Tick-borne Diseases Update

Reports of multiple tick-borne diseases to Maine CDC are indicating an increase in all tick-borne diseases. Physicians have already reported more anaplasmosis cases so far this year than all of last year, and babesiosis and Lyme numbers are steadily increasing as well. Providers should be aware of the risk and prevalence of these diseases and consider them in their diagnoses.

Anaplasmosis:

• 228 cases reported to date in 2016, compared to 186 in all of 2015
• 116 cases reported from the Mid Coast region (Knox 49, Lincoln 43, Sagadahoc 18 and Waldo six)

Babesiosis:

• 49 cases have been reported to date in 2016, compared to 55 in all of 2015
• 13 cases reported from York county, ten cases from Knox county

Lyme disease:

• Lyme disease cases take several months to be entered and classified, so current numbers are not available at this time

Powassan:

• No cases have been reported to date in 2016, compared to one in all of 2015

Co-infections: 

Because all of these diseases are carried by the same tick (Ixodes scapularis), a person may be infected with more than one disease.

• To date, 11 co-infections have been reported: four co-infections with anaplasmosis and Lyme disease, two co-infections with babesiosis and Lyme disease and five co-infections with anaplasmosis and babesiosis.
• In 2015, 22 co-infections were reported: ten co-infections of Lyme disease and anaplasmosis; eight co-infections of Lyme disease and babesiosis; one co-infection of anaplasmosis and babesiosis; one co-infection of Lyme disease, anaplasmosis and babesiosis; one co-infection of Lyme disease and ehrlichiosis; and one co-infection of babesiosis and ehrlichiosis.

Recommendations for Providers:

• Consider tick-borne illnesses in your differential, particularly for individuals with “summer flu” symptoms
• Submit samples for testing
• Treat patients appropriately – recommendations for treatment are available from http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Report cases. All tick-borne illnesses are reportable in Maine, including the erythema migrans rash which is confirmatory. All cases should be reported by phone to 1-800-821-5821 or by fax to 1-800-293-7534.

For more information:

• Maine CDC vectorborne webpages: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml
• Maine Physician’s Reference Guide: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/documents/tick-reference-guide.pdf

• Lyme forms for providers: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/lyme/index.shtml#resourcephysicians
• Guidance on treatment: http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Lyme disease data: https://data.mainepublichealth.gov/tracking/home

Lyme and other tickborne diseases

Lyme disease is the most common vector-borne disease in Maine. Cases have been increasing each year in Maine, and occur in all 16 counties. More than 1,395 cases of Lyme disease were reported statewide in 2014, a record high for Maine.  Lyme disease is most common among school age children and mature adults over the age of 65. Most infections occur during the summer months. A total of 71 cases have already been reported in 2015.

The most common early symptom of Lyme disease is an expanding red rash that occurs 3-30 days after being bitten. Fever, headache, joint and muscle pains and fatigue are also common during the first several weeks. Later features of Lyme disease can include arthritis in one or more joints (often the knee), Bell's palsy and other cranial nerve palsies, meningitis and carditis (AV block). Lyme disease is treatable, and the majority of patients recover after receiving appropriate therapy.

Lyme disease is a reportable condition in the State of Maine.  Providers should report all diagnosed erythema migrans rashes and all positive lab diagnoses.  Cases can be reported by fax at 1-800-293-7534 or by phone at 1-800-821-5821.

Other tickborne diseases: 

Other diseases that are carried by ticks in Maine include anaplasmosis, babesiosis, ehrlichiosis, Powassan and Rocky Mountain spotted fever. They are all reportable in Maine.

In 2014, providers reported 191 cases of anaplasmosis, more the twice the number of cases reported in 2013.  Providers reported 42 cases of babesiosis, a slight increase from 2013.  Four anaplasmosis cases and one babesiosis case have already been reported in 2015.  

For more information:

• Lyme disease data are available on Maine CDC's website at http://go.usa.gov/kGYx
•  For more information on tickborne diseases, including Lyme:  http://go.usa.gov/kGYV
• A Physician's Reference Guide is available and describes the most common tickborne diseases in Maine.  This guide can be found on our website at:http://go.usa.gov/kGrw 
• For IDSA Lyme disease treatment guidelines: http://cid.oxfordjournals.org/content/43/9/1089.full
• To order Lyme educational materials: http://go.usa.gov/kGYh

Tick-Borne Diseases Update

Summer is in full swing and the increase in tick-borne diseases demonstrates that. Maine CDC is receiving reports of multiple tick-borne diseases, some in record numbers. Physicians have already reported more Anaplasmosis cases so far this year than all of last year, and Babesiosis and Lyme numbers are steadily increasing as well. Providers should be aware of the risk and prevalence of these diseases and consider them in their diagnoses.

Anaplasmosis:

• Caused by the Anaplasma phagocytophilum bacteria, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: fever, headache, malaise, and body aches. Encephalitis/ meningitis may occur but is rare
• 98 cases have been reported to date in 2014, compared to 94 in all of 2013
• Polymerase Chain Reaction (PCR) is the preferred testing method

Babesiosis:

• Caused by the Babesia parasite, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: extreme fatigue, aches, fever, chills, sweating, dark urine, and anemia
• 17 cases have been reported to date in 2014, compared to 36 in all of 2013
• PCR or identification of the parasite in a blood smear are the preferred testing methods

Lyme disease:

• Caused by the Borrelia burgdorferi bacteria, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: erythema migrans rash, fever, headache, joint and muscle pains, fatigue, arthritis, Bell’s palsy, meningitis, and carditis
• 526 cases have been reported to date in 2014, compared to 1,376 in all of 2013
• Lyme disease cases take several months to be entered and classified, so although these numbers may seem low they will increase dramatically as reports are received and processed
• Two tier testing (ELISA or EIA, followed by Western blot) is the preferred testing method

Powassan:

• Caused by the Powassan virus, carried by the woodchuck tick (Ixodes cookei) and potentially by the deer tick (Ixodes scapularis)
• Signs and symptoms include: fever, headache, vomiting, weakness, confusion, seizures, and memory loss
• 0 cases have been reported to date in 2014, compared to 1 in all of 2013
• Testing is performed by federal CDC, samples should be sent to Maine’s Health and Environmental Testing Laboratory (HETL) to be forwarded to CDC Fort Collins

Co-infections: Because all of these diseases are carried by the same tick (Ixodes scapularis), a patient may be infected with more than one disease.

• To date in 2014, three co-infections have been reported: two co-infections with anaplasmosis and Lyme disease, and one co-infection with babesiosis and Lyme disease
• In 2013, 16 co-infections were reported: nine co-infections of Lyme disease and anaplasmosis, four co-infections of Lyme disease and babesiosis, two co-infections of anaplasmosis and babesiosis, and one co-infection of Lyme disease, anaplasmosis, and babesiosis.

Uncommon illnesses:

• Ehrlichiosis is a bacterial disease, carried by the Lone Star tick which is unusual in Maine, but very common in the southern United States. PCR is the preferred testing method.
• Rocky Mountain Spotted Fever is a bacterial disease carried by multiple ticks. Maine has a tick that is a potential carrier (the dog tick, Dermacentor variabilis), but they are not known to be infected in Maine.

Recommendations for Providers:

• Consider tick-borne illnesses in your differential, particularly for individuals with “summer flu” symptoms
• Submit samples for testing 
• Treat patients appropriately – recommendations for treatment are available from http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Report cases. All tick-borne illnesses are reportable in Maine, including the erythema migrans rash which is confirmatory. To ease the reporting burden of EM rashes, a registry report option is available (see page 3). All cases should be reported by phone to 1-800-821-5821 or by fax to 1-800-293-7534.

For more information:

• Maine CDC vectorborne webpages: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml
• Maine Physician’s Reference Guide: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/documents/tick-reference-guide.pdf
• Lyme forms for providers: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/lyme/index.shtml#resourcephysicians
• Guidance on treatment: http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Lyme disease data: https://data.mainepublichealth.gov/tracking/home

This information originally appeared in a health alert, which is available at http://www.maine.gov/tools/whatsnew/attach.php?id=625757&an=2 

Public Health Update 7/24/14

Mosquito-borne diseases EEE and WNV   Arboviral diseases, including Eastern equine encephalitis (EEE) and West Nile virus (WNV), are very serious infections that are transmitted by the bite of an infected mosquito. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.  Other New England states have already detected both EEE and WNV this summer.      Clinicians should be aware of the potential for human disease activity in Maine, and to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis or fever ≥100.4°F or 38°C during the summer and early fall.   For more information, see the Health Alert from July 2: http://go.usa.gov/X9MV    Weekly arboviral surveillance reports will be posted to the following website through October: http://go.usa.gov/55u3  Chikungunya Chikungunya virus is also transmitted to people by mosquitoes. Outbreaks have occurred in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. In late 2013, chikungunya virus was found for the first time in the Americas on islands in the Caribbean. The first locally acquired case of chikungunya in the US was reported July 17 in Florida. For case information on chikungunya in the US, seehttp://go.usa.gov/55uA. The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. There is no vaccine to prevent or medicine to treat chikungunya virus infection. Although US CDC does not expect widespread cases of chikungunya in the United States this summer, American travelers infected overseas may continue to return and bring the virus with them. Travelers can protect themselves by preventing mosquito bites. When traveling to countries with chikungunya virus, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens. For more information, visit http://go.usa.gov/55hP or http://www.cdc.gov/chikungunya/

Tick-borne diseases Ticks are generally found in brushy or wooded areas, near the ground; they cannot jump or fly. Ticks are attracted to a variety of host factors, including body heat and carbon dioxide. They will transfer to a potential host when one brushes directly against them and then seek a site for attachment. Ticks cause a variety of diseases in Maine, including Lyme disease, Anaplasmosis, Babesiosis, Ehrlichiosis, and Powassan. More than 1,375 cases of Lyme disease were reported statewide in 2013, a record high for Maine. So far in 2014, there have been 246 reported cases of Lyme disease.  Other case counts for tickborne diseases reported in Maine so far in 2014 include: 80 cases of Anaplasmosis, compared to 94 for all of 2013 9 cases of Babesiosis, compared to 36 cases for all of 2013 5 cases of Ehrlichiosis, compared to 3 for all of 2013 No cases of Powassan, compared to 1 in 2013     For more information: More information on tickborne diseases is available at http://go.usa.gov/kGYV For Lyme disease testing and treatment information, see the health alert at http://go.usa.gov/kscC  Lyme disease data are available on Maine CDC's website at http://go.usa.gov/kGYx A Physician's Reference Guide is available and describes the most common tickborne diseases in Maine.  This guide can be found on our website at:http://go.usa.gov/kGrw For IDSA Lyme disease treatment guidelines: http://cid.oxfordjournals.org/content/43/9/1089.full To order Lyme educational materials: http://go.usa.gov/kGYh

Cyclosporiasis    Cyclosporiasis is an intestinal infection caused by a microscopic parasite. Cases are usually reported from May to August. Five cases have been reported in Maine between June 24 and July 21. Maine CDC issued a Health Alert on July 8 to increase awareness among clinicians about cyclosporiasis and the need to specifically request testing for Cyclospora in patients with prolonged diarrheal illness. The Health Alert is available at http://go.usa.gov/XXDR  Cyclosporiasis is not a reportable condition in Maine due to the low number of cases in previous years (last known case in Maine resident in 2010). However, due to large numbers of cases in the United States in 2013, Maine CDC is requesting providers report cyclosporiasis cases as an unusual condition,  since it is not commonly seen in Maine residents.      For more information, visit http://go.usa.gov/X9tF

Pertussis (whooping cough)    Pertussis (whooping cough) is a cyclical disease that continues to affect a significant number of Maine residents.   There have been 230 reported cases of pertussis so far in 2014, an increase of 43 cases from two weeks ago.  Maine CDC encourages providers continue to test and treat patients. DTaP vaccine is recommended for all infants and children. Tdap vaccine is recommended for all preteens, teens, and adults. For more guidance and information, visit http://go.usa.gov/dCO

TB Hero Dr. Shulamith Bonham, former medical director for Health Care for the Homeless in Portland, has been named 2014 TB Hero by the New England Tuberculosis Consortium.  Dr. Bonham was recognized for creating a low-barrier system for screening and treatment of latent TB infection (LTBI) within the Health Care for the Homeless clinic.

Hepatitis    Health IT and telemedicine are important tools to help early diagnosis and treatment of the growing problem of hepatitis C (HCV) infection in the United States.  US CDC has launched a new pilot program to help use telemedicine to fight HCV, develop new treatment tools, and get them in the hands of providers to try to stem the tide of HCV infections.   For more information, see: http://www.healthit.gov/buzz-blog/health-innovation/pilot-helps-battle-hepatitis-c-health-telemedicine/

Heat-related illness Here in Maine, we don't have very hot weather too often. So when it does get really hot, we are more likely to become sick from heat. This is because our bodies are not used to high heat, and many of our homes and buildings do not have air conditioning.   Certain people like older adults, infants, pregnant women, and people who have chronic diseases or who are sick already may feel much worse or have serious problems in extreme heat. Heat-related illnesses happen when your body cannot cool itself. Some heat illnesses are mild, like heat rash, sunburn, and heat cramps. Others like heat exhaustion, dehydration, and heat stroke can be severe or even life-threatening. To find out how to keep cool and healthy as the weather gets hotter this summer, go to http://go.usa.gov/X9uw

Tick-borne diseases

Ticks are generally found in brushy or wooded areas, near the ground; they cannot jump or fly. Ticks are attracted to a variety of host factors, including body heat and carbon dioxide. They will transfer to a potential host when one brushes directly against them and then seek a site for attachment.

Ticks cause a variety of diseases in Maine, including Lyme disease, Anaplasmosis, Babesiosis, and Powassan. 

More than 1,375 cases of Lyme disease were reported statewide in 2013, a record high for Maine. So far in 2014, there have been 202 reported cases of Lyme disease. 

In 2013, providers reported 94 cases of Anaplasmosis, 36 cases of Babesiosis, and 1 case of Powassan. So far in 2014, there have been 52 cases of Anaplasmosis and four cases of  Babesiosis reported. 

  For more information:

• For Lyme disease testing and treatment information, see the health alert at http://go.usa.gov/kscC 
• Lyme disease data are available on Maine CDC's website at http://go.usa.gov/kGYx
• For more information on tickborne diseases, go to: http://go.usa.gov/kGYV
• A Physician's Reference Guide is available and describes the most common tickborne diseases in Maine.  This guide can be found on our website at:http://go.usa.gov/kGrw
• For IDSA Lyme disease treatment guidelines: http://cid.oxfordjournals.org/content/43/9/1089.full
• To order Lyme educational materials: http://go.usa.gov/kGYh

 The winners of Maine CDC's annual Lyme Disease Awareness Poster Contest have been announced. The press release is available at http://go.usa.gov/XPHB 

Update on tickborne diseases

The deer tick can remain active in its adult stage from fall to spring as long as the temperature is above freezing. The tick will remain alive, but inactive when temperatures are below 40 degrees Fahrenheit.

Maine CDC saw increased numbers of tickborne disease reports in 2013, including multiple cases with onset of symptoms as late as December and the first documented case of Powassan encephalitis in the state since 2004. Providers should continue to consider tick borne illnesses, even during the winter months.

For more information, see the update from Dec. 18 at http://go.usa.gov/ZpAG 

Emerging Tick-borne Disease: Babesiosis

Babesiosis is a parasitic infection transmitted by deer ticks, the same tick that carries Lyme disease. Babesiosis is an emerging infection in Maine with 17 cases being reported between January and mid-August, compared to a total of 10 cases in 2012. Most infections occur in the summer and fall months, so the number of 2013 cases is expected to rise.

So far, cases have been reported this year in Cumberland, Knox, and York counties.

Common symptoms include: extreme fatigue, aches, fever, chills, sweating, dark urine, and possibly anemia. People with babesiosis may experience no symtpoms at all. Babesiosis is treatable, and people who are infected and do not have underlying conditions generally make a full recovery. 

If you are bitten by a tick:

• Remove the tick properly, ideally using tweezers or a tick spoon.
• Clean the area around the bite, and watch for symptoms for 30 days.
• Have your health care provider identify the tick and the engorgement level, or amount of time attached.  Tick identification is available through the Maine Medical Center Research Institute 
• Testing of the tick is not routinely recommended.

If babesiosis is suspected: Your health care provider should test you. If you have babesiosis, you should be treated with medicine for a week to 10 days.

Remember that there are other diseases carried by ticks in Maine, including anaplasmosis and Lyme disease. Symptoms of anaplasmosis include: fever, headache, malaise, and body aches.  The most common early symptom of Lyme disease is an expanding red rash that occurs at the site of the tick bite within 3-30 days after being bitten.  Fever, joint and muscle pains may also occur.  People can get infected with anaplasmosis, babesiosis, and/or Lyme disease at the same time.

Last year, health care providers reported 52 cases of anaplasmosis in Maine, compared to 45 cases so far this year.  In 2012, providers reported 1,111 cases of Lyme disease in Maine, so far 489 cases have been reported in 2013.

Additional information:

• For more information on tick borne diseases, including babesiosis, go to: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml
• To order tick educational materials, go to:  http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/order-form-wn.shtml

Lyme disease

May is also Lyme Disease Awareness Month. Lyme disease is the most common vectorborne disease in Maine. Ticks are already out, and we expect the number of Lyme disease cases to increase as the weather continues to get warmer. Anaplasma, Babesia, and other tickborne diseases are also increasing in Maine.


Maine CDC has issued a health alert (available at http://go.usa.gov/Tmkd) to provide general information regarding ticks and Lyme disease; remind providers to report cases of Lyme disease; provide resources on diagnosis and treatment of Lyme disease; and remind providers about other tickborne diseases in Maine.

Information about Lyme Disease Awareness Month is available at http://go.usa.gov/yTS

For general information about Lyme disease, visit http://go.usa.gov/yTh

Tickborne diseases

Anaplasmosis, a bacterial infection carried by deer ticks, is an emerging infection in Maine. As of Aug. 8, 38 cases have been reported to Maine CDC from 8 counties (Androscoggin, Cumberland, Hancock, Kennebec, Knox, Lincoln, Somerset and York). During 2011, a total of 26 cases were reported. Most infections occur during the summer and fall months, so the number of cases is expected to rise. For more information about anaplasmosis, see the health alert issued Aug. 9.
Other diseases that are carried by ticks in Maine include babesiosis and Lyme disease. In 2011, providers reported 9 cases of babesiosis; 3 cases have been reported to date in 2012. In 2011, providers reported 1,006 cases of Lyme disease; 483 cases have been reported to date in 2012.

Lyme disease is the most common vectorborne disease in Maine. Ticks are out and we expect the number of Lyme disease cases to increase in the warm weather.

For general information about Lyme disease see the May 1 health alert issued by Maine CDC.