What You Should Know About Lyme Disease and Other Tick-Borne Diseases Minnesota Department of Health Disease Prevention & Control 625 Robert St N PO Box 64975 Saint.
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What You Should Know About Lyme Disease and Other Tick-Borne Diseases Minnesota Department of Health Disease Prevention & Control 625 Robert St N PO Box 64975 Saint Paul, MN 55164 (651) 201-5414 Revised October 2009 Goal “Minnesota residents and visitors will take action to prevent exposure to ticks which may carry Borrelia burgdorferi; will know the signs and symptoms of Lyme disease and other tick-borne diseases; and if present, will seek early diagnosis and treatment.” 1995 Minnesota Lyme Disease Public Education Plan Goals of presentation • Be aware of Lyme disease and other tick-borne diseases • Recognize basic signs and symptoms • Seek early diagnosis and treatment • Know whether you live, work or play in endemic areas • Practice prevention activities • Know whom to contact for more information LYME DISEASE Borrelia burgdorferi, the bacteria that cause Lyme disease History 1975 Juvenile cases of arthritis found in Connecticut Disease named Lyme disease 1985 Lyme disease became reportable in Minnesota Lyme Disease Signs & Symptoms 3 to 30 days after deer tick bite • Rash (often “bulls-eye”) • Fever • Chills • Headache • Muscle and joint pain • Fatigue Erythema migrans (EM) rash characteristic of Lyme disease Lyme disease rash without central clearing Lyme Disease Signs & Symptoms Days to weeks after illness onset • Multiple rashes • Facial paralysis on one side • Fever, stiff neck, headache • Weakness, numbness, arm/leg pain • Irregular heart beat • Persistent weakness and fatigue Multiple Rashes • Reaction as bacteria move through body • Not caused by multiple tick bites Multiple Rashes • This is another example of a multiple rash. Lyme Disease Signs & Symptoms Weeks to months after illness onset • Fatigue • Chronic arthritis • Nervous system problems Joint Swelling Joint swelling and pain may occur weeks to months after onset of illness if left untreated. Diagnosis of Lyme Disease • Physical examination • History of possible exposure to deer ticks • Blood tests may be performed – A screening test is done first, followed by a confirmatory test for antibodies to Lyme disease bacteria Remember Early recognition of signs and symptoms of Lyme disease is very important for prompt diagnosis and treatment. Treatment • Lyme disease can be treated • Antibiotics are used to treat Lyme disease • Talk to your doctor about specific treatment Questions about Diagnosis or Treatment of Lyme Disease? Call your doctor or Minnesota Department of Health at 651-201-5414 TICKS Blacklegged Tick (deer tick) American dog tick (wood tick) (spreads Lyme disease) (does not spread Lyme disease) adult male adult female Blacklegged Ticks (Deer Ticks) Blacklegged ticks have three life stages Nymph Adult (female) Larva Blacklegged Tick Larvae • Size of period at end of sentence • Initially does not have Lyme disease bacteria, so does not transmit the bacteria to a host • May get the bacteria from a host who has the bacteria Collecting Immature Blacklegged Ticks Lyme disease researchers often live-trap small mammals to collect blacklegged ticks. Natural Host for Immature Blacklegged Ticks Immature blacklegged ticks can be infected by feeding on mice that are carrying Lyme disease bacteria. Transmission can also occur from the ticks to mice. Blacklegged Tick Nymph Blacklegged Tick Nymph • Size of a poppy seed • Transmits most cases of disease because they are so difficult to detect • Seeks a blood meal from mid-May to midJuly Blacklegged Tick Adults Adult female Adult male Blacklegged Tick Engorgement Male and Female Adult Blacklegged Tick • Feed and mate on large animals in the fall or early spring • After feeding, females lay eggs, then die • Ticks that did not feed or mate go dormant Two-Year Life Cycle of Blacklegged Tick EGGS MEAL 1 • Mouse • Bird LARVAE NYMPHS Eggs laid, adults die MEAL 3 * For adults that did not feed in fall • Person • Deer • Dog MEAL 2 (peak feeding time May-mid July) • Person • Mouse • Dog SPRING SUMMER WINTER FALL Nymphs molt into adults Larvae molt into nymph stage ADULTS MEAL 3 • Person • Deer • Dog Nymphs dormant Blacklegged Tick Habitat Trails and Edge Habitat • Blacklegged ticks live in woody, brushy areas that provide food and cover for hosts such as mice and deer • Exposure to these ticks can be greatest along trails and edges of woods Blacklegged Tick Questing Blacklegged ticks search for a host from the tips of lowgrowing vegetation, generally climbing onto a person or animal near ground level. Blacklegged Tick Feeding To Get Lyme Disease • Blacklegged tick must be infected with Lyme disease bacteria • Only the nymphs and adult females can transmit the Lyme disease bacteria • Tick must be attached 24 - 48 hours before it passes bacteria to host Lyme Disease Cases by State, 2002 Lyme2002 Disease Cases by State as Reported to CDC (nn=23,763 = 23,763) 11 37 1 0 867 12 4 4 261 1807 5535 852 4631 3989 2349 194 26 738 259 D.C. 25 137 1090 2 26 42 6 4 97 47 5 1 7 0 28 26 3 1 12 139 82 21 25 41 4 11 2 5 79 0 3 219 Kittson Roseau Lake of the Woods Koochiching Marshall St. Louis Beltrami Pennington Polk Lyme Disease Areas of Highest Risk in Minnesota Cook Clear Water Red Lake Lake Itasca Mahnomen Norman Hubbard Cass Tick-borne disease risk in Minnesota is highest in forested areas within the shaded zones. Becker Clay Aitkin Wadena Wilkin Crow Wing Carlton Ottertail Pine Todd Mille Lacs Grant Kanabec Douglas Morrison Benton Traverse Stevens Pope Stearns Blacklegged ticks may also be found at lower levels in some forested areas outside this zone. Isanti Big Stone Sherburne Swift Chisago Kandiyohi Anoka Meeker Wright Chippewa Hennepin WashingRam- ton sey Lac Qui Parle McLeod Renville Carver Scott Yellow Medicine Dakota Sibley Lincoln Lyon Redwood Nicollet Le Sueur Rice Goodhue Wabasha Brown Olmsted Pipestone Rock Murray Cottonwood Watonwan Nobles Jackson Martin Blue Earth Faribault Waseca Steele Freeborn Dodge Mower Winona Fillmore Houston Minnesota Department of Health May 2008 Reported Cases of Lyme Disease in Minnesota, 1986-2008 (n = 9,726) 1,300 1,239 1,200 1,100 1,050 1,023 1,000 900 800 700 600 500 465 463 475 400 300 252 256 261 100 202 204 196 200 283 147 94 83 83 107 67 80 0 19 86 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 Number of Cases 917 913 866 Year Reported Cases of Lyme Disease in Minnesota by Location of Residence, 19982007 (n=6,905) 1400 Metro Area Greater Minnesota Number of Cases 1200 1000 800 600 400 200 0 1998 1999 2000 2001 2002 2003 Year 2004 2005 2006 2007 Reported Cases of Lyme Disease by County of Exposure, Twin Cities Metropolitan Area, 1998-2007 County Anoka Washington Ramsey Dakota Hennepin Scott Carver Total No. of Cases 187 183 38 32 18 6 5 469 Top Ten Counties of Exposure for Reported Cases of Lyme Disease, 1998-2007 County 1. Crow Wing 2. Cass 3. Pine 4. Aitkin 5. Anoka 6. Washington 7. Houston 8. Morrison 9. Hubbard 10. Itasca Wisconsin Other Total Cases with Known Exposure No. (%) of Cases 966 (20%) 370 (8%) 302 (6%) 207 (4%) 187 (4%) 183 (4%) 125 (3%) 124 (3%) 103 (2%) 103 (2%) 940 (20%) 1,120 (24%) 4,730 Reported Cases of Lyme Disease by Month of Onset, Minnesota, 1999-2008 (n = 6,277*) 45% 41% 40% Percent of Cases 35% 30% 25% 22% 19% 20% 15% 9% 10% 0% 4% 4% 5% 0% 0% 0% 0% Jan Feb Mar Apr May Jun Jul Aug Sept Oct 1% 0% Nov Dec Month * Excluding 1,415 cases without erythema migrans or with unknown onset dates 25% 24% Reported Cases of Lyme Disease by Age at Onset, Minnesota, 1999-2008 (n=7,610*) 20% 16% Percent 16% 15% 11% 10% 9% 10% 8% 6% 5% 0% 0-12 13-19 20-29 30-39 40-49 50-59 60-69 70+ Age at Time of Onset * Excluding cases with unknown age at time of onset Reported Cases of Lyme Disease in Minnesota by Sex, 1999-2008 Male Female Total 4,732 (62%) 2,960 (38%) 7,692 Human Anaplasmosis Signs and Symptoms • • • • Fever (over 102 degrees) Chills and shaking Severe headache Muscle aches Reported Cases of Human Anaplasmosis in Minnesota by Year, 1995-2008 (n = 1,602) 350 322 300 278 Number of Cases 250 200 186 176 149 150 139 93 100 79 50 30 18 6 76 36 14 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year 30% Reported Cases of Human Anaplasmosis by Age at Onset, Minnesota, 1999-2008 (n = 1,530) 25% 25% 22% 20% Percent 20% 16% 15% 10% 7% 5% 5% 3% 2% 0% 0-12 13-19 20-29 30-39 40-49 50-59 60-69 70+ Age at Time of Onset * Excluding cases with unknown age Human Anaplasmosis Sex Distribution, 1999-2008 Male 980 (64%) Female 554 (36%) Total 1,534 35% Reported Cases of Human Anaplasmosis by Month of Onset, Minnesota, 1999-2008 (n = 1,519*) 30% Percent of Cases 30% 27% 25% 20% 15% 10% 10% 10% 8% 6% 5% 5% 2% 0% 0% 0% Jan Feb Mar 1% 0% Apr May Jun Jul Aug Sept Oct Nov Dec Month * Excluding 15 cases with unknown onset Kittson Reported Cases of Human Anaplasmosis in Minnesota by County of Exposure, 1995-2007 (n = 1,323) Roseau Lake of the Woods Koochiching Marshall St. Louis Beltrami 1 Pennington Polk Red Lake Cook 12 Clear Water 1 Lake Itasca 1 7 22 9 Mahnomen Norman Hubbard 4 155 41 Becker Clay Cass Aitkin 7 Wadena Wilkin Crow Wing 1 Ottertail 368 1 Cases with unknown exposure = 266 Carlton 15 100 Cases with known exposure = 1,057 Pine Todd Grant 5 Douglas 65 Mille Lacs Kanabec Morrison 2 39 Minnesota = 722 Wisconsin = 99 Other State = 7 12 6 Benton Stevens Traverse Pope 1 Stearns 4 Big Stone Swift 9 3 Kandiyohi Meeker 1 Isanti Sherburne Anoka 14 Wright 3 1 Chippewa 9 Chisago Ramsey Hennepin McLeod Carver Yellow Medicine 1 5 2 Lac Qui Parle Renville 7 Washington Scott Dakota Sibley Lincoln Lyon Redwood Brown Rice Le Sueur Nicollet Goodhue 1 1 2 Wabasha Olmsted Pipestone Murray Cottonwood Watonwan Rock Nobles Jackson Martin Blue Earth Faribault Waseca Steele Freeborn 1 Dodge Mower Winona 1 Fillmore 2 Houston 10 * Includes confirmed and probable cases Babesiosis Signs & Symptoms • • • • • • High fever Chills Headache Muscle aches Fatigue Loss of appetite Summary of Tick-Borne Diseases, Minnesota, 1999-2008 (n = 9,333) Number of Cases 8000 7,692 (82%) 6000 4000 1534 (16%) 2000 107(1%) 0 Lyme disease Human anaplasmosis Babesiosis Prevention Actions • Campers, hikers, hunters, people in outdoor occupations, and people who live near the woods may be at risk in the counties known to have blacklegged ticks. • Know whether you live, work or play in an area that has blacklegged ticks • Take precautions when in blacklegged tick habitat, especially from May through July • Remember, preventing exposure to blacklegged ticks requires diligence Lyme Disease Vaccine • Discontinued in 2002 Prevention Use repellents (DEET or permethrin), according to label directions. Tucking pants into socks creates a barrier to ticks. Wearing light-colored clothing helps to more easily spot ticks. Checking for Ticks It is a good idea to check yourself and your children for ticks after spending time in a wooded or brushy area. Pets Check your dog or cat for ticks before bringing them inside. There is a Lyme disease vaccine for dogs, but it does not prevent them from bringing ticks into the home. Avoid Deer Tick Bites • Be aware of high-risk times and places • Walk in the center of trails to avoid picking up ticks from brush • Wear long pants, lightcolored clothing, and repellent Avoiding Blacklegged Ticks at Home If you live in area with ticks, they are usually located around the fringe of your yard and a wooded area. Removing Attached Ticks Ticks have barbed mouth parts. This means that ticks attached to the skin should be pulled out slowly and steadily. To Remove a Deer Tick • Use tick forceps or tweezers • Grasp the tick close to the skin • Pull outward S-L-O-W-L-Y, gently, and steadily • Do not squeeze the tick • Use an antiseptic on the bite Important Messages • Know whether you live, work or play in an area that has deer ticks • Take preventive actions • Seek early diagnosis and treatment Whom to Contact Minnesota Department of Health 651-201-5414 Metropolitan Mosquito Control District 651-645-9149 Minnesota Department of Health’s Lyme Disease Web Site www.health.state.mn.us Scroll down to “Diseases and Conditions” and click on “Diseases A to Z” Click on “Lyme Disease”