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

Tick Watch

Lyme disease:

Lyme disease is transmitted to people when infected deer ticks bite them. The bacterium that causes Lyme disease is called Borrelia burgdorferi, and causes flu-like symptoms such as fever, headache, and fatigue, as well as a skin rash. Often a bulls-eye rash is noticed somewhere on an infected person’s body. Doctors will diagnose the disease and prescribe antibiotics. If left untreated there could be more serious symptoms from Lyme disease, affecting the nervous system, heart, or joints.

Prevention:

·         Wear EPA approved repellent

·         Perform daily tick checks

·         Use caution in tick infested areas

·         Wear protective clothing

Lyme disease awareness month:

The month of May is Lyme disease awareness month in Maine. Throughout May, Maine CDC hosts informational tables, presentations, provides information on ticks and diseases for newsletters, and records a tick-borne disease webinar.

            Events:

See our Lyme Disease Awareness Month page for a list of activities:

http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/lyme/month/index.shtml

Kids in school:

Maine CDC launched a curriculum for children in the 3^rd-5^th grades to educate them on ticks and mosquitoes. This curriculum highlights these vectors and the diseases they carry and how to avoid them and prevent disease. http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/school-curriculum/index.shtml

Tick-Free ME:

As a part of Lyme Disease Awareness Month, Maine Center for Disease Control and Prevention is launching our second annual Tick-Free ME Challenge. This is a month long challenge during t July, where participants monitor their preventive behaviors. The goal of the challenge is to prevent tick-borne diseases through the prevention of tick bites. Enrollment in the challenge began May 1st and continues through June 22ndat participating libraries around the state. The challenge is designed for adults aged 45 years and older as this age group has among the highest rates of Lyme disease in Maine. For a list of libraries and more information visit: www.maine.gov/dhhs/tickfreeme

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 

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 

Lyme Disease Awareness Month

May is Lyme Disease Awareness Month. Lyme disease is the most common vectorborne disease in Maine. Cases have already been reported in 2014, and the number will rise as the weather continues to get warmer.

Lyme disease is a bacterial infection carried by the deer tick. Cases have been increasing each year in Maine, and occur in all 16 counties. More than 1,375 cases of Lyme disease were reported statewide in 2013, a record high for Maine. Lyme disease is most common among school age children and adults older than 65. Most infections occur during the summer months.

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.

What to do after a tick bite:

• Remove the tick properly, ideally using tweezers or a tick spoon. 
• Clean the area around the bite, and watch for signs and symptoms for 30 days. 
• Testing of the tick is not routinely recommended. 
• Prophylactic treatment after a tick bite is not routinely recommended, but can be considered under specific circumstances including. 
• If you suspect Lyme disease, contact your health care provider for laboratory testing. The IDSA guidelines for assessment, treatment, and prevention of Lyme disease are available at http://cid.oxfordjournals.org/content/43/9/1089.full

Other tickborne diseases:
Other diseases that are carried by ticks in Maine include Anaplasmosis, Babesiosis and Powassan. Symptoms of Anaplasma include: fever, headache, malaise, and body aches. Symptoms of Babesia include: extreme fatigue, aches, fever, chills, sweating, dark urine, and possibly anemia. Symptoms of Powassan include: fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, seizures, and encephalitis and meningitis.

In 2013, providers reported 94 cases of Anaplasmosis, 36 cases of Babesiosis, and 1 case of Powassan. Five anaplasmosis cases and two babesiosis cases have already been reported in 2014.

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

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