1. Lyme Disease: Presentation to TDSB Health and Well-being Committee
Howard Shapiro
Associate Medical Officer of Health & Director Healthy Environments
May 31, 2016

2. Overview
Lyme Disease
Tick Vector
Lyme Disease Statistics
Toronto Public Health Program
Final Thoughts

3. Caused by infection with a bacteria
What is Lyme Disease
Caused by infection with a bacteria
Borrelia burgdorferi
Transmitted by a particular species of ticks in Ontario
Blacklegged ticks (Ixodes scapularis)
Important implications
Not spread person to person
Can prevent by preventing tick bites
Treatable with antibiotics – especially early in disease

4. Lyme Disease – Early (days-weeks)
Symptoms
Headache, tiredness, muscle and joint aches and pains, fever (sometimes)
Red rash at site of bite (Erythma migrans)
Treatment
Oral antibiotics for 2-3 weeks
High effective

5. Lyme Disease – Late (weeks-years)
Symptoms
Joints - arthritis (knee and other large joints very common)
Heart – palpitations or irregular beat
Nervous system – drooping face, inflammation of brain and spinal cord, pains/numbness/tingling in hands and feet; fatigue/difficulty thinking
Treatment
Antibiotics – oral or IV for 2 weeks to 1 month
Less effective than for early
Symptoms may persist despite treatment
more likely the longer the time until treatment

6. BL Tick Habitat

7. Blacklegged tick Life stages and size
R. Lindsay PHAC

8. How big is that tick?

9. Tick Attachment

10. Ixodes Tick Life Cycle

11. Questing tick

12. Risk of Lyme Disease Increases with Time Tick Attached

13. Opportunity for Prevention

14. Human Lyme Disease in Toronto: Cases & Incidence Rate 2004-2014

15. Ontario Lyme Cases by Month - 2013

16. Toronto Public Health Lyme Program
Surveillance (monitoring)
Human
Tick (tick populations in Toronto)
Passive people bring in ticks for submission to Lab
Identified and tested for Lyme bacteria
Active
Go to likely locations and search for ticks (ID & testing)
Education
Information for public and physicians through a number of means
Fact sheet for schools
Taking preventive measures requires a lot of effort so people will not do these unless it is worthwhile. Knowing about tick populations in addition to human surveillance can help inform this effort.

17. Tick Dragging

20. Final Thoughts
Risk of Lyme disease in Toronto possible but very low (but may be changing)
Child with Lyme disease cannot give it to someone else
Child with attached tick should have removed promptly (parent, physician)

21. Typical school yard -lawns, sport fields not tick habitat
Final Thoughts
Be aware of tick locations & habitats in and outside of City especially for outdoor activities
Typical school yard -lawns, sport fields not tick habitat
Can prevent ticks and Lyme
Staying in centre of trails
Clothing and DEET
Tick checks, tick removal and showering after being in tick habitat

22. Questions??