1. LYME DISEASE Mary Grace Stobierski, DVM, MPH, DACVPM Michigan Dept. Community Health

3. Borrelia burgdorferi

5. Lyme Disease/ History 1908 Europe: Bannworth’s syndrome, chronic skin lesions associated with tick bites, later found to be penicillin responsive 1975 First description of Lyme arthritis - Old Lyme, CT. Cluster in children. 1983 Isolation of spirochetes from blood, CSF, and skin of patients with Lyme borreliosis Spirochetes isolated from Ixodes sp. ticks Willy Burgdorfer identified spirochetes as belonging to genus Borrelia

6. National Case Definition F or Epidemiologic Surveillance A case is defined as: n A person with Erythema Migrans at least 5 cm in diameter; or n A person with at least one late manifestation and laboratory evidence CDC-1997

7. Reported Cases of Lyme Disease, United States 1982-1999

8. Human Case Reporting

9. 0 20 40 60 80 100 120 140 160 180 198419871990199319961999 Year Reported Reported Lyme Disease Cases in Michigan 1984-2000 7 8 2225 76 180 148 73 52 43 44 25 20 27 18 11 23 1991: New Case Definition

10. Ixodes scapularis (formerly, I. dammini)

12. Adult, female I.scapularis

15. Ixodes scapularis endemic vs adventitiously introduced n Endemic –All three stages abundant –Present from year to year n Introduced –Only 1 stage - usually individual adults on deer –Not present in same location - year to year

16. Peromyscus leucopus White-footed Mouse

17. White-tailed deer

18. Early Lyme Disease Clinical presentation n Incubation period: –3 to 30 days after tick bite n Characteristic skin lesion: –erythema migrans (EM) n Systemic Symptoms Common: –malaise, fatigue, headaches, chills, low-grade fever, myalgias, arthralgias

19. Erythema migrans, with satellite lesion

20. Early Lyme Disease Natural History n Erythema Migrans resolves within 3 to 4 weeks, even without treatment; resolves within days with antibiotics. n Minor systemic symptoms, especially fatigue. n In the absence of treatment most patients will develop other Lyme Disease manifestations.

23. Late Lyme Disease n Cardiac n Neurologic n Arthritis n Ocular n Dermatologic

25. Surveillance Definitions Surveillance: “The collection, collation and analysis of data and the dissemination to those who need to know.” -A.D. Langmuir Passive Surveillance: Health provider initiates reports. Active Surveillance: Health Department initiates reports.

27. Ecologic Field Survey

29. Gogebic Houghton Keweenaw Iron Baraga Marquette Dickinson Alger Delta Menominee Schoolcraft Luce Mackinac Chippewa Cheboygan Presque Isle Charlevoix Antrim OtsegoMontmorency Leelanau Benzie Grand Traverse Kalkaska CrawfordOscoda Alcona Manistee Wexford Ogemaw Iosco Mason Lake Osceola Clare Gladwin Arenac Oceana Newaygo Mecosta Isabella Midland Bay Huron Muskegon Montcalm Gratiot Saginaw Tuscola Sanilac St. Clair Lapeer Shiawassee ClintonIonia Kent Ottawa Allegan BarryEatonIngham Livingston Oakland Macomb Van Buren Kalamazoo Calhoun Jackson Washtenaw Wayne Berrien Cass Hillsdale Lenawee Monroe St. Joseph Branch Missaukee Alpena Roscommon Emmet Genesee Ontonagon 4 1 6 Ixodes Scapularis Michigan Submissions 1985-1996 1 1 8 3 2 1 1 2 241 9 3 1 1 1 1 2 1 1 3 11 2 1 2 1

30. Most Common Tick Submissions 1985-1996 TickNo. Submitted Human Dog Other No. on: D. variabilis D. albipictus A. americanum I. cookei I. scapularis 2554 1302 708 542 824 63 23 737 190 156 17 17 554 103 168 283 333 121 139 73