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1
Lyme Disease and other tick-borne Diseases
Hunterdon County Department of
Health 2006
2
3
What Is Lyme Disease?
Bacterial InfectionPrimarily transmitted by ‘Black-legged’
(Deer Tick)Affects both animals and humansHunterdon remains in top 5 counties for
incidence
4
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