image: Center for Disease Control
Lyme disease has been a public health issue in Connecticut since 1975, when it was first identified. It is the most commonly reported vector-borne disease in the U.S. In 2015 there were 228,453 confirmed and 9,616 probable cases of Lyme disease reported to the Centers for Disease Control and Prevention (CDC) from 50 states and the District of Columbia. Lyme disease is an illness caused by the bacterium Borrelia burgdorferi which is transmitted to humans by the bite of an infected black-legged (Ixodes scapularis) tick, commonly known as the “deer tick.
Along with many other tick-associated diseases such as human ehrlichiosis and human babesiosis, Lyme disease can be readily acquired in any Connecticut town, particularly in areas that are wooded. Just recently in November of 2016, a 5-month old male infant from Eastern Connecticut was diagnosed with Powassan Virus Disease (POWV).
This is the first report of a human case of the disease in the state. POWV is a tickborne flavivirus, similar to Tickborne Encephalitis Virus, which can be transmitted by three types of ticks, including the “deer tick” (Ixodes scapularis). Transmission of the disease occurs as quickly as 15 minutes after tick attachment. Death occurs in approximately 10% of the reported cases. Testing for POWV should be considered whenever a patient in a tick endemic area is evaluated for encephalitis.
In 2015, the state of Connecticut ranked fifth among states reporting Lyme disease with a total of 2,541 cases (confirmed and probable). The state also was fifth among states that had the highest incidence rate of disease.
In 2015, Connecticut reported 1,873 confirmed cases of Lyme disease and 668 probable cases. Among the eight counties in Connecticut, New Haven County reported the highest number of confirmed cases of Lyme disease, Fairfield County reported the second highest and Litchfield County reported the lowest number.
In 2016, the Greenwich Department of Health Laboratory tested a total of 682 ticks and other insects. Of the 454 deer ticks tested in the laboratory, 22% were found to be positive for Lyme disease, 2% were positive for Babesiosis.
According to the CDC, Lyme disease patients are most likely to have illness onset in June, July or August.
“This makes a lot of sense,” said the Dept of Health’s Director of Laboratory Douglas Serafin.
“The months of April and May begin the nymph lifecycle of the ‘deer tick’ which carries the bacterium that causes Lyme disease (Borrelia burgdorferi) and the protozoan organism, Babesia microti that causes babesiosis,” Serafin continued. “The nymphal stage tick is very tiny and can easily go unnoticed on the skin. Nymphs are also more active from June through August which is why it is important to apply personal protections measures.”
“The spring and summer months are especially important for awareness about Lyme disease since everyone is out planting and/or taking part in some kind of outdoor activities,” state Caroline Calderone Baisley, Director of Health. “By applying a few simple precautionary measures like checking for ticks on the body every day and using insect repellant, everyone can still enjoy the warm weather and decrease their risk of infection.”
Children and adolescents are at a higher risk for acquiring Lyme disease because they spend more time in
areas where there are ticks. “When Lyme disease is misdiagnosed and goes untreated it has a profound, devastating impact on the person’s well-being,” explained Caroline Calderone Baisley. It is imperative to do tick checks on the body on a daily basis when coming in contact with a tick habitat and to know the signs and symptoms of this disease. Although an expanding rash on the body is an early sign of Lyme disease, not all cases of the disease exhibit the rash. Other tickborne diseases such as babesiosis can also be possible since the pathogen agent, Babesia microti, can co-infect the same tick that carries the bacterium that causes Lyme disease. The recent first report of a human case of Powassan Virus Disease (POWV) in the State highlights the importance of avoiding tick exposure.
The following is a list of symptoms (not inclusive) and protection measures.
Early symptoms (3-30 days post exposure) include, but not limited to:
• Rash – an expanding red rash usually at the site of the tick bite, but can occur in other locations on the body. Not all cases exhibit a rash.
• Fever and/or chills
• Fatigue
• Muscle, bone and joint pain
• Transient, migrating arthritis
• Stiff neck
• Headache
• Bell’s palsy or other cranial nerve neuritis
• Secondary rash
Late state symptoms (within months post exposure) include, but not limited to:
• Severe arthritis
• Neurological and cardiac complications
• Weakness and fatigue
• Mood and/or sleep problems
Personal Protection Measures:
• Use insect repellent containing 30%-40% DEET. Follow package instructions. Do not apply under clothing or to children under 2 years.
• Wear light-colored clothing and tuck long pants into the socks to make ticks easier to detect and to help keep them off of your skin. Wear close-toed shoes.
• Do thorough tick checks of yourself, your children and pets. Properly remove ticks.
• Research has found the sooner you remove an attached tick, the less likely you are to become infected with Lyme disease. Remove ticks within 24 hours.
Pet Protection Measures:
• Minimize time that dogs and cats spend outdoors and access to areas with leaf litter, brush and tall weeds. This may help reduce the number of ticks brought back into the home.
• Check pets for ticks when they come indoors.
• Check with your veterinarian regarding methods to prevent your pet from getting tick bites.
Landscape Management:
• Keep grass mowed.
• Remove leaf litter, brush, and tall weeds from around the home and at the lawn’s edge.
• Use plantings that do not attract deer or exclude deer through various types of fencing.
• Move firewood, and birdhouses and feeders away from the home.
• Create a 3-foot or wider wood chip, mulch, or gravel barrier between your lawn and woods.
Removing a Tick:
• Using tweezers, grasp the tick mouthparts as close to the skin as possible, and pull the tick out with steady pressure. Do not yank the tick out. Do not pull on the body of the tick.
• Wash the area with soap and water, then dry and apply a topical antiseptic.
• Do not use a hot match, nail polish remover, petroleum jelly or other substances to remove ticks.
• Contact your physician if you are bitten and watch for early symptoms.
In an effort to raise awareness of this important health problem, the Greenwich De[t of Health Laboratory will continue to provide public health literature and offer testing of ticks for the bacterium that causes Lyme disease and the protozoan organism that causes Babesiosis. “Although a tick may test positive, it does not necessarily mean that you will get Lyme disease,” stated Lab Director Doug Serafin.
“Like any other screening tool, the process for testing ticks has a small margin of error and, specifically for these diseases, the tick must be attached for a period of time in order to increase a person’s risk. An engorged infected tick is much more likely to pass on the pathogen agent or protozoan organism than those ticks that are not engorged.
If a tick is found on a person – dead or alive – it should be removed carefully. If tick testing is being considered, the tick should be placed in a tightly sealed small plastic sandwich bag marked with the date and body site of the bite. The cost of tick testing is $65.00, which includes identifying the bacterium that causes Lyme disease and the protozoan organism that causes Babesiosis. Results are normally available within 10 days. The Greenwich Department of Health Lab can be reached at 203-622- 7843 for more information about tick testing. For additional information on Lyme disease and other tickborne diseases, visit the Greenwich Department of Health or log on to the Department of Health webpage at www.greenwichct.org and click “Brochures & Print Material” for the Ticks and Lyme disease link or visit the State of Connecticut, Department of Public Health website at www.ct.gov/dph/ticks..