational Toolkit on Tick and Mosquito-borne Disease was created so that information could be used with multiple audiences in various settings within a community. Potential audiences could include:

• Hikers and or campers • Boy and Girl Scouts • Hunters • Schools (elementary, middle and high school) • Hospitals and health clinics • General public

The control of tick and mosquito-borne diseases represents a major challenge to those providing health care services in the La Crosse area and neighboring countries. It is hoped that the Tick and Mosquito-borne Disease Educational Toolkit will facilitate the coordination of vector-borne disease control activities between all agencies working in this region.

PREFACE

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CREATING A TICK-FREE ZONE AROUND YOUR HOME

While deer ticks are most abundant in wooded areas, they are also commonly found in our lawns and shrubs. There are a number of measures Wisconsin residents can take to reduce the possibility of being bitten by a tick on their property.

Ticks and their primary hosts - mice, chipmunks and other small mammals - need moisture, a place away from direct sunlight and a place to hide. The cleaner you keep the area around the house, the less likely your chances of being bitten by a tick.

Although it may not be possible to create a totally tick-free zone, taking the following precautions will greatly reduce the tick population in your yard.

Keep grass mowed. Remove leaf litter, brush and weeds at the edge of the lawn. Restrict the use of groundcover, such as pachysandra in areas frequented by family and roaming pets. Remove brush and leaves around stonewalls and wood piles. Discourage rodent activity. Clean up and seal stonewalls and small openings around the home. Move firewood piles and bird feeders away from the house. Manage pet activity; keep dogs and cats out of the woods to reduce ticks brought into the home. Use plantings that do not attract deer or exclude deer through various types of fencing. Move children's swing sets and sand boxes away from the woodland edge and place them on a wood chip or

mulch type foundation. Trim tree branches and shrubs around the lawn edge to let in more sunlight. Widen woodland trails. Consider a pesticide application as a targeted barrier treatment. Do not use any pesticide near streams or any

body of water as it may kill aquatic life or pollute the water itself. Always read and follow pesticide label directions and precautions.

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Remove tick with tweezers. Gently pull the

tick straight out, using a firm steady

motion

LLaa CCrroossssee CCoouunnttyy HHeeaalltthh DDeeppaarrttmmeenntt 400 4th Street North La Crosse, WI 54601

(608) 785-9872

AGENCY MEMBER OF THE WISCONSIN PUBLIC HEALTH ASSOCIATION

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NEWS RELEASE

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• Prevent Lyme Disease/Spring and Summer PSA (:30)

o Spring and summer are prime time for ticks that can spread Lyme disease and other

infections. The Centers for Disease Control and Prevention would like to remind you to

wear bug repellent when outdoors, shower as soon as possible after coming indoors,

and check your whole body for ticks--every day. If you've been bitten by a tick and

develop fever, rash, or fatigue, seek medical care.

• Recognize the Early Signs of Lyme Disease PSA (:30)

o A bull's-eye rash can be the first sign of Lyme disease, but not everyone will develop the

rash. If you've been in areas where Lyme disease is common and develop fever, fatigue,

facial paralysis, or joint and muscle pain, seek medical care. Reduce your chances of

getting Lyme disease by wearing insect repellent, showering soon after coming indoors,

and checking for ticks daily.

o To learn more, visit www.cdc.gov/lyme.

o A message from CDC.

• Talking to Patients about Preventing Tick Bites

o This program is presented by the Centers for Disease Control and Prevention.

o You know that ticks can spread serious diseases like Lyme disease, Rocky Mountain

spotted fever, or babesiosis, but when was the last time you talked to a patient about

tick bite prevention?

o Welcome to CDC Audio Rounds. I’m Dr. Robert Gaynes with the Centers for Disease

Control and Prevention.

o Your patients, who spend time outdoors, especially in brushy areas or tall grass, are at

risk for getting tick bites. Hikers, campers, outdoor workers, gardeners, golfers, and

children are at particular risk. Ticks can be active any time the ground temperature is

50 degrees Fahrenheit or higher. In some regions, ticks can be active year-round. Here’s

how your patients can prevent tick bites:

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! First, tell them to wear repellent that contains at least 20 percent DEET. Parents

should apply repellent to children, avoiding the hands, eyes, and mouth. People

who spend a lot of time outdoors should consider wearing permethrin-treated

clothing, including boots, pants, and socks. Permethrin-treated items can be

purchased online or at sporting goods stores and can remain protective through

repeated washings.

! Second, tell your patients to check themselves and their children for ticks every

day. Places that ticks frequently hide are in the ears, on the back of the neck, and

in the groin area.

! Third, advise them to remove clothing where ticks might be hiding, and take a

shower to wash off any unseen ticks. Research has shown that showering within

two hours of coming indoors can protect against Lyme disease.

! Finally, tell your patients who spend time in tick habitats or find an attached tick

to watch for fever and rash, and to see you if they have any symptoms or

concerns.

o To order or download Lyme disease informational materials for your patients, go to the

Lyme disease prevention toolkit at www.cdc.gov/Lyme.

o For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO.

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Wisconsin Schools The La Crosse County Health Department urges all people to avoid mosquito bites whenever possible. The risk of a healthy person acquiring a mosquito-borne virus (West Nile virus, La Crosse Virus) from a bite is “very low,” however all people should take the appropriate measures to protect themselves.

Everyone should know. . .

• Mosquito-borne virus’ can be transmitted primarily through the bite of an infected mosquito; although, there have been isolated cases occurring in blood transfusions and organ donation recipients, from mother to baby during pregnancy and through breast milk. People cannot become infected through ordinary contact with an infected bird, horse, or human.

• No vaccine exists to protect humans against West Nile virus or La Crosse Encephalitis. Individuals must personally

A Message for Parents & Students:

• Avoid mosquitoes whenever possible. • Stay indoors or take personal protective measures, especially between dusk and dawn. • Use mosquito repellent with DEET (up to 30 percent for adults and 10 percent or less for

children, two years - 12 years of age as recommended by the American Academy of Pediatrics). Follow the label directions. For more information visit: www.dhs.wisconsin.gov or www.co.la-crosse.wi.us/health/Vector

• When outdoors, wear long-sleeved shirts and pants along with socks and shoes.

A Message for Classroom Teachers:

• The Internet provides instant access to volumes of information about West Nile virus. • You can find the latest Wisconsin facts about West Nile Virus, La Crosse Virus, and other

mosquito-borne virus’ at: www.co.la-crosse.wi.us/health/Vector or www.dhs.wisconsin.gov

• The Centers for Disease Control and Prevention website also offers information: www.cdc.gov.

• Allowing students outdoors for recess poses no greater risk to mosquito-borne virus than if they were outside at home – just be wary of mosquitoes.

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A Message for Activities & Athletic Directors & Staff:

• Early morning, near dusk, and after dark events pose a potential risk for you, your students, and other people attending or participating. These are the times when mosquitoes are most likely to be out feeding.

• You can help protect students and spectators from mosquito-borne virus. • Work with your school’s administration and the safety officer to eliminate standing,

stagnant water, which is a prime breeding area for mosquitoes. • Talk to local mosquito control officials about pre-event surveillance and control of both

larvae and adult mosquitoes. • Remind students and spectators of the importance of using DEET repellent products

according to the directions on the label. Encourage them to wear long sleeves and long pants if possible.

• Encourage children to participate in clean-up campaigns at school. • At events, remind the crowd to protect themselves and their communities by helping

eliminate mosquito breeding areas.

A Message for Administrators:

• Reduce the mosquito breeding sources – the most effective and economical method toward long-term mosquito control.

• Check for and rid your campus of easily recognized mosquito breeding areas: containers of stagnant water, especially cans near cafeteria exteriors; used tires; gutters; grassy ditches and pools of standing, stagnant water, especially with organic debris; and construction sites or vocational-technical arenas that might harbor standing water.

• Call your local health department to report all species of dead birds. Find Health Info and county info at: www.co.la-crosse.wi.us/health or www.dhs.wisconsin.gov

• Communicate to your faculty, staff, and students – make sure they know how to protect themselves and what you’re doing to assure a safe campus.

• Contact your local mosquito control officials or city public works department for information about mosquito control in your area.

• Consider scheduling outside events during daylight hours rather than in the evening.

WHEN USING REPELLENTS, ALWAYS FOLLOW THE LABEL DIRECTIONS AND KEEP OUT OF THE REACH OF SMALL CHILDREN (MAY BE TOXIC IF INGESTED).

POISON CONTROL: 1-800-222-1222

La Crosse County Health Department

COMMUNITY ACTION

By taking active steps to educate and promote awareness of vector-borne illness, individual communities can make a significant impact in the health and well being of their residents as well as guests. Promotion of educational programs through schools, clubs, community organizations, common interest groups (hunters, agriculture), and continued involvement with university extension are just a few simple ways.

Simple Steps Communities Can Take

Mosquito-Borne Disease 1. Have signage or educational posters in public buildings concerning steps individuals can take to

decrease habitat for mosquito-borne diseases.

a. Promote reporting of sites that offer habitat.

b. Promote personal protection like repellent (making sure to read label), making sure screens are in good repair, cutting down weeds or other high vegetation which can offer daytime harborage for mosquitoes.

c. When outside at dusk or dawn (high mosquito feeding periods) take precautions such as repellents.

2. Promote waste tire disposal by having cost efficient, easily accessible tire recycling sites.

3. Educate governmental staff to recognize mosquito-borne disease habitat, such as untrimmed tires, uncovered boats, buckets and other contains and report the sites to public health for inspection.

4. Try to engineer ditches and culverts to promote water flow and prevent long-standing water pools.

1. Signage for prevention as for mosquitoes.

2. Signs in parks explaining tick disease prevention.

3. Widen paths, limit high grass and weeds were ticks thrive.

a. Thin out trees and cut low vegetation around parks or public area’s that offer habitat for small mammals (the reservoir for tick-borne diseases) and for tick vectors for disease.

4. Educate pet owner to the threat of pets bringing ticks into their home by allowing pets to walk through high vegetation or to run at large without supervision.

5. Remind the public that even small areas of high vegetation can offer good tick habitat.

Tick-Borne Disease

Vector Contro l

Community Action

1. Promote mosquito disease prevention through electronic media and local media. Repetition of the same messages is always important but try to add new information with these messages.

2. Communities can work with their state department of environmental protection to have a date and site where citizens can dispose of tires free of charge.

3. Government officials have legal authority to manage an area if it poses a public health risk. Local communities can develop ordinances dealing specifically with vector control including definitions of violations, control measures, and penalties.

4. Have mosquito habitat clean-up efforts in areas with a high prevalence of disease. Additional resources to prevent tick-borne disease through landscape management is found at http://www.cdc.gov/lyme/prev/in_the_yard.html

5. Actively look at local, regional, and national incidence of mosquito-borne disease in CDC ArboNET. If the mosquito data shows disease infection above a threshold, increase the message of mosquito-borne disease prevention and increase efforts at local mosquito control. High mosquito infection rates are a precursor to future high human disease incidence.

6. Local health departments and communities should finish case reviews promptly and accurately. Prompt environmental assessments (and following community intervention) allow us to prevent future disease incidence.

7. Ask state health departments for assistance with vector-borne disease issues.

8. Local health departments and communities can offer internships for public health students interested in vector-borne disease. Students want to learn new skills and public health interns are positive about vector-borne disease projects. Vector-borne disease projects offer many different experiences in public health, from outdoor fieldwork to community intervention to laboratory work to data analysis.

9. Assist with state mosquito and tick surveillance programs. State government has resources (or has connections) to test mosquitoes and ticks for human pathogens.

10. Share mosquito-control resources with neighboring communities.

Additional Steps Communities Can Take

Taking Action to Prevent Vector-Borne Disease Significantly Contributes to the Overall Health of a Community

REMEMBER: Even Small Communities Can Make a Big Difference