1. Tickborne Disease Epidemiology Fairfax County Fairfax County, VA, May 30, 2015 Shawn Kiernan District Epidemiologist Fairfax County Health Department

2. Outline Communicable Disease/Epidemiology Unit Tickborne Disease Epidemiology in Fairfax County

3. All Public Health is Local Nearly 3,000 local health departments in the U.S. – Governmental entities of towns, cities, counties, and/or districts

4. Public Health Core Functions Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Assure the quality and accessibility of health services Respond to disasters and assist communities in recovery Prevent epidemics and the spread of disease

5. CD/Epidemiology Unit Objective: Identify and prevent the further spread of communicable diseases

6. Surveillance Over 70 diseases on the Virginia Reportable Disease List – Physicians and directors of medical care facilities – Laboratories – Other facilities (e.g. nursing homes, day cares) – Includes bioterrorism agents, suspected outbreaks of any disease, and diseases of public health concern

8. Vector-borne Transmission Vector-borne transmission is the term commonly used to describe an illness caused by an infectious disease that is transmitted to people by blood-sucking arthropods. The arthropods (insects or arachnids) that most commonly serve as vectors include: mosquitoes, fleas, lice, biting flies and bugs, mites, and ticks. Vectors typically become infected by a disease agent while feeding on infected vertebrates (e.g., birds, rodents, other larger animals, or humans), and then pass on the microbe to a susceptible person or other animal. In almost all cases, an infectious microbe must infect and multiply inside the arthropod before the arthropod is able to transmit the disease through its salivary glands. The most common vector-borne diseases in Virginia are carried by mosquitoes and ticks.

9. Lyme Disease 1975- Mysterious cases of rheumatoid arthritis in children living in Lyme, CT Symptoms increased during summer, and the children lived and played in wooded areas – Children often recalled having a skin rash prior to arthritis – Researchers suspected deer ticks to be vector (1982) Dr. Willy Burgdorfer, a zoologist and microbiologist, discovers the bacterium that causes Lyme disease, Borrelia burgdorferi Dr. Burgdorfer / Source: NIAID/RML

10. Source: CDC Reported Lyme disease cases, United States

11. Reported cases of tickborne disease, Fairfax County 2004-2013 Disease2004200520062007200820092010201120122013 5 year average (2008- 2012) Ehrlichiosis/Anaplasmosis02221117176118.4 Lyme disease110102208191260256146149260200.4 Spotted fever rickettsiosis7811596 20262314.4

14. Signs and symptoms of Lyme disease in humans

15. Treatment and Outcome Lyme disease is treated with antibiotics Recommended regimens range from 2-4 weeks, by pill or intravenously, depending on stage of illness Most patients treated with antibiotics recover completely A few patients, particularly those diagnosed with later stages of disease may have persistent symptoms

16. Questions