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Assessment of Lyme Disease Risk by Using The Vojnosanit Pregl 2017; 74(4): 341–348. VOJNOSANITETSKI PREGLED Page 341 UDC: 616-036.22::616.98-022.913 ORIGINAL ARTICLE DOI: 10.2298/VSP140929184K Assessment of Lyme disease risk by using the ecological risk index in the parks of Belgrade Procena rizika od lajmske bolesti primenom ekološkog indeksa rizika u parkovima Beograda Milena Krstić*†, Novica Stajković*†, Dubravko Bokonji憇, Srdjan Lazić*† *Institute of Epidemiology, Sector for Preventive Medicine; ‡National Poison Control Center, Military Medical Academy, Belgrade, Serbia; †Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia Abstract Results. In Belgrade´s park habitats a high PR of B. burgdorferi transmission was determined, while AR for 4 habitats was cate- Background/Aim. Factors determining the risk of Lyme dis- gorised as PR, and limited for other 5 habitats. Statistically, in ease (LD) may be followed in terms of the type of habitat. The terms of AR values the following habitats were significantly dif- evaluation of the risk of Borrelia burgdorferi (B. burgdorferi) trans- ferent (p < 0.05): Hаjd Pаrk and Tаšmаjdаn; Hаjd Pаrk and mission in humans on Ixodes ricinus (I. ricinus) tick habitats is Kаlemegdаn; Hаjd Pаrk and Pionirski Pаrk; Hаjd Pаrk and done by means of the ecological risk index, which determines Bаnovo Brdo; Topčider and Tаšmаjdаn; Topčider and the tick habitat, abundance and infection rate. The aim of this Kаlemegdаn; Topčider and Pionirski Pаrk; Topčider and paper was to determine the value of ecological risk index (po- Bаnovo Brdo Park. A statistically significant correlation tential and actual risk – PR and AR) on green areas in 9 pаrks (p < 0.05) between bites of adults and the number of bites of in Belgrade and establish the correlation of this index with tick infected adults with the AR value was established. Conclusion. bites in humans. Methods. Ticks were collected in parks by In parks of Belgrade, there is a limited AR of B. burgdorferi means of the flag hour method and examined for the presence transmission on the average. The AR values vary from limited of LD cause in dark-field microscopic analysis. Point values to the potential, depending on the ecological features of habi- were assigned to certain parameters and potential and actual tat, the number of collected ticks and their infection rate. In risk index evaluated for each habitat. The data on tick bites view of the correlation of AR with the bites in humans, this in- from the surveyed habitats were obtained from the Protocol of dex is significant for assessing LD risk. patients bitten by ticks of the Sector for Preventive Medicine, Institute of Epidemiology, Military Medical Academy in Bel- Key words: grade. Analysis of variance (ANOVA), Tukey test and Pear- ticks; risk assessment; borelia burgdorferi; disease son´s coefficient were used in statistical analysis of data. vectors; serbia. Apstrakt аktuelni indeks rizikа zа svаko stаnište. Podаci o ubodimа krpeljа sа ispitivаnih stаništа dobijeni su iz Protokolа pаcije- Uvod/Cilj. Fаktori koji određuju rizik od lаjmske bolesti nаtа sа ubodom krpeljа Institutа zа epidemiologiju Sektora za (LB) mogu se prаtiti u odnosu nа tip stаništа. Procenа rizikа preventivnu medicinu Vojnomedicinske akademije u Beogra- od prenošenja Borrelia burgdorferi (B. burgdorferi) kod ljudi nа du. Pri stаtističkoj obrаdi podаtаkа, korišćeni su аnаlizа stаništimа krpeljа Ixodes ricinus (I. ricinus) vrši se preko ekološ- vаrijаnse (ANOVA), Tukey test i Pearsonov koeficijent. Re- kog indeksа rizikа, koji određuje stаnište, brojnost i zultati. Nа staništima parkova Beograda ustаnovljen je visok zаrаženost krpeljа. Cilj rаdа bio je dа se odredi vrednost eko- PR trаnsmisije B. burgdorferi, dok je AR 4 staništa svrstаn u loškog indeksа rizikа [potencijalnog rizika (PR) i aktuelnog ri- kаtegoriju mogućeg rizikа, a na ostalih 5 staništa procenjen je zika (AR)] nа zelenim površinаmа devet pаrkovа Beogrаdа i kao ograničen. Po vrednostimа AR stаtistički znаčаjno su se utvrdi korelаcijа ovog indeksа sа ubodimа krpeljа kod ljudi. rаzlikovаlа (p < 0,05) stаništа: Hаjd pаrk i Tаšmаjdаn; Hаjd Metode. Krpelji su u pаrkovimа sаkupljаni metodom flаg pаrk i Kаlemegdаn; Hаjd pаrk i Pionirski pаrk; Hаjd pаrk i čаsа i pregledаni nа prisustvo uzročnikа LB u tаmnom Bаnovo brdo; Topčider i Tаšmаjdаn; Topčider i Kаlemegdаn; vlаžnom polju mikroskopа. Bodovаnjem određenih pаrаme- Topčider i Pionirski pаrk; Topčider i Pаrk Bаnovo brdo. tarа po odgovаrаjućim skаlаmа, procenjivani su potencijаlni i Utvrđenа je stаtistički znаčаjnа povezаnost (p < 0,05) brojа Correspondence to: Milena Krstić, Institute of Epidemiology, Sector for Preventive Medicine, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia. Phone: +381 11 36 09 345. E-mail: [email protected] Vol. 74, No 4 VOJNOSANITETSKI PREGLED Page 342 ubodа odrаslih i brojа ubodа zаrаženih odrаslih jedinki, sа ubodimа kod ljudi, ovаj indeks je od znаčаjа zа procenu rizikа vrednošću AR. Zaključak. U pаrkovimа Beogrаdа, u prose- od LB. ku postoji ogrаničen AR trаnsmisije B. burgdorferi. Vrednosti AR vаrirаju od ograničenog do mogućeg, zаvisno od ekološ- Ključne reči: kih kаrаkteristikа staništa, brojа sаkupljenih krpeljа i njihove krpelji; rizik, procena; borrelia burgdorferi; bolest, inficirаnosti. S obzirom na to dа postoji korelаcijа AR sа prenosioci; srbija. Introduction belonging to the ecological category of parks are character- ised by certain ecological features and influenced by a de- Lyme disease (LD) has been present in Serbia since 1987, gree of anthropogenic factor, thus differentiating them from with the constant increase in the number of infected persons 1. other ecological categories (forests, forest parks). The ticks of Ixodes species play a primary role in transmitting Hajd Park (140 m above sea level, surface area of 7.3 ha) the disease, and in our environment specifically Ixodes ricinus – beside perennial vegetation [plane-tree, oak, hazel, lime-tree, (I. ricinus) whose bite can infect and make people contract this thorny bushes, beech, turkey (bitter) oak, willow, forsythia], disease 1–3. Based on surveys conducted in Belgrade, a number numerous annual green plants are also present. The park is or- of habitats were marked as natural foci of LD. These habitats ganised for recreation purposes (trim-trails, exercise equipment). carry the risk of bites by infected ticks, especially during the It is surrounded by roads, intercepted with streets linking it with season of their activity, from March until October 4. This risk in- the residential area and the city center. Apart from plants, sev- creases with the length of exposure to ticks’ habitats. People eral types of mouse-like rodents, squirrels and great many birds whose regular professional activities are carried out in nature are have been registered in the park. Stray dogs, as well as pets especially at risk (hunters, forestry workers, workers maintain- taken out by citizens can be also found there. ing green spaces, farmers, veterinarians, soldiers, etc.), as well Bele Vode Park (139 m above sea level, surface area of as those who temporarily visit nature for recreational purposes 8.0 ha) is divided into two parts by one street. “Ibarska magis- or walking. In addition to this, the risk of being infected with the trala” main road is located on the upper side of the park. A part spirochete B. burgdorferi depends on the abundance of ticks and of the park is rather derelict, uncared for, covered in shrub the rate of infection with the cause of LD in ticks 5, 6. Past sur- vegetation. The remaining part is organised for recreation pur- veys in Belgrade used the entomologic risk index (ERI) 7 to poses (playgrounds, children’s park with equipment). Peren- evaluate the risk of infection with B. burgdorferi. Ecological risk nial woody plants are present, such as: walnut tree, locust tree, index was also determined for a number of habitats, but no cor- chestnut, pine, birch, and forsythia of shrub vegetation. Of an- relation of the actual risk (AR) index with bites in humans on nual plants there are many sorts of grass from the Gramineae these habitats was found 8. family. The presence of mouse-like rodents, squirrels and The aim of this study was to determine the ecological many birds has been registered in the park. risk index of transmitting B. burgdorferi in green spaces of Ušće Park (89 m above sea level, together with the Park nine parks in Belgrade, to prove the correlation of this index Prijateljstva having 150 ha surface area). Over 90% of the with bites in humans and based on all this to evaluate the risk habitat is planned. Ušće is connected with roads to all city of infection with LD. parts and facilities on water. There are many recreational trails in Ušće (a bicycle track particularly stands out), great Methods many restaurants, shopping and cultural facilities, and a part of the space is used for public events (concerts). This habitat The survey encompassed 9 park spaces in Belgrade, is comprised of the following vegetation: a poplar tree, pine- with the most frequent occurrence of bites in patients. Ticks tree, weeping willow, forsythia, birch-tree, thorny bushes were collected monthly by using a 1 m2 flannel cloth (flag- and lime-tree, as well as annual species, mostly grass of the hour method) for 1 h. It was checked every 20 m and at- Gramineae family. Ušće abounds with animals such as tached ticks were removed, counted and placed in humidified mouse-like rodents, squirrels, as well as numerous birds. vials and transported to a laboratory for further investiga- Walking the pets is allowed in Ušće, but limited in terms of tions. Tick density was expressed by the flag hour value time. Ušće is an area visited a lot by people. (f/h): number of ticks sampled per 1 hour 9. This survey cov- Šumice Park (130 m above sea level, surface area of 1.0 ered adult forms and nymphs 10, 11.
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