1. An Outdoor Menace Don’t be “Ticked” By Lyme Disease What you may not know D. Eakins, MPH PUBH 61651 7/20/2014

2. Did you know?  The number of Americans diagnosed with Lyme Disease is estimated to be about 300,000  Although Lyme Disease is commonly associated with the Northeast part of the U.S., the number of cases are becoming more prevalent in other parts of the country as well  Lyme Disease risk is increasing due to bites from the blacklegged tick  Lyme Disease has recently been confirmed in humans residing in the South D. Eakins, MPH PUBH 6165 2 7/20/2014

3. A Brief History  First discovered in the mid-1970s  Symptoms observed in children from Lyme, Connecticut  Initially diagnosed as juvenile rheumatoid arthritis  Clinicians targeted causative agent as infectious bacteria  Isolated from the gut of ticks endemic to Shelter Island, NY  Confirmation made by Willy Burgdorfer, NIAID researcher D. Eakins, MPH PUBH 6165 3 7/20/2014

4. WHAT IS LYME DISEASE? Infectious Disease  Caused by spirochete bacterium  Transmitted by ticks  Multi-systemic Signs & Symptoms  Fever  Headache  Fatigue  Skin rash  Infection D. Eakins, MPH PUBH 6165 4 7/20/2014

5. WHO CAN GET LYME DISEASE?  Hikers  Hunters  Campers  Fishermen  Gardeners  Landscapers  Rural Inhabitants  Outdoor Recreation Lovers D. Eakins, MPH PUBH 6165 5 7/20/2014

6. THE CULPRIT SPIROCHETE BACTERIUM BORRELIA SPECIES  B. burgdorferi  B. americana  B andersonii D. Eakins, MPH PUBH 6165 6 7/20/2014

7. HOW LYME DISEASE IS TRANSMITTED  An unfed nymph carries spirochete bacteria in the lumenal side of its gut  Spirochetes multiply 17-fold in the midgut  Spirochetes travel from midgut through hemolymph to the salivary glands  Regurgitated gut fluid is transmitted during feeding through salivary glands  Salivary glands release spirochetes into vertebrate host D. Eakins, MPH PUBH 6165 7 7/20/2014

8. THE VECTOR (aka Spirochete Transmitter) D. Eakins, MPH PUBH 6165 8 7/20/2014

9. LYME DISEASE HOSTS  Mice  Deer  Humans  Wild Birds  Other Animals D. Eakins, MPH PUBH 6165 9 7/20/2014

10. TICK LIFE CYCLE D. Eakins, MPH PUBH 6165 10 7/20/2014

11. MECHANISM OF ACTION AGENT DUAL PATHWAY D. Eakins, MPH PUBH 6165 11 7/20/2014

12. TICK GEOGRAPHICAL DISTRIBUTION D. Eakins, MPH PUBH 6165 12 7/20/2014

13. How do the cases stack up? Confirmed cases of Lyme disease by state or locality, 2001-2011 Year 20012002200320042005200620072008200920102011 U.S. Total 17,02923,76321,27319,80423,30519,93127,44428,92129,95922,56124,364 D. Eakins, MPH PUBH 6165 13 7/20/2014

14. Case Prevalence D. Eakins, MPH PUBH 6165 14 7/20/2014

15. Cases by Age and Sex D. Eakins, MPH PUBH 6165 15 7/20/2014

16. LYME DISEASE SURVEILLANCE  Regular surveillance is done by the CDC  Reports are submitted by U.S. Health Departments  Lyme Disease information is made available to the public through the CDC Morbidity and Mortality Weekly Report  Public health practitioners use reported information to tailor interventions especially for endemic populations D. Eakins, MPH PUBH 6165 16 7/20/2014

17. A Look at Some Signs Classic Bull’s Eye Rash D. Eakins, MPH PUBH 6165 17 7/20/2014 Spreading Rash

18. PREVENTION! Outdoor ProtectionTick Removal D. Eakins, MPH PUBH 6165 18 7/20/2014

19. A testimony from someone who knows… D. Eakins, MPH PUBH 6165 19 7/20/2014

20. TREATMENT OPTIONS 7/20/2014 D. Eakins, MPH PUBH 6165 20 If caught early, Lyme Disease can be treated with one of the following antibiotics:  Doxycycline  Amoxicillin  Cefuroxine Axetil If the illness is related to neurological or cardiac complications, intravenous application of the following may be required:  Penicillin  Ceftriaxone

21. REFERENCES  American Lyme Disease Foundation (ALDF). (2011). U.S. maps and statistics. Retrieved from http://www.aldf.com/usmap.shtml http://www.aldf.com/usmap.shtml  Centers for Disease Control and Prevention (CDC). (2013). Americans diagnosed with Lyme disease: Number may be 10 times more than reported. ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2013/08/130819182855.htm http://www.sciencedaily.com/releases/2013/08/130819182855.htm  Centers for Disease Control and Prevention (CDC). (2013). Confirmed lyme disease cases by age and sex - - United States, 2001 – 2010. Retrieved from http://www.cdc.gov/lyme/stats/chartstables/incidencebyagesex.html http://www.cdc.gov/lyme/stats/chartstables/incidencebyagesex.html  Centers for Disease Control and Prevention (CDC). (2011). Life cycle of blacklegged ticks. Retrieved from http://www.cdc.gov/lyme/transmission/blacklegged.htmlhttp://www.cdc.gov/lyme/transmission/blacklegged.html  Centers for Disease Control and Prevention (CDC). (2014). Life cycle of hard ticks that spread disease. Retrieved from http://www.cdc.gov/ticks/life_cycle_and_hosts.htmlhttp://www.cdc.gov/ticks/life_cycle_and_hosts.html  Centers for Disease Control and Prevention (CDC). (2014, May). Lime disease. Retrieved from http://www.cdc.gov/lyme/ http://www.cdc.gov/lyme/  Centers for Disease Control and Prevention (CDC). (2014). Lyme Disease. Treatment. Retrieved from http://www.cdc.gov/lyme/treatment/index.htmlhttp://www.cdc.gov/lyme/treatment/index.html  Centers for Disease Control and Prevention (CDC). (2013). Lyme disease frequently asked questions. Retrieved from http://www.cdc.gov/lyme/faq/index.html#lonestar onhttp://www.cdc.gov/lyme/faq/index.html#lonestar  Center for Disease Control and Prevention (CDC). (2013). Reported cases of lyme disease by year, United States, 2003 – 2012. Retrieved from http://www.cdc.gov/lyme/stats/chartstables/casesbyyear.html http://www.cdc.gov/lyme/stats/chartstables/casesbyyear.html 7/20/2014 D. Eakins, MPH PUBH 6165 21

22. REFERENCES, Cont’d  Centers for Disease Control and Prevention (CDC). (2012). Lyme Disease. Reported cases of lyme disease: United States, 2012. Retrieved from http://www.cdc.gov/lyme/stats/maps/map2012.html http://www.cdc.gov/lyme/stats/maps/map2012.html  Centers for Disease Control and Prevention (CDC). (2011). Signs and symptoms of lyme disease. Retrieved from http://www.cdc.gov/lyme/signs_symptoms/index.htmlhttp://www.cdc.gov/lyme/signs_symptoms/index.html  Centers for Disease Control and Prevention (CDC). (2008, October). Surveillance for lyme disease – United States, 1996 – 2006. Morbidity and Mortality Weekly Report, 57(SS10):1-9. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm  Clark, K., Leydet, B., & Hartman, S. (2013). Lyme borreliosis in human patients in Florida and Georgia, USA. International Journal of Medical Sciences, 10(7):915-931. doi:10.7150/ijms.6273.  Clark, K. (2014, May 14). Lyme disease is spreading. [Video File]. Retrieved from http://www.youtube.com/watch?v=NwVuzx3RdZc http://www.youtube.com/watch?v=NwVuzx3RdZc  Eisen, R., Piesman, J., Zielinski-Gutierrez, E., & Eisen, L. (2012). What do we need to know about disease ecology to prevent Lyme disease in the northeastern United States? Journal of Medical Entomology, 49(1):1-236. doi: http://dx.doi.org/10.1603/ME11138http://dx.doi.org/10.1603/ME11138  Fallon, B., & Nields, J. (1994, November). Lyme disease: A neuropsychiatric illness. The American Journal of Psychiatry, 151(11):1571-1583. Retrieved from http://ajp.psychiatryonline.org/article.aspx?articleID=170646 http://ajp.psychiatryonline.org/article.aspx?articleID=170646  Gathany, J. & Nicholson, W. (2013). Americans diagnosed with Lyme disease: Number may be 10 times more than reported. ScienceDaily. [Photo]. Retrieved from http://www.sciencedaily.com/releases/2013/08/130819182855.htm http://www.sciencedaily.com/releases/2013/08/130819182855.htm  Hamer, S., Tsao, J., Walker, E., & Hickling, G. (2010, August). Invasion of the lyme disease vector ixodes scapularis: Implications for Borrelia burgdorferi endemicity. Ecohealth, 7(1):47-63. doi: 10.1007/s10393-010-0287-0. 7/20/2014 D. Eakins, MPH PUBH 6165 22

23. REFERENCES, Cont’d  Hear Nebraska. (2012). Concert to benefit lyme disease treatment, education. [Photo]. Retrieved from http://hearnebraska.org/feature/concert-benefit-lyme-disease-treatment- education-guest-column/http://hearnebraska.org/feature/concert-benefit-lyme-disease-treatment- education-guest-column/  Lime Disease.org. (2013). Touched by lyme: How to protect yourself in tick territory. Retrieved from http://lymedisease.org/news/touchedbylyme/protect-yourself-from- ticks.htmlhttp://lymedisease.org/news/touchedbylyme/protect-yourself-from- ticks.html  Lime Disease Guide.org. (LDG) (n.d.). Lime disease morphology. [Photo]. Retrieved from http://lymediseaseguide.org/lyme-disease-morphology http://lymediseaseguide.org/lyme-disease-morphology  Lyme Disease Guide.org. (n.d.). Lyme disease prevention – vaccination. [Photo]. Retrieved from http://lymediseaseguide.org/lyme-disease-prevention-vaccinationhttp://lymediseaseguide.org/lyme-disease-prevention-vaccination  Middlesex-London Health Unit (MLHU). (2014). How to properly remove a tick. [Photo]. Retrieved from https://www.healthunit.com/submit-tick-health-unithttps://www.healthunit.com/submit-tick-health-unit  Munderloh, P. & Kurtti, T. (2005). The abc’s of lyme disease spirochaetes in ticks. The Lancet, 366:962. [PDF].  New York State Department of Health (NYSDH). (2011). Lyme disease (tick-borne borreliosis, lyme arthritis). Retrieved from https://www.health.ny.gov/diseases/communicable/lyme/fact_sheet.htm https://www.health.ny.gov/diseases/communicable/lyme/fact_sheet.htm  Nuttall, P. A., & Labuda, M. (2004). Tick-host interactions: Saliva-activated transmission. Parasitology, 129, S177-89. Retrieved from http://search.proquest.com/docview/750573476?accountid=14872 http://search.proquest.com/docview/750573476?accountid=14872  Piesman, J., & Schneider, B. (2002). Dynamic changes in lyme disease spirochetes during transmission by nymphal ticks. Experimental & Applied Acarology, 28(1-4), 141-5. Retrieved from http://search.proquest.com/docview/220128404?accountid=14872http://search.proquest.com/docview/220128404?accountid=14872 7/20/2014 D. Eakins, MPH PUBH 6165 23

24. REFERENCES, Cont’d  Radolf, J., Caimano, M., Stevenson, B. & Hu, L. (2012, February). Of ticks, mice, and men: understanding the dual host lifestyle of lyme disease spirochaetes. Nature Reviews Microbiology, 10:87-99. doi: 10.1038/nrmicro2714.  Sheil, W. Jr. (2014). Lyme disease pictures slideshow: Symptoms and treatment. MedicineNet.com. [Photo]. Retrieved from http://www.medicinenet.com/lyme_disease_pictures_slideshow/article.htm  University of North Florida (UNF). (2014, May). Lyme disease confirmed in humans from southern states. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2014/05/140513091115.htm www.sciencedaily.com/releases/2014/05/140513091115.htm  U.S. Department of Health and Human Services. National Institutes of Health. National Institute of Allergy and Infectious Diseases (NIAID). (2012). A history of lyme disease, symptoms, diagnosis, treatment and prevention. Retrieved from http://www.niaid.nih.gov/topics/lymedisease/understanding/Pages/intro.aspx http://www.niaid.nih.gov/topics/lymedisease/understanding/Pages/intro.aspx  Virginia Department of Public Health (VDPH). (2014). Vector-borne disease control. Retrieved from http://www.vdh.virginia.gov/epidemiology/DEE/Vectorborne/http://www.vdh.virginia.gov/epidemiology/DEE/Vectorborne/ 7/20/2014 D. Eakins, MPH PUBH 6165 24