1. Lyme Disease Maduabuchi Prince Gabriel PhD Epidemiology
Walden University
PUBH 8165 Environment Health
Instructor: Dr. Donald Goodwin.
Winter Quarter, 2011.
The target audience:
General Public & Public Health Student
This is the title page.

2. Objectives Of the Presentation
Define Lyme disease and the vector that causes Lyme disease.
Review the significance, prevalence, incidence, statistics and the effect of Lyme disease.
We will evaluate how Lyme disease is screened.
Ways to stop transmission .
The Objective of the presentation is to look into Lyme disease as an environmental Health issue and ways to prevent Lyme disease. We will Define Lyme disease and the vector that causes Lyme Disease, review information from CDC and other bodies on Lyme Disease significance, Prevalence, incidence, statistics and the effect of Lyme disease to the population of interest and the nation in general.
How do we screen for Lyme disease, ways to stop Transmission of this disease. Also look into Prevention, Control and Eradication of the Vector that causes Lyme Disease. Finally, evaluate some recent development and policies on the prevention of this disease.

3. Objectives Of the Presentation cont.
Prevention, control and eradication of the Ixodes scapularis and Ixode pacificus that causes Lyme Disease.
We will look at some recent development and policies on the prevention of this disease, and eradication of the, host, vector, and Lyme disease.
Finally, Provide more reading materials.

4. Definitions and overview
What is Lyme disease. Lyme disease is a vector borne disease, caused by a spirochete bacteria called Borrelia burgdorferi.
What are the signs and symptoms of Lyme disease. The first signs and symptoms of Lyme disease is a red rash called erythema migrans, flu like symptoms, and joint pain.
American Lyme Disease Foundation, (2006); Center for Disease Control, (2011).
Lyme disease is a vector Borne Disease, caused by a spirochete bacteria called Borrelia Burgdurferi. This bacteria is found in deer tick (Black Lagged Tick). Deer Tick is the vector that carries the bacteria. Tick transmits the disease to humans and animals when they bite the victim.
Borrelia Burgdurferi, lives in mice, squirrels , ticks and other smaller animals. The first signs and symptoms of Lyme disease is a red rash, flu like symptoms, and joint pain.
When the infection is left untreated, the infection can spread to the joints, heart, and the nervous system.

5. Erythema migrans Google images, (2011).
This is a complicated rash from Lyme disease.
Google images, (2011).

6. What vector causes Lyme disease
Deer tick or Blacklegged tick. The scientific name is Ixodes scapularis. When the Ixodes scapularis have a blood meal on its host, they will leave them infected with Borrelia burgdorferi after 36-48hours of engorging.
The infected nymphal is the main cause of Lyme disease than the adult blacklegged tick.
If the tick is removed before the first 36hours, then the individual will not be infected by the disease.
American Lyme Disease Foundation, (2006)
Deer Tick or Black legged tick. They can transmit the disease after attaching to human body of animal for 36-48hours

7. Picture of Ixodes scapularis (Deer tick) on human body
This is deer ticks attached to the human body, after about 36hrs of attachment to the human body they will transmit borrelia Burgdorferi Bacteria.
Google images, (2011).

8. Picture of Ixodes scapularis. This tick is very tiny in size.
This is the picture of the Deer tick showing the scale in centimeter. The deer tick is smaller than the wood or dog tick. To the left is the female deer tick, second from the left is the male deer tick. To the extreme right is the larva.
Minnesota Department of Health, (2011)

9. Three host life cycle of Ixodes scapularis
The scatch image that I made showing the three host life cycle of Ixodes Scapularis.
Image scratched by Maduabuchi Gabriel with information from the
Stafford, (2007) .

10. Explanation to the three host life cycle of Ixodes scapularis
The tick have four stages in their life cycle, egg, larva, nymph and the adult (male and female).
The larvae and the nymphs changes to another stage after digesting a blood meal by shedding the molting or the cuticles.
The Larvae feeds on an animal and drop to the ground and molts to a nymph. First host.
Stafford, (2007)

11. Explanation to the three host life cycle of Ixodes scapularis cont.
The nymph feeds on small mammals and birds, engorged drop to the ground and molt to an adult. Second host.
The adult tick feeds on medium and large mammals (third host) and the female tick will produce one single batch of eggs and die.
Stafford, (2007)

12. 3D Illustration of B.burgdorferi
This is a 3D illustrated picture of a Lyme disease. You can see the picture of the bacteria under the human skin. Visible you will see a red circled rash outside the skin of the Lyme Disease Victim.
Google Images, (2011)

13. Areas with Lyme disease
The map showed that the Lyme disease infestation is more in the Northeastern and the north central areas of the united states.
Center For Disease Control, (2009)

14. Significance and prevalence of Lyme disease.
Most frequently reported vector borne disease in the US.
Northeastern and North Central states of the United States more at risk.
American Lyme Disease Foundation, (2006).
Looking into Lyme disease is very important because this is the most frequently reported vector-borne disease in the united states.
Lyme Disease is Prevalent in the Northeast (upper east coast) and the upper Mid-West.

15. Statistics : 1st five state with highest incidence rate in 2009.
In 2009, Delaware had highest incidence of Lyme disease.
Connecticut the second
New Hampshire the third.
Massachusetts the fourth.
Maine was the fifth state.
Center for Disease Control, (2010).
In 2009, Delaware had highest incidence of Lyme disease with reported cases, followed by Connecticut with 78.2 incidence rate, New Hampshire was the 3rd with incidence rate of 75.2, followed by of Massachusetts with 61 incidence rate and finally, Maine was the 5th state with incidence rate of 60 These are confirmed cases of Lyme disease per 100,000 people according to Center for Disease Control. For the public health student listening, this information will be useful.

16. Incidence of Lyme disease
During there was a total of 248,074 cases of Lyme disease reported to CDC in the 50 states, District of Columbia and the US territories.
Out of these total number, 93% of the total reported was from Connecticut, Delaware, Massachusetts, Maryland, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin.
The highest incidence was among children 5-14years of age, 53% of the cases reported was among male.
Center for Disease Control, (2006).
According to the CDC report incidence of Lyme disease is more common in boys 5-19years of age and 30years and above

17. Where do you find the vectors
In the woods
Around deer.
In homes closes to bushes.
Leaves around the home.
Piles of woods.
Untrimmed trees around the home.
The Vectors are found in the woods especially where there is a lot of deer. The tick that bites the human that causes Lyme disease are the deer tick.

18. Control of transmission:
Non human host-mice, deer, birds.
Vectors: Deer tick (Ixodes scapularis).
Vector controlling agents: insecticides, incent repellants.
Steeve, Coburn & Glickstein, (2004 p 1100)
Lyme Disease transmission can be controlled by eradication of non human hosts such as mice and deer and other host for the disease. Eradication of deer can be done as “host targeted acaricides against rodents and deeris another way to control Transmission. You can also eradicate this disease by destroying the vectors using insecticides such as incent repellants and other insecticides.

19. Tick management strategies for the control of Ixodes scapularis.
Personal protection: prevention of tick bites, tick checks after visiting the woods and bushes, and tick removal.
Landscape management: cutting of the grasses, tick safe landscape modification to make it unsuitable for ticks.
Management of host abundance: fencing, host reduction and destruction of the host habitats.
Host targeted Acaricides: the treatment of the host like the white footed mice, chipmunks or deer through passive tropical applications.
Biological or natural control: use of fungal pathogens and biopesticides to control tick.
Stafford, (2007)

20. Personal protection to prevent Lyme disease.
Wearing long sleeve and long pants in wooded areas.
Use of Insect repellants.
Shower immediately coming out from the woods
Self checks after visiting the woods.
Call your doctor for check up for un-usual Rash.
Center for Disease Control, (2006).

21. Environmental prevention for Lyme disease.
Clearing the surroundings. Keeping the lawns mowed, and removing things from the edge of the lawn.
Removing brushes and leaves around stonewalls and wood piles.
Discouraging rodents activities.
Keep dogs cats and other mammal pets away from the woods to reduce them bringing tick back to the house.
Fencing homes to exclude deer and planting plants that do not attract Deer.
Using pesticide :DEET or permethrin-based mosquito and tick repellants should be used in the yard when working in the lawns.
American Academy of Pediatrician, (2000); Stafford, (2007)
Some of the environmental ways to prevent Lyme disease are: Clearing the brushes, trees, woods and other habitats around the houses can help in reducing tick in and around the homes. Fencing homes near wooded areas to prevent deer from coming into residential area can help control tick. Using pesticide where there is a lot of tick infestation to control the vector. When you are living in Lyme disease infested area you be vaccinated with Lyme disease vaccines, single dose osp vaccine or recombinant OspA (rOspA) vaccine.

22. Clinically treatment of Lyme disease.
You can treat Lyme disease clinically by the use of antibiotics after diagnosis through laboratory test. Antibiotics can also be used as a prophylaxes to prevent Lyme disease.
Wormser, et al. (2006)
When you have being confirmed with test that you are infected with Lyme disease, It can be treated with Antibiotics. Doxycycline, amoxicillin and cefuroxime axetil in physician recommended doses have been proved to be effective in the treatment of lime disease.

23. Laws and policies about Lyme disease.
Lyme disease is a reportable disease. By this I mean that when you are infected by Lyme disease, the hospital where you are diagnosed with the disease will report the incidence to the health department and then this will be reported to center for Disease control.
Center for Disease Control, (2006).
In the United States, Lyme Disease is a reportable disease and the laboratory, doctors offices are expected to report incidence of lime disease to the health department .

24. Recommendations and conclusion
More work is needed on better vaccines and insecticides to be used to prevent the disease and eradicate the vectors. The last vaccine that was in use for Lyme disease was discontinued in 2002 due to lack of demand for the vaccine.
Education and information is the key. Pass on information to your friends, colleagues and family members on the need to prevent tick bite especially the blacked legged tick and ways to prevent its spread.
Stafford, (2007)

25. Reference:
American Academy of Pediatricians, (2000) Prevention of Lyme disease. Pediatrics, 105,
American Lyme Association , (2006) Lyme disease. Retrieved January 15, 2011 from
Center For Disease Control, (2010) reported cases of Lyme disease United States Retrieved January, 15th from
Center For Disease Control, (2006) Lyme disease I Incidence. Retrieved January, 15th from
Google Images, (2011) Images of tick and Erythema Migrans Retrieved January, 15th 2011 from
These are the references

26. Reference cont.
Minnesota Department of Health, (2010). Blacklegged tick . Retrieved February, 5th 2011 from
Stafford, K. C. (2007). Tick management handbook. Produced by The Connecticutt Agricultural experimental station. Retrieved
February, 6th 2011 from:
Steers, A., Coburn J., & Glickstein, L. (2004) The emergency of Lyme disease. The Journal of clinical investigation, 115(8),
Retrieved January, 15, 2011 from
Wormser, G. P., Dattwayler, R. J., Shapiro, E. D., Halperin, J. J., Steere, A. C., Klempner, M. S.,… Nadelman R.O., (2006) The
Clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical
practice guidelines by the infectious disease society of America. Clinical Infectious Disease, 43, Retrieved
January, 15, 2011 from

27. Resources on Lyme disease from CDC
NEW Free Lyme Disease Continuing Medical Education for Clinicians
Brochures and educational materials
Protect Yourself from Tick-Borne Diseases. ( PDF - 1 page, 782KB)
Lyme Disease: A Public Information Guide ( 16 pages, 4.94MB)
Tickborne Diseases in Massachusetts, a physicians’ reference manual (26 pages, 2MB)
Tick Management Handbook: An integrated guide for homeowners, pest control operators, and public health officials for the prevention of tick-associated diseases. ( 84 pages, 8,800KB) (From Connecticut Agricultural Experiment Station, New Haven CT)
Lyme Disease: The Facts, the Challenge (29 pages, 407KB) (From U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health)
Information about repellents:
Insect repellent use and safety , Insect repellent protection times
Continuation of reference.

28. More Resources From CDC
Prevention
How Can We Prevent Lyme Disease? Edward B. Hayes, M.D., and Joseph Piesman, D.Sc. (Access granted courtesy of New England Journal of Medicine)
Ecology and transmission
Surveillance for Lyme Disease --- United States, MMWR,October 3, 2008 / 57(SS10);1-9
Lyme Disease --- United States, June 15, 2007 / 56(23);
Case definition and report forms
Lyme Disease Surveillance Case Definition (revised Jan 2008)
Lyme Disease Surveillance Case Report Form -For Public Health Officials Use ( 2 pages, 737 KB)
Some useful resources.

29. Other helpful Resources
American Lyme disease foundation.
Some useful resources.

30. ANY QUESTION ?????? Questions
Thanks for listening is there any questions?