Lyme Disease – Watch out for Spring and Summer Lyme Disease – Watch out for Spring and Summer! Presentation by Naomi Azunie Ph.D student in Public Health – Community health Education Walden University Professor : Dr. Denise Feda Environmental Health – Summer 2012 This presentation is based on the environmental aspect of the Lyme Disease. We are going to explore historical aspects of the Lyme disease the causes, transmission, signs and symptoms, diagnosis and treatment and prevention. At the end of the presentation some suggested sites with life saving information on Lyme disease will help people better understand the impact and implication of Lyme disease. This picture is a female tick that is infected with Lyme bacteria and ready to bite. Reference MedicineNet.Inc. (2004). Tick – Lyme disease. Retrieved on July 23, 2012 from http://www.medicinenet.com/ticks/article.htm 1

Objectives of this presentation Improve corporation between community partners and resources available to create awareness. Identify organizations with goals to improve public health effort on environment to stop Lyme disease Provide communities with updated statistics and educative materials on Lyme disease To encourage hospitals and clinics to provide effective diagnosis and treatment of Lyme disease Lyme disease is a public health concern and very important that people living in communities know about the impact of this disease on community’s health and to take active part in the fight to eliminate Lyme disease. By using resources like public libraries to provide educative and statistics on Lyme disease communities will be aware of this disease and report incidence of the disease in their communities. 2

Quick Facts on Lyme Disease Described in 1975 and was nationally a notifiable disease in 1991. The 5th most commonly reported vector borne illness in the United States in 2009 A tick-borne disease caused by spirochete Borrelia burgdorferi First identified in 1982 In humans can cause abnormalities of the skin, joint , heart, and the nervous system. Affects all ages, sex, and attack rates higher in children under 15 and in adults ages 45 to 65 (GAO, 2001) Lyme disease has been around for a while and the good news is that it was identified and notified so that people should be aware of its impact on the environment and health of people. Research has always been are key in comparing cases and controls and drawing conclusions based on findings. According the CDC about 94% of Lyme disease were reported in 2010 from 12 different states. These information are vital for people everywhere because as we examined Lyme disease in the context of the environment, it affects everyone and that is the reason people should know about the disease so they can prevent themselves. References Center for Disease Control. (2012). Lyme disease Fast Facts. Retrieved on July 23, 2012 from http://www.cdc.gov/lyme/stats/index.html General Accounting Office. (2001). Lyme disease programs and Resources. Retrieved on July 23, 2012 from www.gao.gov/new.items/d01755.pdf Standhope, M. and Lancaster, J. (2008). Public health nursing population-centered health care in the community. (2nd Ed). Mosby Inc 3

Endemic distribution of Lyme Disease in the United States Over the past 10 years cases have been reported mostly in States of the northeastern, mid-Atlantic, and the north-central regions of the United States. Many cases have been reported from counties in northwestern California This is the geographic distribution of states and regions that cases of Lyme disease have been reported to the CDC. Since Lyme disease is a traveler's disease this map will educate travelers to be careful when planning a trip to the areas with high rates of cases. The picture to the right is courtesy of the Center of Disease Control where the map was retrieved. Reference Center for Disease Control. (2012). Interactive map of Lyme disease. Retrieved on August 3, 2012 from http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html

Distribution Prevalent in the Northeast, the upper Midwest, and Pacific Northwest. More than 9,600 cases reported in 1992 to the CDC About 94% of cases were reported from 12 states in 2010 with Delaware ranking highest. Common during spring and summer time Wooded and grassy areas where deer and mice are encroach by residential homes are common habitats for ticks Lyme disease is distributed in areas where human and other creatures have interaction and with white flight into suburban areas which are surrounded by wooded and grassy areas where animals carry ticks inhabit. The abandon homes in the urban areas have also become a safe heaven for these animals carry ticks like the white foot mouse. This information about distribution of the disease is very helpful so that when travelling we should plan towards these at risk areas. References Center for Disease Control (CDC) (2012). Reported Lyme disease cases by states 2000- 2010. Retrieved on August 3, 2012 from http://www.cdc.gov/lyme/stats/chartstables/reportedcases_statelocality.html Willen, J. L. (1994). Lyme disease: A seasonal risk. Nation’s Business Vol. 82, Issue 8. Retrieved on August 3, 2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/lyme disease: A seasonal risk.

Causes of Lyme Disease A tick-borne vector caused by the spirochete, Borrelia burgdorferi. The vector – ixodes scapularis carry the bacteria from host- the deer and white mouse. Blacklegged tick carry bacteria to humans through bite. Ticks must feed for 72 hours before transmitting enough spirochetes to infect humans Have an incubation period of seven to ten days. Pets can carry ticks because of their hairy skin and spread to humans. Lyme disease to the ordinary man is called the deer disease because deer and most animals in living in the wood are exposed to carrying ticks. This aspect of the cause of Lyme disease is important because people who are pet owners if they find blacklegged tick, that should signal something to them if they have information about Lyme disease. One great thing about Lyme disease is the fact that It is not contagious so people do not have to worry about those who are infected but care need to be taken as we interact with people and animals. Reference Standhope, M. and Lancaster, J. (2008). Public health nursing population-centered health care in the community. (2nd Ed). Mosby Inc Selius, B. A. and Alper, B. S. (2004). Lyme disease. Cortlandt Forum. Vol. 17 Issue 6, p73-79 6

Transmission of Lyme Disease In humans infections are through bites of ticks called nymphs and adult ticks Pets are common carriers to humans No known fact about human to human transmission Infected persons not allowed to donate blood The American College of Physicians have produced a great guide for patients and people in general to understand the cycle of Lyme disease. From the picture transmission is through nymphs and adult ticks and the most frequent season for disease occurrence is during all four seasons but with a high in the winter season. Transmission is through bite of an infected tick. References American College of Physicians. (2012). Lyme Disease: a patient guide. Retrieved on July 23, 2012 from http://www.acponline.org/clinical_information/resources/lyme_disease/patient/prevention.htm Center for Disease Control. (2012). Lyme disease transmission. Retrieved on July 23,2012 from http://www.cdc.gov/lyme/transmission/index.html http://www.acponline.org/clinical_information/resources/lyme_disease/patient/prevention.htm 7

Transmission of Lyme Disease Fetus infection occurs through placenta. May result in still birth if infected during pregnancy Can survive in blood stored for donation No scientific evidence of transmission through blood transfusion Reference Lyme Disease Association. (2012). What is Lyme disease. Retrieved on July 23, 2012 from http://lymediseaseassociation.org/index.php?option=com_content&view=article&id=552:what-is-lyme-disease&catid=64:medical&Itemid=403 8

Signs and Symptoms of Lyme Disease Three clinical stages of disease manifestation. Stage one – about 3- 30 days after bite. Erythema migrans develops 1-4 weeks after the bite. flu-like symptoms including fever, headache, stiff-neck, body aches, and fatigue, malaise, nervousness, and depression. Stage two – dissemination to multiple organ systems Symptoms includes: severe headache, stiffness neurological and cardiac abnormalities, arthritis or nervous system problems and in rare cases heart problems. Lyme disease can also resolve to eye inflammation, hepatitis and severe fatigue Stage three – chronic infection which result muscle pain, inflammation, recurrent attacks of arthritis, myocarditis, Lyme meningitis, and unilateral Bell’s palsy. Nervous system problems like memory loss, difficulty concentrating Early diagnoses of Lyme disease in the first stage of clinical diagnosis reduces a person’s chance of suffering from more serious effects of the disease as a result of lack of thorough diagnosis. The symptoms provided can help even people who have not been exposed to the disease. References National Institute of Allergy and Infectious Diseases. (2012). Lyme Disease. Retrieved on July 23, 2012 from http://www.niaid.nih.gov/topics/lymedisease/understanding/pages/into.aspx Standhope, M. and Lancaster, J. (2008). Public health nursing population-centered health care in the community. (2nd Ed). Mosby Inc Steere, A. C., Hutchison, G. J., Rahn, D. W., Sigal, L. H., Craft, J. E., DeSanna, E. T., and Malawista, S. E. (1983). Treatment of the early manifestations of lyme disease. Annals of internal medicine. Vol, 99, Issue 1, p22. 9

Diagnosis Distinctive features of the lesions makes easy diagnoses. Western Blot assay- best antibody test used in diagnosing at later stage. Western Blot technique provides serum IgM or IgG results. Serologic tests available but not essential to diagnosis in early stage. CDC recommends ELISA - a very sensitive like -IFA for first weeks of infection – effective at later stage. Other test like the echocardiogram to look at the heart and electrocardiogram and MRI of the brain are examined to detect late stage of disease With advances in medical technology, it now possible to detect Lyme disease in the late stage. Most treatment of Lyme disease is with antibotics with the exception of pregnant women and children who are 8years old. This information is communities so that people who are pregnant or breastfeeding and those under age are not given medication that can have adverse effect on their health. References National Library of Medicine. (2011). Lyme disease. Retrieved on July 23,2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002296/ Standhope, M. and Lancaster, J. (2008). Public health nursing population-centered health care in the community. (2nd Ed). Mosby Inc. Bratton, R. L., Whiteside, J. W., Hovan, M. J., Engle, R. L., and Edwars, F. D. (2008). Diagnosis and treatment of Lyme disease. Clinic Proceedings. Vol.83. Issue 5, p 566-571. Retrieved on August 4,2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/ 10

Treatment Antibiotics treatment not suitable for pregnant women and children younger than 9years. Treatment effective in early stage Doxycycline- 100mg orally twice daily Amoxicillin – 500mg orally 3 times daily Cefuroxime axetil – 500mg orally, twice daily Oral treatment taken within 14 to 21 days Duration of treatment varies depending on the stage. Antibiotics has been an active medication in treating Lyme disease during the early stage of the disease Reference Bratton, R. L., Whiteside, J. W., Hovan, M. J., Engle, R. L., and Edwars, F. D. (2008). Diagnosis and treatment of Lyme disease. Clinic Proceedings. Vol.83. Issue 5, p 566-571. Retrieved on August 4,2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/

Prevention and Control of Lyme Disease Avoid walking outdoor during tick season between spring to summer time Light-colored clothing to easily identify ticks Long sleeve shirt and tuck into long pants before going outdoor to wooded area Spray insect repellent with DEET Walk in the center of trails to avoid grass and bushes. Bath immediately after outdoor walks, wash and dry clothes. Check body and carefully remove any attached ticks People 15 years and over should consider getting a vaccine especially those in high risk areas References Center for Disease Control. (2012). Preventing tick bite. Retrieved on July 23,2012 from http://www.cdc.gov/lyme/prev/index.html Standhope, M. and Lancaster, J. (2008). Public health nursing population-centered health care in the community. (2nd Ed). Mosby Inc. Willen, J. L. (1994). Lyme disease: A seasonal risk. Nation’s business. Vol. 82, Issue 8. Retrieved on August 3, 2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/lyme disease Halsey, N. A. and Abramson, J. S. (2000). Prevention of Lyme disease. American academy of pediatrics. Vol. 105 Issue 1. Retrieved on August 3, 2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail? Goldsmith, C. (1999). How to avoid Lyme disease. Current health. Vol. 25, Issue 8, p16. Retrieved on August 4, 2012 from walden library. 12

Suggested sites for information on Lyme disease Lyme disease is a public health concern and many people may or will get infected. Here are some important websites that have valuable information concerning Lyme disease. Information concerning repellent registered by the Environmental Protection Agency (EPA) can be found at http://cfpub.epa.gov/oppref/insect/ For more understanding of Lyme disease visit these websites http://www.cdc.gov/lyme/ http://www.acponline.org/clinical_information/resources/lyme_disease/patient/preventio n.htm http://lymediseaseassociation.org/index.php?option=com_content&view=article&id=55 2:what-is-lyme-disease&catid=64:medical&Itemid=403 http://www.hopkins-arthritis.org/arthritis-info/lyme-disease/clinical-presentation.html http://www.healthunit.org/hazards/documents/lyme.htm http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query- meta?v%3Aproject=medlineplus&query=lyme+disease&x=0&y=0 http://www.webmd.com/a-to-z-guides/lyme-disease-nord

References American College of Physicians. (2012). Lyme Disease: a patient guide. Retrieved on July 23, 2012 from http://www.acponline.org/clinical_information/resources/lyme_disease/patie nt/prevention.htm Bratton, R. L., Whiteside, J. W., Hovan, M. J., Engle, R. L., and Edwars, F. D. (2008). Diagnosis and treatment of Lyme disease. Clinic Proceedings. Vol.83. Issue 5, p 566-571. Retrieved on August 4,2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/ Center for Disease Control. (2012). Lyme disease Fast Facts. Retrieved on July 23, 2012 from http://www.cdc.gov/lyme/stats/index.html Center for Disease Control. (2012). Lyme disease transmission. Retrieved on July 23,2012 from http://www.cdc.gov/lyme/transmission/index.html Center for Disease Control. (2012). Preventing tick bite. Retrieved on July 23,2012 from http://www.cdc.gov/lyme/prev/index.html

References continue Center for Disease Control. (2012). Interactive map of Lyme disease. Retrieved on August 3, 2012 from http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html Center for Disease Control (CDC) (2012). Reported Lyme disease cases by states 2000- 2010. Retrieved on August 3, 2012 from http://www.cdc.gov/lyme/stats/chartstables/reportedcases_statelocality.html DeSanna, E. T., and Malawista, S. E. (1983). Treatment of the early manifestations of lyme disease. Annals of internal medicine. Vol, 99, Issue 1, p22. General Accounting Office. (2001). Lyme disease programs and Resources. Retrieved on July 23, 2012 from www.gao.gov/new.items/d01755.pdf Halsey, N. A. and Abramson, J. S. (2000). Prevention of Lyme disease. American academy of pediatrics. Vol. 105 Issue 1. Retrieved on August 3, 2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail? Goldsmith, C. (1999). How to avoid Lyme disease. Current health. Vol. 25, Issue 8, p16. Retrieved on August 4, 2012 from walden library.

References cont’d Lyme Disease Association. (2012). What is Lyme disease. Retrieved on July 23, 2012 from http://lymediseaseassociation.org/index.php?option=com_content&view=article &id=552:what-is-lyme-disease&catid=64:medical&Itemid=403 MedicineNet.Inc. (2004). Tick – Lyme disease. Retrieved on July 23, 2012 from http://www.medicinenet.com/ticks/article.htm National Library of Medicine. (2011). Lyme disease. Retrieved on July 23,2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002296/ National Institute of Allergy and Infectious Diseases. (2012). Lyme Disease. Retrieved on July 23, 2012 from http://www.niaid.nih.gov/topics/lymedisease/understanding/pages/into.aspx Selius, B. A. and Alper, B. S. (2004). Lyme disease. Cortlandt Forum. Vol. 17 Issue 6, p73-79 Stanhope, M. and Lancaster, J. (2008). Public health nursing population-centered health care in the community. (2nd Ed). Mosby Inc

References cont’d Steere, A. C., Hutchison, G. J., Rahn, D. W., Sigal, L. H., Craft, J. E., DeSanna, E. T., and Malawista, S. E. (1983). Treatment of the early manifestations of lyme disease. Annals of internal medicine. Vol, 99, Issue 1, p22.tlandt Forum. Vol. 17 Issue 6, p73-79. Willen, J.L. (1994). Lyme disease: A seasonal risk. Nation’s Business. Vol. 82, Issue 8. Retrieved on August 3, 2012 from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/lyme disease