1. 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

2. 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!

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

4. Ticks & Lyme Disease

5. 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

6. 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

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

8. 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

9. 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

10. Tick Surveillance Program

11. 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

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

13. 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

14. Results

15. 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

16. 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

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

18. Discussion & Next Steps

19. 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

20. 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.

21. Active Surveillance for Ticks
Drag sampling 5 sites weekly, May-June 2014
If Ixodes found: Heightened Active Surveillance
Likely include small mammal trapping

22. 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

23. 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

24. Questions?

25. Ixodes spp – Life cycle
CDC

26. 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 A Dictionary of Epidemiology, 4th edition. Oxford University Press, Inc