1. Prepared by Mr. Shoup

3. LYME DISEASE Should We Be Concerned? One of the fastest growing diseases in the United States today. Lyme disease is the most commonly reported vector borne illness in the U.S. Lyme disease from 2004-2013, over 40,224 cases have now been confirmed in New York State. More information go to: http://www.health.state.ny.us/diseases/communicable/lyme/ http://www.cdc.gov/lyme/stats/index.html http://www.cdc.gov/lyme/stats/chartstables/reportedcases_statelocality.html

4. What Are We Going To Learn? Brief History Life Cycle of the Tick Three signs and symptom Three stages How to Avoid Lyme Disease

5. Brief History Medical Literature in Europe in 1883-Called ECM- found in sheep. 1969-Wisconsin grouse hunter-1 st documented case. Was editor of the Guns Digest at one time. 1975-First Outbreak in state of Old Lyme, Connecticut. 1982-Bacteria found in a tick. 11 states record lyme disease 497 cases 1985-25 states report lyme disease 1988-43 states report lyme disease 1992-49 states report lyme disease 1998-49 states report lyme disease but numbers almost double from 1992 2001-49 states report Lyme disease over doubled from 1998 2005 Highest number of tick cases since documentation 5,565 per 100,000 people 2006-2007 number of cases dropped in the 4,000+ per 100,000 people 2008-23.1 per 100,000 people confirmed Lyme disease 2013-8.6 per 100,000 people. 9.104 probable per 100,000 (27,203)

6. In 2013, 95% of confirmed Lyme disease cases were reported from 14 states: #4 Connecticut 58.7/100,000 #6 Delaware 43.2/100,000 #3 Maine 84.8/100,000 #13 Maryland 13.5/100,000 #5 Massachusetts 57/100,000 #10 Minnesota 26.4/100,000 #2 New Hampshire100/100,000 #9 New Jersey 31.3/100,000 #12 New York 17.9/100,000 #8 Pennsylvania 39/100,000 #7 Rhode Island42.2/100,000 #1 Vermont 107.6/100,000 #14 Virginia 11.2/100,000 #11 Wisconsin 25.2/100,000 http://www.cdc.gov/lyme/stats/chartstables/incidencebystate.html

7. New York Cases Only 1993-2002 2818-1993 5200-1994 4438-1995 5301-1996 3327-1997 4640-1998 4402-1999 4329-2000 4083-2001 5535-2002 2003-2013 5399-2003 5100-2004 5565-2005 4460-2006 4165-2007 5741-2008 highest to date/1yr. 4134-2009 2385-2010 3118-2011 2044-2012 3512-2013 confirmed

8. Area for Risk for Lyme Disease

9. Cases by Year for Lyme Disease-All States

10. Lyme Disease by Age

11. Cases by Month

12. Name for the Ticks Eastern Tick: Ixodes Dammini Deer/Bear Tick Western Tick: Ixodes Pacificus Western Black Legged Tick Southern Tick: Ixodes Scapularis Black Legged Tick Lone Star Tick: Kentucky

13. Bacteria-Spirochete

14. Bacteria-Spirochete under microscope

15. Tick before and after feeding Actual size before feeding Size of tick after feeding (raisin or sesame seed size) Normal Size of parasite: larva, nymph, adult Four stages of life cycle: Egg, Larva, Nymph, Adult Feeding ticks Tick increase in size Increase in size Feeding ticks

16. Ticks that carry Lyme Disease

17. Life Cycle of The Tick

18. Difference between sign and symptom A symptom is any subjective evidence of disease, while a sign is any objective evidence of disease. Therefore, a symptom is a phenomenon that is experienced by the individual affected by the disease, while a sign is a phenomenon that can be detected by someone other than the individual affected by the disease. For examples, anxiety pain, and fatigue are all symptoms. In contrast, a bloody nose is a sign of injured blood vessels in the nose that can be detected by a doctor, a nurse, or another observer. Medical Author: William C. Shiel Jr., MD, FACP, FACR

19. Signs and Symptoms Stage 1 Flu-Like Symptoms Not everyone infected with the bacteria gets ill. If a person does become ill, the first symptoms include one or more of these symptoms: (3-30days+) (7days average) Headache Rash-EM-Erythema Migrans 70%-80% Fever 102 Chills Stiff Neck Nausea/Fatigue Joint Pain stiffness in the joints Muscle Pain, muscle weakness Swollen Lymph glands Lethargy Jarisch Herxheimer Reaction http://www.righthealth.com/topic/Lyme_Disease_Rash_Photos

20. Up to 12 inches Stage 1 Symptoms

21. 1 st Stage Symptoms-Rashes http://www.canlyme.com/rash.html

22. Signs and Symptoms Stage 2 Rash may get bigger Severe headaches light and sound sensitivity Dizziness Pain in muscles and joints especially in the areas of the knee, elbow and shoulders. Arthritis Neurological effects: Bell’s Palsy-facial paralysis Facial twitches Jerking movements Difficulty concentrating, confusion, difficulty thinking Disorientation or getting lost-memory loss Seizures Speech errors Tingling in the hands and feet Lymph glands get swollen

23. Stage 2 Signs & Symptoms Continued Irregular heart beats Blurred Vision Ringing, Buzzing of the ear Sore Throat, Dry Cough Nausea Diarrhea Insomnia Menstruation Problems Encephalitis Encephalitis-inflammation to the brain

24. Bells Palsy Beginning lookAfter look

25. Bells Palsy

26. Signs & Symptoms Stage 3 Skin-hard leathery patches of skin around bite area. Heart Damage/Muscular Damage Arthritis most often in the knees Neurological disorders: Encephalitis Uncontrollable walk-Cerebrum-voluntary actions Mental confusion loss of short term memory Partial Paralysis Loss of memory-long term Eyes to inflammation of the cornea to blindness Kidney Damage/Bladder dysfunction Liver Damage

27. Summary: Lyme Disease Three Stages

28. Cases by Symptom, 2001-2010

29. How To Prevent Lyme Disease Wear light/protective clothing Use tick repellents-Permethrin-on clothes only not skin Use Deet Ex: Deep Woods Off over the age of 12 Check yourself from the woods Bathe as soon as possible from the woods Wash clothing in hot water/Hot Dryer heat Pay special attention to your: Back, Underarms, Groin Area, Head Area Look for something that looks like a black freckle size. Check your pet from a woods before they enter the house Remove ticks carefully: gentle firm tugging motion

30. Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone go to your doctor for removal. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, take to doctors. Never crush a tick with your fingers. How to Remove a Tick

31. Review: How to remove a tick! http://www.health.state.ny.us/diseases/communicable/lyme/

32. What To Do If You Find A Tick Monitor tick bite area Put tick in a container and give to Health Department or Doctor Check for Rash for 1-8 weeks after the bite

33. Treatment Penicillin WASH AREA OF THE BITE WITH SOAP/WATER/ANTISEPTIC CDC recommends a two-step process when testing blood for evidence of Lyme disease. Both steps can be done using the same blood sample. 1) ELISA or IFA test. These tests are designed to be very "sensitive," meaning that almost everyone with Lyme disease, and some people who don't have Lyme disease, will test positive. If the ELISA or IFA is negative: it is highly unlikely that the person has Lyme disease, and no further testing is recommended. If the ELISA or IFA is positive or indeterminate ( sometimes called "equivocal") a second step should be performed to confirm the results. Step 2 Western Blot Test