1. Novel Tickborne Disease and Tickborne Disease Incidence, Kansas, 2012-2014 Daniel Neises, MPH Senior Epidemiologist Bureau of Epidemiology and Public Health Informatics

2. Learning Objectives List the two most prevalent tickborne diseases in Kansas Identify the areas of the state where most of these infections occur.

3. Ixodes Species Life Cycle

4. Tickborne Disease Incidence, Kansas, 2012-2014 Disease Confirmed and Probable Cases Spotted Fever Rickettsiosis423 Ehrlichiosis/Anaplasmosis118 Tularemia*77 Lyme Disease73 Bourbon virus1 *Transmitted by ticks as well as deer flies, rabbits, and other animals

5. SpeciesTick VectorGeographic Distribution Rickettsia rickettsii Dermacentor variabilis (American dog tick) East of the Rocky Mountains and limited areas on the Pacific Coast. Rickettsia parkeri Amblyomma maculatum (Gulf Coast tick) Eastern and southern U.S., particularly along the coast Rickettsia species 364D Dermacentor occidentalis (Pacific Coast tick) Northern California, Pacific Coast Spotted Fever Rickettsiosis

6. Rocky Mountain Spotted Fever Characterized by acute onset of fever – Headache, myalgia, malaise, nausea/vomiting – Macular or maculopapular rash 4-7 days following onset ( ~ 80% patients) Often on palms and soles

7. Ehrlichiosis/Anaplasmosis Similar diseases – Anaplasmosis used to be considered a type of ehrlichiosis Ehrlichia chaffeensis and Ehrlichia ewingii bacteria Anaplasma phagocytophilum bacteria Characterized by acute onset of fever with: – Headache, myalgia, malaise – Anemia, leukopenia, thrombocytopenia, or elevated hepatic transaminases – Nausea, vomiting, or rash may be present

8. Rocky Mountain Spotted Fever Incidence per 100,000 population, 2012-2014* *Mapped by county of exposure, not residence

9. Ehrlichiosis Incidence per 100,000 population, 2012-2014* *Mapped by county of exposure, not residence

10. Anaplasmosis Incidence per 100,000 population, 2012-2014* *Mapped by county of exposure, not residence

11. Tickborne Rickettsial Diseases, Confirmed and Probable Cases

12. Tickborne Rickettsial Diseases by Hospitalization Status

13. Heartland Virus 2012, NW Missouri (Heartland Regional Medical Center in St. Joseph) – 2 patients hospitalized with fever, headache, fatigue and diarrhea – A virus analysis = novel, genetically unique phlebovirus. – Likely transmitted by Lone Star tick As of May 2014 – 10 cases identified among residents of Missouri, Oklahoma, and Tennessee – 2 deaths

14. Bourbon Virus Late Spring 2014, KU Med Center – Previously healthy man from Bourbon County – History of tick bite, fever, fatigue, thrombocytopenia and leukopenia – Given doxycycline for presumed tickborne illness – Multiorgan failure developed, and he died 11 days after illness onset – Testing results for known tickborne pathogens were negative Tested for antibodies against Heartland virus, indicated presence of another virus Virus identified as a novel Thogotovirus, “Bourbon Virus”

15. Bourbon Virus Planned tick and human studies

16. KDHE Resources Disease statistics – kdheks.gov/epi/statistics.htm Epidemiology Hotline – Infectious Disease Epidemiologists available to answer questions, provide recommendations 1-877-427-7317 epihotline@kdheks.gov