Lyme Disease Signs_ Symptoms _ P

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Lyme Disease Signs_ Symptoms _ P Powered By Docstoc
					Lyme Disease and other
  tick-borne Diseases



    Hunterdon County
   Department of Health
          2006            1
2
      What Is Lyme Disease?


 Bacterial Infection
 Primarily transmitted by ‘Black-legged’
  (Deer Tick)
 Affects both animals and humans
 Hunterdon remains in top 5 counties for
  incidence
                                            3
Mouthparts of a tick
  (barbed hypostome in center
    anchors tick as it feeds)




                                4
          Reported Lyme Disease Cases
Number of Confirmed Lyme Disease Cases by Report Year – Hunterdon County, 1988 to 2008




                                                                                     5
      Typical Seasonal Distribution of
      Reported Lyme Disease Cases
140

120

100

80
60

40

20
  0
      Jan   Feb   Mar   Apr   May   Jun   Jul   Aug   Sept   Oct   Nov   Dec

                                                                               6
                                        LYME cases by Age
                       60                                                                                            60

                                        Male
                       50                                                                             50




                       40               Female
Num b e r of C ase s




                                                                                                           40
                                                                                            39

                                                                                                 35
                                                                                                                34
                       30                                  30



                                                      23
                       20
                              19
                                   18
                                                 16                                  17

                                                                13              13
                       10                                              10

                                         1   1                              5

                        0
                            Unk nown             2 - 9               20 - 29              40 - 49               60 +
                              Age



                                                                                                                          7
“Family Portrait”




                    8
Engorged
Nymphal
Tick




      9
                    Tick Facts...
 Ticks must be attached 36
  - 48 hours to transmit
  bacteria
 In Hunterdon, ~20% of
  nymphal ticks carry
  bacteria
 Nymphal ticks cause
  majority of Lyme cases
 Most cases ‘caught’ around
  the home
 Nymphal ticks most active
  late May thru July
 Adult ticks most active late
  Oct. and early November.
                                    10
              Wood Tick

 Larger than
  Deer Tick
 Does NOT
  transmit Lyme



                          11
12
Adult Deer Tick




                  13
 Three
  Active
  Stages
 Need „host‟
  at each
  stage
  (Such as
  mouse, other
  animal or
  person)
 Not born
  with
                 White-footed mice
  bacteria       serve as the principal
 Do NOT fly     reservoirs of infection
  or jump        on which many larval
                 and nymphal ticks
 Attach as      feed and become
  host           infected with the LD
  passes by      spirochete.
                                           14
15
     Common Tick Habitats
 Tall grassy
  areas
 Leaf litter
 Ground cover
 Low bushes /
  shrubs
 Need moisture
  to survive

                            16
Signs and Symptoms
  of Lyme Disease




                     17
    Clinical Manifestations
 Early Lyme (Days to month after bite)
  -- Erythema Migrans (‘Bull’s Eye Rash’)
  -- +/- Flu-like symptoms
 Early Disseminated Lyme / Late Lyme
  -- Neurologic or cardiac abnormalities
  -- Musculoskeletal symptoms
  -- Migratory arthritis

                                            18
19
20
      Recommendations for
           Testing

   No blood test if rash present
   Two-test approach
   ELISA test
   Western Immunoblot for positive or
    equivocal ELISA


                                         21
                TREATMENT
 Doxycycline, amoxicillin, and ceftin
 Usually treated for 4-6 weeks.

 A recent study of in the New England Journal of
  Medicine indicates that a four-week course of oral
  doxycycline is just as effective in treating late LD, and
  much less expensive, than a similar course of
  intravenous Ceftriaxone (Rocephin) unless
  neurological or severe cardiac abnormalities are
  present.

                                                         22
  Personal Protection
Measures to Reduce Your
         Risks




                          23
Before going out...
 Wear light-colored
  clothing
 Tuck shirt into pants
  and pants into
  socks
 Wear ‘closed’ shoes



                     24
                    Perform
                 Frequent Tick
                   Checks….


…while in tick
 habitats AND
when returning
    home
                                 25
 Avoid „tick-
  friendly‟ habitats
  when possible
 Keep to center of
  path




                   26
 Tick Repellents
for Personal Use
       30% - 40% DEET
        content most effective
        for ticks
       Use on skin or clothing
       Target shoes, pant legs
       Not for children < 3 yrs
       See guidelines for
        children
       FOLLOW DIRECTIONS
        CAREFULLY
                               27
 Tick Repellents
for Personal Use
         Permethrin-
          containing products
         USE ON
          CLOTHING ONLY
         Insecticide
         FOLLOW
          DIRECTIONS
          CAREFULLY

                                28
Using ‘Host Reduction’
   to Reduce Risks
  for Lyme Disease




                         29
 Move birdfeeders and
  firewood away from
  family activity area
  (like picnic and/or play
  area)




                              Avoid common ‘host
                               habitats’


                                              30
Modifying Your Habitat to
 Reduce Risks for Lyme
        Disease



                            31
VS.
      32
               Keep grass short
               Prune trees and
                shrubbery
               Remove old leaf
                piles
               Allow sunlight!



Remember:
Ticks need
   moisture
 to survive                        33
   Properly timed and
   targeted pesticide
   use is an effective
  means of tick control
  Late May: granular
Late September: liquid




                      34
 Tick Repellents
 Keep off the
  furniture!
 Signs of Lyme in
  pets

                 35
Proper Tick Removal

             Use fine-point
              tweezers
             Grasp CLOSE
              TO SKIN
             Pull gently
             Wash area with
              soap, water
              and antiseptic

                          36
Remember…
It’s not the tick you remove that is likely to
   give you Lyme Disease, it’s the one
   you never find!
…In fact, if an attached tick is found and
   removed, your chances of developing
   Lyme disease is just 1-3%


                                             37
                 Ehrlichiosis
A disease caused by bacteria in the genus Ehrlichia. 2
types have been identified in the U.S.: HME and HGE.
            Transmitted by the deer tick.

  It is considered an acute infection without chronic
long-term consequences. The severity of the disease
varies from person to person. May be life-threatening
   or fatal for elderly and others with compromised
                    immune systems.




                                                     38
                Symptoms
 Person may be asymptomatic or may have
  mild to severe symptoms.
 Initial symptoms include fever, headache,
  malaise, and muscle aches. Other symptoms
  include nausea, vomiting, diarrhea, cough,
  and joint pains. May also have a rash.
  Severe complications include prolonged
  fever, renal failure, seizures, or coma.
 As many as half of all patients require
  hospitalization. 2-3% of patients die from the
  infection.                                    39
             Treatment

 Treatment should be initiated
  immediately when there is suspicion of
  Ehrlichiosis. Treatment should not be
  delayed until lab confirmation is
  obtained.
 100 mg. Doxycycline twice daily for a
  minimum of 7 days. Severe cases may
  require longer treatment.
                                       40
              Babesiosis
 Babesiosis is a malaria-like illness
  caused by a protozoan parasite
  (Babesia microti in the U.S.) that is
  primarily transmitted by the
  black-legged deer tick.




                                          41
             Symptoms
 May be asymptomatic; symptoms
  include fever, chills, sweating, muscle
  aches, fatigue, and hemolytic anemia.
  Symptoms typically occur after an
  incubation period of 1-4 weeks, and can
  last several weeks. Disease is more
  severe in the elderly and
  immunosuppressed individuals.
                                        42
             Treatment

 Clindamycin + quinine or atovaquone
  plus azithromycin for 7 days.




                                        43
       Health Department
      Educational Activities

 Tick ID cards and Lyme Disease Alert
  notices to parents
 County employee Lyme awareness
  spring program
 Public presentations to community
  groups/businesses


                                         44
  More Educational Activities
 Youth camp counselor training
 On-line education program for teachers
 Press releases and PSA
  announcements
 Public health updates to physicians
 General information/referral/mailings
 GIS mapping of cases

                                           45
   Health Department website:
www.co.hunterdon.nj.us/health/lymeinfo.htm


                Or Call:
      908-788-1351 or 908-806-4570


                                      46
           References


 Centers for Disease Control and
  Prevention (CDC)
 American Lyme Disease Foundation—
              www.aldf.com



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