Results of a Passive Tick Surveillance System in Alberta Allison N Scott, Daniel Fitzgerald, Lisa Lachance, Kimberley Simmonds, and the Arthropod-Borne Diseases Committee (AABDC) Government of Alberta 2014 Canadian Public Health Association Conference Toronto, Ontario May 29, 2014

Collaborators Agriculture and Rural Development, GOA Rashed Cassis Daniel Fitzgerald Alberta Health, GOA Dean Blue Patti Kowalski Lisa Lachance Martin Lavoie Kimberley Simmonds Theresa St. Jean The Arthropod-Borne Diseases Committee Alberta Health Services Lance Honish First Nations and Inuit Health Branch And Many More!

Outline Ticks & Lyme Disease Tick Surveillance Program in Alberta Results Discussion & Next Steps

Ticks & Lyme Disease

Lyme Disease Borrelia burgdorferi Vector: Ixodes spp ticks Identified in 1976 in Lyme, Connecticut Cluster of juvenile arthritis cases Multi-system inflammatory disease Early symptoms: Rash, headache, fever, fatigue Can affect heart, joints, brain Small number of patients can have pain, fatigue, or other symptoms chronically after treatment Best if treated early http://en.wikipedia.org/wiki/Borrelia_burgdorferi http://www.cdc.gov/ticks/symptoms.html

Lyme Disease – Key Point Can be difficult to diagnosis as the symptoms can be non-specific, especially if characteristic rash absent Knowing that the individual has been in an endemic area and exposed to ticks is important for diagnosis http://www.cdc.gov/ticks/symptoms.html

Ixodes scapularis Black-Legged Tick Feeding Drop off Carrier of Borrelia burgdorferi Feeding Insert mouthparts Several days Drop off

Ixodes spp Ticks Endemic in the United States Establishing themselves in Eastern Canada Climate change: warm, mixed forest/grassland Ogden 2014 CCDR Volume 40-5

Adventitious Tick: Going where no Ixodes has gone before One method of spread: migratory birds Flyway over Edmonton Key: Suitable habitat to overwinter/reproduce birding.about.comodbirdingbasicsssNorth-America-Migration-Flyways.htm

Tick Surveillance Program

Objectives: Determine if Ixodes ticks can be found in Alberta Determine the percentage of Ixodes ticks that carry Borrelia burgdorferi Utilize geographic information to pick sites for active surveillance

Passive Surveillance Humans and the Environment Companion Animals AHS Environmental Health Office Veterinarian Agriculture and Rural Development Lab Alberta Health

Methods Standardized lab methods Descriptive statistics (SAS) Dichotomous identification key to speciate ticks Established PCR protocol utilized to identify Borrelia burgdorferi Descriptive statistics (SAS) Mapped postal code of residence (ARC GIS) Restricted to hosts that were Alberta residents and had not travelled in the previous 2 weeks. Finding nymph or larva would suggest a population capable of reproducing

Results

B. burgdorferi positive Results   All Tick species Ixodes species B. burgdorferi positive Ixodes spp Total Ticks Submitted 960 171 (18%) 27 (16%) Ticks Submitted by Alberta Residents With No Travel Outside of Alberta 580 139 (24%) 25 (18%) Tick Submitted by Alberta Residents With No Travel 378 105 (28%) 21 (20%) Only adult Ixodes ticks found from individuals who had not travelled

Results 54% of Ixodes ticks submitted by Alberta residents with no travel history reside in Edmonton Zone Submitter’s Postal Code of Residence No travel in previous two weeks

Results Submitter’s Postal Code of Residence No travel in previous two weeks

Discussion & Next Steps

Discussion Ixodes ticks found in Alberta Mostly in Edmonton Zone 20% of Ixodes positive for Borrelia burgdorferi Only adults found But more than one tick likely acquired in certain areas

Active Surveillance Triggered Criteria Reasonable Evidence Strong Evidence Same Submitter * 1 or more nymph or larval blacklegged ticks >1 blacklegged tick of any stage from the same person or animal in a suitable environment   Different Submitter* >1 blacklegged tick of any stage from a different submitter in a suitable environment >2 blacklegged tick submissions of any stage found at least 1 year apart AND The ticks were found in a suitable environment Human Cases Single locally acquired human case Cluster of locally acquired human cases * In the same location. The location is in the same town, city or geographic area not defined by a specific surface area size.

Active Surveillance for Ticks Drag sampling 5 sites weekly, May-June 2014 If Ixodes found: Heightened Active Surveillance Likely include small mammal trapping http://www.youtube.com/watch?v=QfKhopJNuj0

Strengths and Limitations Strong partnership between Alberta Agriculture, Alberta Health Services, and Alberta Health Collaborating with municipalities Limitations: Residential postal codes, not locations Unable to interview companion animal owners Postal codes for companion animals currently only available for 2013 Small sample size

Next Steps Active surveillance Changes to forms Enhanced information on outdoor locations pets/people had been in previous two weeks Continued passive surveillance Increase sample sizes Enhanced advertising for 2014 season

Questions? www.health.alberta.ca/health-info/lyme-disease

Ixodes spp – Life cycle CDC

Tick Surveillance Surveillance: “Systematic ongoing collection, collation, and analysis of data and the timely dissemination of information to those who need to know so that action can be taken.” Passive Surveillance and Active Surveillance Last, John M. 2001. A Dictionary of Epidemiology, 4th edition. Oxford University Press, Inc