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					                                                                                                                  Lyme disease…A little bite to
                                                                                                                      possible major consequences
                                                                                                                             Key components                                             The most common
                                                                                                                                                                                          insect-borne
                                                                                                 SE PA                                                                                  disease in the US
                                                                                                New Castle
                                                                                                County, DE

                                                                                               Cecil County,
                                                                                                    MD


          The Lyme Disease Association of Southeastern Pennsylvania, Inc.
                                        non-
           (LDASEPA), an all volunteer non-profit 501(c)3 organization, is
             intended as a resource for individuals interested in learning
                                                tick-
                 about Lyme disease and other tick-borne diseases.

                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.       1                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   2




           Lyme disease…A little bite to                                                                          Lyme disease…A little bite to
               possible major consequences                                                                            possible major consequences
                      Key components                                             The most common                             Key components                                             The most common
                                                                                   insect-borne                                                                                           insect-borne
                                                                                                               spirochete
                                                                                 disease in the US                                                                                      disease in the US



              deer                                                                                                   deer
              tick                                                                                                   tick




                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.       3                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   4




           Lyme disease…A little bite to                                                                          Lyme disease…A little bite to
               possible major consequences                                                                            possible major consequences
                      Key components                                             The most common                             Key components                                             The most common
                                                                                   insect-borne                                                                                           insect-borne
        spirochete                                                                                             spirochete
                                                                                 disease in the US                                                                                      disease in the US


                                                                                        spirochete                                                                                             spirochete
                                                                                        reservoirs                                                                                             reservoirs
              deer                                                                                                   deer
              tick                                                                                                   tick




                                                                                                                                                                                              deer tick
                                                                                                                                                                                           reproduction
                                                                                                                                                                                             (primary)
                                                                                                                                                                                            & dispersal
                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.       5                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   6




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                          1
           Lyme disease…A little bite to                                                                      Lyme disease…A little bite to
               possible major consequences                                                                        possible major consequences
                         Key components                                          The most common                            Key components                                          The most common
                                                                                   insect-borne                                                                                       insect-borne
        spirochete                                                                                         spirochete
                                                                                 disease in the US                                                                                  disease in the US


                                                                                        spirochete                                                                                         spirochete
                                                                                        reservoirs                                                                                         reservoirs
              deer                                                                                               deer
              tick                                                                                               tick
                                                                                         population                                                                                         population
                                                                                          growth                                                                                             growth

                                                                                                             our desire
                                                                                                              to live in
                                                                                       deer tick              previous                                                                    deer tick
                                                                                    reproduction           deer habitat,                                                               reproduction
                                                                                      (primary)             “residential                                                                 (primary)
                                                                                     & dispersal           development”
                                                                                                           development”                                                                 & dispersal
                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    7                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    8




           Lyme disease…A little bite to                                                                       Symptoms…more than a rash!
               possible major consequences
                                                                                                                                                              “classic” rash,
         Key components                                        The most common                                                                                 but any rash
                                                                 insect-borne                                                                                   is suspect
                                                                                                                deer tick
                                                               disease in the US

                                                             Symptoms
                                                                          spirochete”
                                                             The microbe “spirochete”
                                                             Lyme disease dilemmas                                                                                                   can be hidden!

                                                             Endemic regions/ages at risk
                                                             Infection incidence (CDC)
                                                             Ticks/risk of being bitten
                                                             Protection practices

                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    9                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    10




            Symptoms…more than a rash!                                                                         Symptoms…more than a rash!
           only 50-60% of patients report a rash!                                                             only 50-60% of patients report a rash!

                                                           “classic” rash,                                                                                    “classic” rash,
                                                            but any rash                                                                                       but any rash
                                                             is suspect                                                                                         is suspect
             deer tick                                                                                          deer tick


                                                                                                            Flu-
                                                                                                            Flu-like symptoms…fever, chills (May, June, July)
                                                                                                                      symptoms
                                                                                                            Fatigue…unrelenting
                                                                                                            Fatigue
                                                                                                            Musculoskeletal pain, arthritis…severe
                                                                                                                                     arthritis
                                                                                  can be hidden!            Heart, eye, hearing & GI…serious
                                                                                                                                     GI                       can be hidden!

                                                                                                            Neurologic symptoms…headache, stiff-neck, balance, facial paralysis,
                                                                                                                         symptoms
                                                                                                            cognitive impairment, sleep disturbance, nightmares, hyper-sensitivities
                                                                                                            Neuropsychiatric symptoms…depression, anxiety, panic attacks,
                                                                                                                                symptoms
                                                                                                            suicide, oppositional, ADHD, and possibly ASD behavior (children)



                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    11                Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    12




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                        2
            Symptoms…more than a rash!                                                                        Symptoms…more than a rash!
          only 50-60% of patients report a rash!                                                            only 50-60% of patients report a rash!

                                                           “classic” rash,                                                                                   “classic” rash,
                                                            but any rash                                                                                      but any rash
                                                             is suspect                                                                                        is suspect
             deer tick                                                                                         deer tick


         Flu-
         Flu-like symptoms…fever, chills (May, June, July)
                   symptoms                                                                                Flu-
                                                                                                           Flu-like symptoms…fever, chills (May, June, July)
                                                                                                                     symptoms
         Fatigue…unrelenting
         Fatigue                                                                                           Fatigue…unrelenting
                                                                                                           Fatigue
         Musculoskeletal pain, arthritis…severe
                                  arthritis                                                                Musculoskeletal pain, arthritis…severe
                                                                                                                                    arthritis
         Heart, eye, hearing & GI…serious
                                  GI                       can be hidden! Bell’s palsy                     Heart, eye, hearing & GI…serious
                                                                                                                                    GI                       can be hidden! Bell’s palsy

         Neurologic symptoms…headache, stiff-neck, balance, facial paralysis,
                      symptoms                                                                             Neurologic symptoms…headache, stiff-neck, balance, facial paralysis,
                                                                                                                        symptoms
         cognitive impairment, sleep disturbance, nightmares, hyper-sensitivities                          cognitive impairment, sleep disturbance, nightmares, hyper-sensitivities
         Neuropsychiatric symptoms…depression, anxiety, panic attacks,
                             symptoms                                                                      Neuropsychiatric symptoms…depression, anxiety, panic attacks,
                                                                                                                               symptoms
         suicide, oppositional, ADHD, and possibly ASD behavior (children)                                 suicide, oppositional, ADHD, and possibly ASD behavior (children)

                                                                                                                              diverse and fluctuating symptoms!
                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   13                Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   14




            Symptoms…children in school                                                                       Symptoms…children in school
                    Dozing in class,                                                                                  Dozing in class,
              missing class due to tiredness                                                                    missing class due to tiredness


                                                                                                                                                         Difficulty seeing and following
                                                                                                                                                     visually presented material, frequent
                                                                                                                                                     blinking or tics, inability to coordinate
                                                                                                                                                                  eye movement




                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   15                Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   16




            Symptoms…children in school                                                                       Symptoms…children in school
                    Dozing in class,                                                                                  Dozing in class,
              missing class due to tiredness                                                                    missing class due to tiredness


                                                       Difficulty seeing and following                                                                   Difficulty seeing and following
        Thinking sluggishness,                     visually presented material, frequent                  Thinking sluggishness,                     visually presented material, frequent
          slowness of word                         blinking or tics, inability to coordinate                slowness of word                         blinking or tics, inability to coordinate
               retrieval                                        eye movement                                     retrieval                                        eye movement


                                                                                                           Poor frustration management,
                                                                                                          aggression, explosive outbursts,
                                                                                                             irritability, hyperactivity




                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   17                Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   18




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                      3
            Symptoms…children in school                                                                    Symptoms…children in school
                   Dozing in class,                                                                               Dozing in class,
             missing class due to tiredness                                                                 missing class due to tiredness


                                                    Difficulty seeing and following                                                                Difficulty seeing and following
        Thinking sluggishness,                  visually presented material, frequent                  Thinking sluggishness,                  visually presented material, frequent
          slowness of word                      blinking or tics, inability to coordinate                slowness of word                      blinking or tics, inability to coordinate
               retrieval                                     eye movement                                     retrieval                                     eye movement


         Poor frustration management,                                                                   Poor frustration management,
        aggression, explosive outbursts,                           Inability to perform                aggression, explosive outbursts,                           Inability to perform
           irritability, hyperactivity                          previously mastered tasks                 irritability, hyperactivity                          previously mastered tasks


                                                                                                                              Short-term sequential or
                                                                                                                               spatial memory deficit

                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   19             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   20




            Symptoms…children in school                                                                    Symptoms…children in school
          Dyslexic-like behaviors,                                                                       Dyslexic-like behaviors,
        poor reading comprehension                                                                     poor reading comprehension                               Inability to activate
           and handwriting skill                                                                          and handwriting skill                                   or sustain effort
                                                                                                                                                                   and attention




                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   21             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   22




            Symptoms…children in school                                                                    Symptoms…children in school
          Dyslexic-like behaviors,                                                                       Dyslexic-like behaviors,
        poor reading comprehension                               Inability to activate                 poor reading comprehension                               Inability to activate
           and handwriting skill                                   or sustain effort                      and handwriting skill                                   or sustain effort
                                                                    and attention                                                                                  and attention


                             Inconsistent or sloppy                                                                         Inconsistent or sloppy
                        school work, late assignments,                                                                 school work, late assignments,
                        decline in grades, overwhelmed                                                                 decline in grades, overwhelmed
                                 by schoolwork                                                                                  by schoolwork



                                                                                                          Missed school
                                                                                                        days, school phobia



                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   23             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   24




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                4
           Symptoms…children in school                                                                The microbe…Borrelia burgdorferi
          Dyslexic-like behaviors,                                                                                Spirochete…related to ”syphilis”
                                                                                                                  Spirochete
        poor reading comprehension                              Inability to activate                                 Several physical forms
           and handwriting skill                                  or sustain effort                                    Genetically complex
                                                                   and attention


                            Inconsistent or sloppy
                       school work, late assignments,
                       decline in grades, overwhelmed
                                by schoolwork


                                                 Withdrawal from peers or shift
          Missed school
                                                 to a lower functioning group,
        days, school phobia
                                               cessation of involvement in sports
                                               or other extra-curricular activities

                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   25               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   26




        The microbe…Borrelia burgdorferi                                                              The microbe…Borrelia burgdorferi
                                                                                                        A mechanism to evade immune response:
                 Spirochete…related to ”syphilis”
                 Spirochete                                                                                                                 expression”
                                                                                                       “cyclic change in spirochete antigen expression”
                     Several physical forms
                      Genetically complex
                                                                                                                                                     relapse                    relapse

                                                          Systemic
                                                   Evades immune response
                                                                                                                                                                                     2nd
                                                                                                                                                        initial                   immune
                                                                                                                                                      immune                      response
                                                                                                                                                      response                     evaded
                                                                                                                          immune                       evaded
                                                                                                                          response                                                    3nd
                                                                                                        illness             starts                        2nd                     response
                                                                                                       severity                                       response                      starts
                                                                                                                                                        starts




                                                                                                           infection

                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   27               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   28




        The microbe…Borrelia burgdorferi                                                              The microbe…Borrelia burgdorferi
                 Spirochete…related to ”syphilis”
                 Spirochete                                                                                       Spirochete…related to ”syphilis”
                                                                                                                  Spirochete
                     Several physical forms                                                                           Several physical forms
                      Genetically complex                                                                              Genetically complex


                                                          Systemic                                                                                         Systemic
                                                   Evades immune response                                                                           Evades immune response

                     Invades cells &                                                                                Invades cells &
               the central nervous system                                                                     the central nervous system


                                                                                                                                        Transmitted by a deer tick
                                                                                                                            (other biting insects, blood, across placenta,
                                                                                                                                          & sexual contact?)

                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   29               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   30




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                 5
                   disease…
              Lyme disease…dilemmas                                                                              disease…
                                                                                                            Lyme disease…dilemmas
         Public and physicians are                                                                     Public and physicians are
         not sufficiently informed                                                                     not sufficiently informed                                Lab tests are inadequate
                                                                                                                                                                (physician default)




                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   31             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   32




                   disease…
              Lyme disease…dilemmas                                                                              disease…
                                                                                                            Lyme disease…dilemmas
         Public and physicians are                                                                     Public and physicians are
         not sufficiently informed                               Lab tests are inadequate              not sufficiently informed                                Lab tests are inadequate
                                                                 (physician default)                                                                            (physician default)


              Misdiagnosis…flu, spider bite,
              Misdiagnosis                                                                                 Misdiagnosis…flu, spider bite,
                                                                                                           Misdiagnosis
              ADD, CFS, FM, MS, ALS, Parkinson’s                                                           ADD, CFS, FM, MS, ALS, Parkinson’s
              and Alzheimer’s disease                                                                      and Alzheimer’s disease

                                                                                                                co- infections
                                                                                                         Missed co-infections…
                                                                                                             (Babesia, Bartonella,
                                                                                                           Ehrlichia, Anaplasma, etc.




                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   33             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   34




                           Co-infections
                           Co-                                                                                   disease…
                                                                                                            Lyme disease…dilemmas
                                                                                                       Public and physicians are
         Babesia (Babesiosis)…malaria-like parasite; infection of                                      not sufficiently informed                                Lab tests are inadequate
                                                                                                                                                                (physician default)
         red-blood cells; chills, fatigue, night sweats (drenching), spaciness sense,
         depression, headache, muscle pain
                                                                                                           Misdiagnosis…flu, spider bite,
                                                                                                           Misdiagnosis                                                        No vaccine
                                                                                                           ADD, CFS, FM, MS, ALS, Parkinson’s                                 (LYMErix™
         Bartonella (Bartonellosis)…bacterium;                                                             and Alzheimer’s disease                                           hla-dr4 gene?)
         cat scratch fever; agitated fatigue, insomnia, sweats,
         headaches, anxiety, panic, agitation, rage, aggression,
         confusion, (CNS > Lyme symptoms), heel pain,                                                           co- infections
                                                                                                         Missed co-infections…
                                                                                                             (Babesia, Bartonella,
         gastritis, red stretch-like marks
                                                                                                           Ehrlichia, Anaplasma, etc.


         Ehrlichia/Anaplasma (Ehrlichiosis/Anaplasmosis)…
         rickettsial bacterium; similar to Lyme symptoms, except violent headaches
         and high fever

                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   35             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   36




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                6
                           disease…
                      Lyme disease…dilemmas                                                                                                   disease…
                                                                                                                                         Lyme disease…dilemmas
             Public and physicians are                                                                                          Public and physicians are
             not sufficiently informed                                      Lab tests are inadequate                            not sufficiently informed                                      Lab tests are inadequate
                                                                            (physician default)                                                                                                (physician default)


                     Misdiagnosis…flu, spider bite,
                     Misdiagnosis                                                            No vaccine                                 Misdiagnosis…flu, spider bite,
                                                                                                                                        Misdiagnosis                                                            No vaccine
                     ADD, CFS, FM, MS, ALS, Parkinson’s                                    (LYMErix™
                                                                                          (LYMErix™                                     ADD, CFS, FM, MS, ALS, Parkinson’s                                    (LYMErix™
                                                                                                                                                                                                             (LYMErix™
                     and Alzheimer’s disease                                             hla-
                                                                                         hla-dr4 gene?)                                 and Alzheimer’s disease                                             hla-
                                                                                                                                                                                                            hla-dr4 gene?)


                       co- infections
                Missed co-infections…                                           Short-
                                                                                Short-term antibiotic                              Missed co-infections…
                                                                                                                                          co- infections                                           Short-
                                                                                                                                                                                                   Short-term antibiotic
                        (Babesia, Bartonella,                                   treatment failures                                         (Babesia, Bartonella,                                   treatment failures
                     Ehrlichia, Anaplasma, etc.                                                                                         Ehrlichia, Anaplasma, etc.


                                                                                                                                                                                  Controversy…medical/political
                                                                                                                                                                                  Controversy
                                                                                                                                                                                  (antibiotic treatment duration
                                                                                                                                                                                  & chronic infection)

                             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.            37                        Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.            38




       Endemic regions & ages at risk                                                                                      Endemic regions & ages at risk
        Centers for Disease Control (CDC)                                                                                  Centers for Disease Control (CDC)




                                                                                                 ~95% of cases                                                                                                      ~95% of cases


                                                                                                                  1                                                                                                                  1
                                                                                         2                                                                                                                  2
                                                           3                                                                                                                  3

                                                                                                           ic                                                                                                                 ic
                                                                                                        em                                                                                                                 em
                                                                                                    end :                                                                                                              end :
                                                                                                 er-   n                                                                                                            er-   n
                                                                                              hyp regio                                                                                                          hyp regio




                                                                                                                               > 20,000 cases/yr reported




                                                          CDC surveillance criteria record only ~1 out of 10 cases                 cases of Lyme Disease, 1991- 2005
                                                                                                                                                          1991-              CDC surveillance criteria record only ~1 out of 10 cases

                             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.            39                        Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.            40




       Endemic regions & ages at risk                                                                                      Endemic regions & ages at risk
        Centers for Disease Control (CDC)                                                                                  Centers for Disease Control (CDC)
                                                                                                                                              ages of individuals
                                                                                                                                            from whom deer ticks
                                                                                                                                                were removed



                                                                                                 ~95% of cases                                                                                                      ~95% of cases


                                                                                                                  1                                                                                                                  1
                                                                                         2                                                                                                                  2
        children/teenagers        outdoor adult            3                                                               children/teenagers        outdoor adult            3
                                   population                                                                                                         population

                                                                                                             ic                                                                                                                 ic
                                                                                                        em                                                                                                                 em
                                                                                                    end :                                                                                                              end :
                                                                                                 er-   n                                                                                                            er-   n
                                                                                              hyp regio                                                                                                          hyp regio




            > 20,000 cases/yr reported                                                                                         > 20,000 cases/yr reported




                                       1991-
                cases of Lyme Disease, 1991- 2005         CDC surveillance criteria record only ~1 out of 10 cases                 cases of Lyme Disease, 1991- 2005
                                                                                                                                                          1991-              CDC surveillance criteria record only ~1 out of 10 cases

                             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.            41                        Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.            42




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                                                        7
        LD survey of Cecil County, 21921 zip code                                                       LD survey of Cecil County, 21921 zip code
        & Pocopson Township, Chester County, PA                                                         & Pocopson Township, Chester County, PA




                                                                                                                               Individuals        Individuals Households                   Individuals
                                                                                                                                (%) NOT              (%)       (%) with                   (%) reporting
                                                                                                                               diagnosed          diagnosed member(s)                    post-treatment
                                                                                                             Survey site         with LD           with LD     with LD                      symptoms
                                                                                                              Pocopson         795/1006                211                164                        68
                                                                                                              Township           (79)                  (21)               (48)                      (31)
                                                                                                          Cecil County          554/675                103                 84                        23
                                                                                                         21921 zip code           (84)                 (16)               (34)                      (23)
                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    43               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.          44




                     surveillance”
          2006 CDC “surveillance”                                                                                    surveillance”
                                                                                                          2006 CDC “surveillance”
        Lyme disease cases (19,931)                                                                     Lyme disease cases (19,931)
             State/County                     Cases               Rank              Incidence*               State/County                       Cases               Rank              Incidence*
        PA                                     3,242                  2                     26          PA                                       3,242                  2                     26
        Chester County                         ~550                    -                    102         Chester County                           ~550                    -                    102
        MD                                     1,248                  7                       22        MD                                       1,248                  7                     22
        Cecil County                               63                  -                      63        Cecil County                                63                   -                      63
        DE                                         478               10                       56        DE                                         478                 10                       56
        New Castle County                          289                 -                      55        New Castle County                          289                   -                      55
        *cases per 100,00 population (8% US average)                                                    *cases per 100,00 population (8% US average)

                    CDC surveillance criteria record only ~1 out of 10 cases                                          CDC surveillance criteria record only ~1 out of 10 cases

                                                                                                                    Lyme disease was ~8X the number of U.S. West Nile cases!

                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    45               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.          46




       2007 provisional CDC “surveillance”
                             surveillance”                                                              Residential development impact
          Lyme disease cases (20,599)                                                                                    …increase in infected ticks

                                                                                                                      Species                             Ability to transmit the
        State/County             Cases ’06>’07
                                        06>’                        Rank             Incidence*                                                          Lyme disease spirochete
                                                                                                             White-
                                                                                                             White-footed mouse                                       Very high
        PA                        3,242 > 4,666                      2>1                26>38
                                                                                                             Eastern chipmunk                                         Very high
        Chester County                         -                        -              102>111               Shrews                                                   Very high
        MD                         1,248 > 2298                      7>3                 22>41                      *
                                                                                                             Raccoon*                                                        Low
        Cecil County                           -                        -                 63>?                      *
                                                                                                             Opossum*                                                        Low
        DE                            482 > 697                     10>9                 56>82                            *
                                                                                                             Striped skunk*                                                  Low
        NC County                              -                        -                  55>?                                   *
                                                                                                             Red and grey squirrel*                                          Low
                                                                                                                              *
                                                                                                             White-tailed deer*                                              Low
        *cases per 100,00 population (8% US average)
                                                                                                             Birds (~ground feeding)                        Low-? (migratory/feeders)
                    CDC surveillance criteria record only ~1 out of 10 cases
                                                                                                                  *high numbers of ticks, but poor transmitters = dilution effect
                  Lyme disease was ~8X the number of U.S. West Nile cases!

                  Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    47               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.          48




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                          8
                                                                       adult females                                                                                                adult females

         Ticks & risk of being bitten                                                                         Ticks & risk of being bitten
                                                                                     STARI                                                                                                        STARI
                                                               Lyme                                                                                                         Lyme
                                                              disease                                                                                                      disease

                                                               Deer tick                                                                                                    Deer tick
                                                               Ixodes scapularis                                                                                            Ixodes scapularis
                                                                deer tick                                                                                                    deer tick

                                          nymph adult                                                                                                  nymph adult
                                     (poppy seed size)                                                                                            (poppy seed size)




             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.             49                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.             50




                                                                       adult females                                                                                                adult females

         Ticks & risk of being bitten                                                                         Ticks & risk of being bitten
                                                                                                                                                                                                  STARI
                                                               Lyme                                                                                                         Lyme
                                                              disease                                                                                                      disease               larval
                                                                                                                                                                                                 mass
                                                                                                                                                                                                 attack
                                                               Deer tick                                                                                                    Deer tick
                                                               Ixodes scapularis                                                                                            Ixodes scapularis
                                                                deer tick                                                                                                    deer tick                lone star tick

                                          nymph adult                                                                                                  nymph adult
                                     (poppy seed size)                                                                                            (poppy seed size)


                                                                                         engorged deer tick                                                                                           engorged deer tick




                                                                                         female laying eggs                                                                                           female laying eggs




             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.             51                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.             52




                                                                       adult females                                                                                                adult females

         Ticks & risk of being bitten                                                                         Ticks & risk of being bitten
                                                                                                              Increasing risk of being bitten

                                                                                     STARI                                                                                                        STARI
                                                               Lyme                                                                                                         Lyme
                                                              disease               larval                                                                                 disease               larval
                                                                                    mass                                                                                                         mass
                                                                                    attack
                                                                                                                          adults                                                                 attack
                                                               Deer tick                                                                                                    Deer tick
                                                               Ixodes scapularis                                                                                            Ixodes scapularis
                                                                deer tick                lone star tick                                                                      deer tick                lone star tick

                                          nymph adult                                                                                                  nymph adult
                                     (poppy seed size)                                                                                            (poppy seed size)


                                                                                                                            nymphs
                                                                                         engorged deer tick                                                                                           engorged deer tick




                                                                                         female laying eggs                                                                                           female laying eggs
                                                                                                                          adults
                                                                                             saliva…
                                                                                        tick saliva…                                  Risk:                                                               saliva…
                                                                                                                                                                                                     tick saliva…
                                                                                    immunosuppressors                                anytime                                                     immunosuppressors
                                                                                                                                     ~28° F
                                                                                    protects spirochete                                                                                          protects spirochete
             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.             53                 Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.             54




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                                     9
                                                                                     adult females                                                                                                        adult females

         Ticks & risk of being bitten                                                                                        Ticks & risk of being bitten
          Increasing risk of being bitten                                                                                     Increasing risk of being bitten

                                                                                                 STARI                                                                                                                STARI
                                                                           Lyme                                                                                                                 Lyme
                                                                          disease                larval                                                                                        disease                larval
                                                                                                 mass                                                                                                                 mass
                         adults                                                                  attack
                                                                                                                                              adults                                                                  attack
                                                                           Deer tick                                                                                                            Deer tick
                                                                           Ixodes scapularis                                                                                                    Ixodes scapularis
                                                                            deer tick                 lone star tick                                                                             deer tick                 lone star tick

                                                          nymph adult                                                                                                          nymph adult
                                                     (poppy seed size)                                                                                                    (poppy seed size)


                          nymphs                         How long must an                                                                      nymphs                          How long must an
                                                          infected tick be                             engorged deer tick                                                       infected tick be                            engorged deer tick

                                                            attached for                                                                                                          attached for
                                                           transmission?                                                                                                         transmission?
                                                                                                       female laying eggs                                                                                                   female laying eggs
                         adults                                                                                                               adults                                ~24-
                                                                                                                                                                                    ~24-36 hours?
                                                                                                                                                                              difficult in most cases to
                                     Risk:                                                                 saliva…
                                                                                                      tick saliva…                                        Risk:
                                                                                                                                                                            determine the length of time                        saliva…
                                                                                                                                                                                                                           tick saliva…
                                    anytime                                                      immunosuppressors                                       anytime                                                      immunosuppressors
                                    ~28° F                                                                                                               ~28° F                 from bite to detection!
                                                                                                 protects spirochete                                                                                                  protects spirochete
                         Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.                  55                    Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.                  56




                           Life of a deer tick…                                                                                                 Life of a deer tick…
                         2 years, 4 stages, and 3 bites                                                                                       2 years, 4 stages, and 3 bites
         Spring           Summer              Fall/winter         Spring           Summer             Fall/winter            Spring            Summer              Fall/winter         Spring           Summer             Fall/winter

                         Year 1                                                                                                               Year 1                                                Year 2

         eggs                                                                                                                eggs                                                              2nd bite                               3rd bite
                          larvae          1st bite                                                                                             larvae          1st bite         nymphs                            adults
                                                                                                                                                                                                                                         ♀
                                                                                                                                                                               poppy seed
                 hatch                     mice                                                                                       hatch                     mice              size           mice
                                                                                                                                                                                                                                  deer, etc.
                                        Chipmunks                                                                                                            Chipmunks                                     3-5 days                   humans
                                                                                                                                                                                                 cats      attached
                                        (reservoir)                                                                                                          (reservoir)
                                                                                                                                                                                                 dogs
                                         change to                                                                                                            change to                        humans                           deer primary
                                          nymph,                                                                                                               nymph,                                                         reproductive host
                                        over-winter                                                                                                          over-winter           majority of cases reported: May-June




                            Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.               57                       Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.               58




                           Life of a deer tick…                                                                                                 Life of a deer tick…
                         2 years, 4 stages, and 3 bites                                                                                       2 years, 4 stages, and 3 bites
         Spring           Summer              Fall/winter         Spring           Summer             Fall/winter            Spring            Summer              Fall/winter         Spring           Summer             Fall/winter

                         Year 1                                                Year 2                                                         Year 1                                                Year 2

         eggs                                                             2nd bite                               3rd bite    eggs                                                              2nd bite                               3rd bite
                          larvae          1st bite         nymphs                            adults                                            larvae          1st bite         nymphs                            adults
                                                                                                                    ♀                                                                                                                    ♀
                                                          poppy seed                                                                                                           poppy seed
                 hatch                     mice              size
                                                                                                             deer, etc.               hatch                     mice              size
                                                                                                                                                                                                                                  deer, etc.
                                                                            mice      3-5 days                                                                                                   mice      3-5 days
                                        Chipmunks                                                                humans                                      Chipmunks                                                                humans
                                                                            cats      attached                                                                                                   cats      attached
                                        (reservoir)                                                                                                          (reservoir)
                                                                            dogs                                                                                                                 dogs
                ~2,000                   change to                        humans                                                    ~2,000                    change to                        humans
                 eggs                                                                                      deer primary              eggs                                                                                       deer primary
                                          nymph,                                                         reproductive host                                     nymph,                                                         reproductive host
                                        over-winter           majority of cases reported: May-June                                                           over-winter           majority of cases reported: May-June

                                                                                           female over-winters                                                                                                  female over-winters




                                                                                                                                      95% of the tick’s life is on the
                                                                                                                                    ground, in leaf litter, on grass, etc!

                            Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.               59                       Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.               60




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                                                            10
                            Life of a deer tick…                                                                                                  Protection…why?
                                                                                                                                                  Protection…
                          2 years, 4 stages, and 3 bites
                                                                                                                                                                getting…
                                                                                                                               Every bite increases the risk of getting…
         Spring            Summer            Fall/winter           Spring           Summer             Fall/winter
                                                                                                                                                                                poison”
                                                                                                                                        More spirochetes…”the dose makes the poison”
                          Year 1                                                Year 2                                                                        increase
                                                                                                                                        More virulent strains…increase disease severity
                                                                                                                                              tick-
                                                                                                                                        Other tick-borne infectious microorganisms…
         eggs                                                              2nd bite                               3rd bite
                           larvae          1st bite        nymphs                             adults                                    Babesia, Anaplasma, Erhlichia, Bartonella, etc.
                                                                                                                     ♀
                                                          poppy seed
                  hatch                     mice             size
                                                                                                              deer, etc.
                                                                             mice     3-5 days
                                         Chipmunks                                                                humans
                                                                             cats     attached
                                         (reservoir)
                                                                             dogs
                ~2,000                    change to                        humans
                 eggs                                                                                       deer primary
                                           nymph,                                                         reproductive host
                                         over-winter           majority of cases reported: May-June

                                                                                            female over-winters




                  95% of the tick’s life is on the
                ground, in leaf litter, on grass, etc!

                             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.               61                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    62




                            Protection…
                            Protection…why?                                                                                                       Protection…
                                                                                                                                                  Protection…why?
                                          getting…
         Every bite increases the risk of getting…                                                                                                              getting…
                                                                                                                               Every bite increases the risk of getting…
                                                            poison”
                    More spirochetes…”the dose makes the poison”                                                                                                                poison”
                                                                                                                                        More spirochetes…”the dose makes the poison”
                                          increase
                    More virulent strains…increase disease severity                                                                                           increase
                                                                                                                                        More virulent strains…increase disease severity
                          tick-
                    Other tick-borne infectious microorganisms…                                                                               tick-
                                                                                                                                        Other tick-borne infectious microorganisms…
                    Babesia, Anaplasma, Erhlichia, Bartonella, etc.                                                                     Babesia, Anaplasma, Erhlichia, Bartonella, etc.

         Protection Reality!                                                                                                   Protection Reality!
                    No existing method will eliminate deer ticks                                                                        No existing method will eliminate deer ticks
                    Can reduce tick numbers and risk of infection                                                                       Can reduce tick numbers and risk of infection
                    Key is to integrate control practices                                                                               Key is to integrate control practices

                                                                                                                                                       despite adequate knowledge about
                                                                                                                                                the risk of infection, many people do not follow
                                                                                                                                                          behaviors to reduce this risk

                          Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.                  63                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    64




                Landscape modifications                                                                                              Landscape modifications
                                                  higher risk!                      lower risk                                                                          higher risk!                      lower risk




                                                            Ticks need high humidity                                                                                              Ticks need high humidity
                                                            Increase areas of sunlight                                                                                            Increase areas of sunlight
                                                            Relocate play equipment…high risk
                                                                          equipment                                                                                               Relocate play equipment…high risk
                                                                                                                                                                                                equipment
                                                                                                                              CDC
                                                            are lawns next to woods                                                                                               are lawns next to woods
                                                                                                                                                                Tick zone


                                                                                                                                                                                                               Create 3+ ft wood chip
                                                                                                                                                                                                               barrier
                                                                                                                                                                                                               Keep lawn mowed
                                                                                                                                                                                              Tick-safe        Deer fencing
                                                                                                                               Tick-safe zone                                                   zone


                          Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.                  65                     Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    66




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                                                  11
                      Perimeter insecticide                                                                                  Perimeter insecticide
                           applications                                                                                           applications
                                                                                                                   Increasing risk of being bitten



                                                      Commercial…                                                                                            Commercial…
                                                      tree/lawn care                                                                                         tree/lawn care
                                                      companies                               Tick zone                                                      companies                                Tick zone
                                                                                                                                   nymphs

                                                     Do- it- yourself…
                                                     Do-it-yourself…                                                                                        Do- it- yourself…
                                                                                                                                                            Do-it-yourself…
                                                     hose-on application,                                                                                   hose-on application,
                                                     coarse spray directed                                                                                  coarse spray directed
                                                     to the ground, leaf                                                                                    to the ground, leaf
                                                     litter, and low shrubs;                                                       adults
                                                                                                                                                            litter, and low shrubs;
                                                     granular application                                                                                   granular application


                         Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    67                    Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.           68




       Control ticks on reservoirs & deer                                                                      Control ticks on reservoirs & deer
        Increasing risk of being bitten          Damminix®.…permethrin® treated cotton balls                   Increasing risk of being bitten          Damminix®.…permethrin® treated cotton balls
                                                 Place near mice nesting                                                                                Place near mice nesting
                                                 areas…wood/brush piles, stone                                                                          areas…wood/brush piles, stone
                                                 walls, rock piles, etc.                                                                                walls, rock piles, etc.

              Spring                                                                                                 Spring
                                                                                                                                                               4-poster deer feeder (USDA)
                                                                                                                                                          Corn                        Paint rollers             90% of ticks
                                                                                                                                                        reservoir                      containing               on head/neck
                                                                                                                                                                                      permethrin®
               Fall                                                                                                   Fall




        www.damminix.com/default.asp                                                                           www.damminix.com/default.asp                          www.crdaniels.com/dandux/outdoors.htm
                         Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    69                    Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.           70




                           Protect yourself                                                                                       Protect yourself
                       Avoid risky behaviors…
                                   behaviors                                                                                  Avoid risky behaviors…
                                                                                                                                          behaviors
            leaf litter, deer paths, logs/stone walls,                                                             leaf litter, deer paths, logs/stone walls,
                    untreated pets, bird feeders                                                                           untreated pets, bird feeders
                                                                                                                                                                     colors…
                                                                                                                                                          Wear light colors…
                                                                                                                                             long pants, shirt, hat, tight-weave socks
                                                                                                                                                         over cuffs (tape)




                         Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.    71                    Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.           72




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                                         12
                      Protect yourself                                                                                Protect yourself
                 Avoid risky behaviors…
                             behaviors                                                                           Avoid risky behaviors…
                                                                                                                             behaviors
          leaf litter, deer paths, logs/stone walls,                                                      leaf litter, deer paths, logs/stone walls,
                  untreated pets, bird feeders                                                                    untreated pets, bird feeders
                                                         colors…
                                              Wear light colors…                                                                                         colors…
                                                                                                                                              Wear light colors…
                           long pants, shirt, hat, tight-weave socks                                                         long pants, shirt, hat, tight-weave socks
                                       over cuffs (tape)                                                                                 over cuffs (tape)
         DEET®…skin & clothing                                                                           DEET®…skin & clothing
                                        Permethrin…clothing,
                                        Permethrin                                                                                        Permethrin…clothing,
                                                                                                                                          Permethrin
                                            ~ 4 weeks (0.5%)                                                                                  ~ 4 weeks (0.5%)
                                                                                                          Do tick check…hairline
                                                                                                                  check
                                                                                                          & where clothes fit tightly




                    Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   73              Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   74




                      Protect yourself                                                                                Protect yourself
                 Avoid risky behaviors…
                             behaviors                                                                           Avoid risky behaviors…
                                                                                                                             behaviors
          leaf litter, deer paths, logs/stone walls,                                                      leaf litter, deer paths, logs/stone walls,
                  untreated pets, bird feeders                                                                    untreated pets, bird feeders
                                                         colors…
                                              Wear light colors…                                                                                         colors…
                                                                                                                                              Wear light colors…
                             long pants, shirt, hat, tight-weave socks                                                       long pants, shirt, hat, tight-weave socks
                                         over cuffs (tape)                                                                               over cuffs (tape)
         DEET®…skin & clothing                                                                           DEET®…skin & clothing
                                          Permethrin…clothing,
                                          Permethrin                                                                                      Permethrin…clothing,
                                                                                                                                          Permethrin
                                              ~ 4 weeks (0.5%)                                                                                ~ 4 weeks (0.5%)
          Do tick check…hairline
                  check                                                                                   Do tick check…hairline
                                                                                                                  check
          & where clothes fit tightly      Shower immediately                                             & where clothes fit tightly      Shower immediately

                                                                                                         Keep outdoor clothes
                                                                                                            in the garage




                    Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   75              Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   76




                      Protect yourself                                                                                Protect yourself
                 Avoid risky behaviors…
                             behaviors                                                                           Avoid risky behaviors…
                                                                                                                             behaviors
          leaf litter, deer paths, logs/stone walls,                                                      leaf litter, deer paths, logs/stone walls,
                  untreated pets, bird feeders                                                                    untreated pets, bird feeders
                                                         colors…
                                              Wear light colors…                                                                                         colors…
                                                                                                                                              Wear light colors…
                             long pants, shirt, hat, tight-weave socks                                                       long pants, shirt, hat, tight-weave socks
                                         over cuffs (tape)                                                                               over cuffs (tape)
         DEET®…skin & clothing                                                                           DEET®…skin & clothing
                                          Permethrin…clothing,
                                          Permethrin                                                                                      Permethrin…clothing,
                                                                                                                                          Permethrin
                                              ~ 4 weeks (0.5%)                                                                                ~ 4 weeks (0.5%)
          Do tick check…hairline
                  check                                                                                   Do tick check…hairline
                                                                                                                  check
          & where clothes fit tightly      Shower immediately                                             & where clothes fit tightly      Shower immediately

         Keep outdoor clothes                             Insect Shield™ (Buzz Off)…
                                                                  Shield™           Off)                 Keep outdoor clothes                                     Shield™
                                                                                                                                                          Insect Shield™ (Buzz Off)…Off)
            in the garage                               permethrin treated outdoor apparel                  in the garage                               permethrin treated outdoor apparel
                                                                 by Exofficio, etc.                                                                              by Exofficio, etc.

                                                                                                         washing with detergent will NOT kill ticks; clothes dryer at high temperature will
                    Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   77              Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   78




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                   13
          Protect pets from ticks…                                                                       Protect pets from ticks…
                  unprotected pets = high risk to                                                                unprotected pets = high risk to
                       children and adults                                                                            children and adults
              Frontline: Top Spot®, Top Spot® Plus, and Liquid®                                              Frontline: Top Spot®, Top Spot® Plus, and Liquid®
             - ticks and fleas (Plus), dogs and cats                                                        - ticks and fleas (Plus), dogs and cats
             - 1 month tick protection (systemic)                                                           - 1 month tick protection (systemic)
             - Also monthly liquid application                                                              - Also monthly liquid application
               in/on ears (cats)                                                                              in/on ears (cats)


                                                                                                          Preventic®
                                                                                                          dog collar




                   Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   79             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   80




          Protect pets from ticks…                                                                       Protect pets from ticks…
                  unprotected pets = high risk to                                                                unprotected pets = high risk to
                       children and adults                                                                            children and adults
              Frontline: Top Spot®, Top Spot® Plus, and Liquid®                                              Frontline: Top Spot®, Top Spot® Plus, and Liquid®
             - ticks and fleas (Plus), dogs and cats                                                        - ticks and fleas (Plus), dogs and cats
             - 1 month tick protection (systemic)                                                           - 1 month tick protection (systemic)
             - Also monthly liquid application                                                              - Also monthly liquid application
               in/on ears (cats)                                                                              in/on ears (cats)


           Preventic®                                                                                     Preventic®
           dog collar                                                                                     dog collar


           Dogs as Lyme disease sentinels:                                                                Dogs as Lyme disease sentinels:
           SNAP® 4Dx test…Lyme disease,                                                                   SNAP® 4Dx test…Lyme disease,
           heartworm, etc.                                                                                heartworm, etc.                 pets should be inside or outside
                   Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   81             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   82




                       @%it”
                   If “@%it” happens                                                                                  @%it”
                                                                                                                  If “@%it” happens
         embedded tick                                                                                  embedded tick
                                                                                                                                                                    Use clean tweezers or tick
                                                                                                                                                                    removal tool
                                                                                                                                                                    Grasp the tick close to skin
                                                                                                                                                                    Slowly and steadily pull
                                                                                                                                                                    upward until the tick
                                                                                                                                                                    releases




                   Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   83             Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   84




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                 14
                       @%it”
                   If “@%it” happens                                                                                    @%it”
                                                                                                                    If “@%it” happens
         embedded tick                                                                                    embedded tick
                                                                     Use clean tweezers or tick                                                                       Use clean tweezers or tick
                                                                     removal tool                                                                                     removal tool
                                                                     Grasp the tick close to skin                                                                     Grasp the tick close to skin
                                                                     Slowly and steadily pull                                                                         Slowly and steadily pull
                                                                     upward until the tick                                                                            upward until the tick
                                                                     releases                                                                                         releases
                                    Never…use alcohol, Vaseline, match, etc.                                                         Never…use alcohol, Vaseline, match, etc.
                                    May trigger injection of salivary fluids and                                                     May trigger injection of salivary fluids and
                                    disease-causing microbes!                                                                        disease-causing microbes!
                                    Save tick to show physician                                                                      Save tick to show physician
                                                            1- 877-
                                    Tick testing (NJ Labs., 1-877-Tick Test or                                                                               1- 877-
                                                                                                                                     Tick testing (NJ Labs., 1-877-Tick Test or
                                    732- 249-
                                    732-249-0148)                                                                                    732- 249-
                                                                                                                                     732-249-0148)

                                                                                                                          unattached ticks can survive indoors for days
                   Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   85               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   86




                         Thank you and…
                                   and…                                                                       Helpful Lyme disease links
                                                                                                        Lyme Disease Association of Southeastern PA (LDASEPA):
                                                                                                        www.lymepa.org/
                                                                                                        The National Lyme Disease Association (LDA):
                                                                                                        www.lymediseaseassociation.org
                                                                                                        ILADS - the International Lyme and Associated Diseases Society:
                                                                                                        Professional medical society about Lyme disease. www.ilads.org
                                                                                                        Columbia University Lyme Disease Research: www.columbia-lyme.org
                                                                                                        Physician referrals call LDASEPA at 610-388-7333 or email Lymepa@lymepa.org
                                                                                                        Find a support group: www.Lymenet.org
                                                                                                        IGeneX, Inc., Palo Alto, California: (lab/explanations of tests)
                                                                                                        www.igenex.com
                                                                                                        MDL, New Jersey: http://www.mdlab.com/html/home.html (testing lab)
                                                                                                        The Centers for Disease Control and Prevention (CDC):
                                                                                                        http://www.cdc.gov/ncidod/dvbid/lyme/index.htm

                   Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   87               Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.   88




R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA                                                                                                                                                                   15

				
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