Celine Hotte Lyme Disease North Bay Parry Sound District Health1 Unit Lyme Disease Lyme disease is an infection transmitted through the bite of an infected . In Ontario, Lyme disease is spread by the blacklegged tick ( scapularis), often referred to as a ‘deer tick’. The bacterium Borrelia burgdorferi causes Lyme Disease and is traded back-forth between Blacklegged , small mammals & migratory birds. Humans acquire the Lyme disease infection through the bite of infected blacklegged ticks.

Adult Female Blacklegged Tick, Ixodes scapularis

2 3 Blacklegged Tick Life Cycle

• Life cycle completed in approximately 2 years • 4 stages in life cycle: 1) Egg 2) Larva 3) Nymph 4) Adult • Deer tick/blacklegged tick is a 3 host tick where each mobile stage (larva, nymph, adult) feeds on a different host • Once eggs hatch, ticks require a blood meal at each subsequent stage (larva to nymph to adult) in order to move onto next stage and complete its lifecycle • Ticks can feed on mammals, birds, reptiles, and amphibians • Ticks are most active in the summer months, but can be found at anytime of the year when the temperature is above freezing • Adult & nymph ticks survive winters buried under leaf litter while engorged (have had a blood meal)-Ticks may also overwinter on a host animal • Adult male tick dies after mating with the adult female tick and the female will die after laying eggs (1500-2000 eggs)

Blacklegged Tick 2 Year Life Cycle Content source: Centers for Disease Control

4 Infective Stages of Blacklegged Tick Life Stage & Sex Ability to Infect?

• Egg • NO

• Larva - Asexual • NO – B. Burgdorferi is not transmitted from female to egg – larvae are born “clean”. • Nymph - Asexual • YES – B. Burgdorferi may be acquired by the larvae during blood meal before molting into an infected nymph which can then transmit. • Adult Male - Sexual • NO – Infected males will develop from infected nymphs but are not known to feed so do not transmit. • Adult Female - Sexual • YES – Infected females will develop from infected nymphs and can transmit during blood meal before egg production.

5 Tick Habitat •Ticks thrive in locations that provide them with moist, shaded habitat. •Wooded or forested areas are suitable (provide both shade and leaf litter for ground cover to protect active ticks). •Areas with tall grasses and bushes are also suitable areas for ticks. •Areas that support variety of wildlife populations of small mammals, birds and large mammals such as deer which are the natural hosts for the blacklegged ticks.

6 What to look for?

7 Tick ‘Look-alikes’

1) Spider Beetle 2) Pseudoscorpion 3) Bed Bug 4) Spider

8 Degrees of Engorgement

Photo: http://www.tickencounter.org/

9 Ticks

Adult Female Adult Female Squirrel American Dog Tick Adult Female Adult Female Moose Tick Tick (Ixodes cookei) Tick (Ixodes marxi) (Dermacentor variabilis) Blacklegged Tick (Dermacentor albipictus) (Ixodes scapularis)

10 How Ticks Find Their Hosts? •Many species of ticks find their hosts by a behaviour known as "questing”. •Questing is where a tick will position themselves onto a leaf or blade of grass by their 3rd or 4th pair of legs. They hold the 1st pair of legs outstretched, waiting to climb onto the host. •When a host brushes a spot where the tick is waiting, it quickly climbs aboard as they cannot jump or fly. •Once the tick locates a suitable area on the hosts body, it will begin to feed.

11 How Ticks Spread Lyme Disease? •Once a tick finds its host, it will locate a suitable area on the hosts body to attach in order to start feeding. •The tick grasps the skin and cuts into the surface. •The tick then inserts its feeding tube. •Tick saliva contains anesthetic properties so the person or animal cant actually feel the tick bite. •Ticks will slowly suck the blood of its host for several days. If the host animal has the bacteria (Borrelia burgdorferi) that causes Lyme disease, the tick will ingest the bacteria with the blood. •Small amounts of saliva from the tick may also enter the skin of the host animal during the feeding process. If the tick contains the Lyme disease bacteria, the host animal may acquire the bacteria in this way. •Lyme disease transmission typically requires a minimum attachment period of 24 hours. •After feeding, most ticks will drop off the host and prepare for the next life stage. At its next feeding, it can then transmit the acquired bacteria causing Lyme disease to the new host.

12 Early Signs and Symptoms (3 to 30 Days After Tick Bite) Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash Erythema migrans (EM) rash -Occurs in about 70 to 80% of infected persons -Begins at the site of the tick bite after a delay of 3-30 days (average is about 7 days) -Expands gradually over several days reaching up to 12 inches or more -May feel warm to the touch but is rarely itchy or painful

-Sometimes clears as it enlarges, resulting in a target or “Classic” Erythema migrans skin rash “bull’s-eye” appearance

13 Later Signs and Symptoms (days to months after tick bite) Severe headaches and neck stiffness Additional EM rashes on other areas of the body Facial palsy (droop on one or both sides of the face) Arthritis with severe joint paint and swelling, particularly the knees and other large joints, and bones Intermittent pain in tendons, muscles, joints, and bones Heart palpitation or an irregular heart beat Episodes or dizziness or shortness of breath Inflammation of the brain and spinal cord Nerve pain Shooting pains, numbness, or tingling in the hands or feet

14 Lyme Disease Diagnosis & Treatment Lyme disease is diagnosed based on: •Signs & symptoms •History of possible exposure to infected blacklegged ticks *Laboratory blood tests may be used if the patient develops Lyme disease symptoms and suspects they may have been bitten by a blacklegged tick. *Antibiotics available (most successful when treated early).

15 Prevention •Wear closed-toed shoes, long sleeved shirts and pants. •Pull your socks over your pant legs to prevent ticks from crawling up your legs. •Wear light-coloured clothes to spot ticks easier. •Use bug spray containing DEET or Icaridin on your skin and clothing (follow label directions). •Shower or bathe within 2 hours of being outdoors to wash away any loose ticks. •Use trails, whenever possible, and stay to the center of hiking trails/paths. •Check clothing, backpacks or items which may have come in contact with ticks. •Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors (add additional dryer time to wet or damp clothes). •If clothes need to be washed first, use hot water (cold and medium temperatures will not kill ticks)

16 Tick Checks

•Complete “full body” tick checks on yourself, your children and your pets after returning from possible tick- infested areas.

•Use a mirror to inspect areas of your body that are difficult to see

•Do not stop checking for ticks if you find one tick as there may be more.

17 18 What to do if you get bit?

• Removing ticks within 24 hours greatly reduces infection. • Use clean fine-tipped tweezers to gently grasp the tick as close to the skin as possible and pull slowly upward with a steady pressure. • AVOID squeezing or twisting the tick as it can cause the tick to release the agent causing LD. • If a small piece of the ticks mouthpart remains in the skin after the tick is removed, try to remove it gently with tweezers and keep the area clean to prevent infection. • Be sure to wash your hands and cleanse the skin around the tick bite with soap and water or disinfectant (rubbing alcohol). • Place the tick in a sealable container and bring the tick to your healthcare provider or health unit to be identified and tested. • Note the date of the tick bite and location you most likely acquired the tick.

19 North Bay Parry Sound District Health Unit Tick Stats:

2019 2018 2017 2016

37 Ticks Submitted (as of 51 Ticks Submitted 72 Ticks Submitted 32 Ticks Submitted July 30, 2019) 13 Ixodes scapularis (as of 30 Ixodes scapularis 36 Ixodes scapularis 12 Ixodes scapularis July 30, 2019) 1 Positive for Lyme 7 Positive for Lyme 0 Lyme Disease 1 Positive for Lyme Disease Disease Disease

20 Ticks of Ontario (Common) Species Pathogen Disease Infective Stage Tick/Disease Significance Blacklegged Tick Borrelia burgdorferi Lyme disease Nymph, Adult (F) Both Increasingly common (Ixodes scapularis) Anaplasma Granulocytic Nymph, Adult (F) Tick is increasingly phagocytophylum Anaplasmosis common/Disease uncommon

American Dog Tick Rickettsia rickettsia Rocky Mountain Spotted Larva (rare), Nymph, Tick is common/Disease is (Dermacentor Fever Adult (M&F) uncommon variabilis) Francisella tularensis Tularemia Larva (rare), Nymph, Tick is common/Disease is Adult (M&F) uncommon

Brown Dog Tick Richettsia rickettsia Rocky Mountain Spotted Larva, Nymph, Adult Tick is common/Disease is (Rhipicephalus Fever uncommon sanguineus) Ehrlichia canis Canine Ehrlichiosis Nymph, Adult Tick is common/Disease is uncommon

Babesia canis Canine Babesiosis Nymph, Adult Tick is common/Disease is uncommon

21 Ticks of Ontario (Less Common)

Species Pathogen Disease Infective Stage Tick/Disease Significance

Groundhog Tick Powassan Nymph, Adult Ticks are moderately (Ixodes cookei) Encephalitis common/Disease is ------uncommon/Nest Squirrel Tick Associate/Rapid (Ixodes marxi) Transmission Lone Star Tick Ehrlichia ewingii Granulocytic Nymph, Adult Tick is very (Amblyomma Ehrlichiosis uncommon/Disease americanum) is uncommon/Very poor vectors Ehrlichia chaffiensis Monocytotrpic Nymph, Adult Tick is Ehrlichiosis uncommon/Disease is uncommon/ Very poor vectors

22 For more information… North Bay Parry Sound District Health Unit: 705-474-1400 ext.5400

23 References

1. Harvey, A. (2000). -borne diseases in Canada: A clinician’s perspective from the “cold zone”. Paediatrics Child Health. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817793/ 2. Lyme Disease. (2017). Government of Canada. Retrieved from: https://www.canada.ca/en/public-health/services/diseases/lyme-disease.html 3. Lyme Disease in Ontario. (2016). Ministry of Health. Retrieved from: https://www.ontario.ca/page/lyme- disease?gclid=EAIaIQobChMIzMCF__KE1QIVCRBpCh1N-wmtEAAYASAAEgLB__D_BwE 4. Lyme Disease. (2017). Public Health Ontario. Retrieved from: https://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/Pages/IDLandingPages/Lyme-Disease.aspx 5. Lyme Disease. (2015). Centers of Disease Control and Prevention. Retrieved from: https://www.cdc.gov/lyme/index.html 6. Tick ID. CanLyme. Canadian Lyme Disease Foundation. Retrieved from: https://canlyme.com/lyme-basics/tick-id/ 7. Vector-borne diseases 2015 summary report. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Toronto, ON. Queen’s Printer for Ontario;2016 8. Tick-Borne Diseases. Province of Manitoba-Manitoba Health, Seniors, and Active Living Resources>Communicable Disease Control. Retrieved from: https://www.gov.mb.ca/health/publichealth/cdc/tickborne/index.html 9. Morris, Ed. (2016). Lyme Disease Staff Presentation. Ontario Parks. (PowerPoint). 10. CDC Centers for Disease Control and Prevention (2019). Lyme Disease. Retrieved from: https://www.cdc.gov/lyme/diagnosistesting/index.html

24 References Cont’d.

11. Center for Disease Control and Prevention. 2017. Citing Online Sources: West Nile Virus: Transmission[online[ Available from https://www.cdc.gov/westnile/statsmaps/preliminarymapsdata2017/index.html

12. Public Health Agency of Canada. 2017. West Nile Virus and Other Mosquito-Borne Disease National Surveillance Report – October 15 to October 21, 2017. [online] Available from https://www.Canada.ca/en/publichealth/services/publications/diseases-conditions/west-nile-virus-surveillance/2017/October-15-21-2017-week-42.html

13. Public Health Ontario. 2017. Citing online sources: Vector-Borne Disease Surveillance Reports [online]. Available from http://www.publichealthontario.ca/en/DataAndAnalytics/Pages/WNV.aspx

14. West Nile Virus Mosquito Surveillance Report and notes on Eastern Equine Encephalitis Virus Mosquito Testing 2017. North Bay Parry Sound District health Unit Entomogen. Dr. Fionna Hunter, Mr. Alessio Gasparotto

15. Purdue University. (2008). Medical Entomology-Insects and Ticks. Retrieved from: https://extension.entm.purdue.edu/publichealth/insects/tick.html

16. Centers of Disease Control & Prevention. (2019). Tick Removal. Retrieved from: https://www.cdc.gov/ticks/removing_a_tick.html

17. Habegger, S. (2014). Lyme Disease in Canada: An Update on the Epidemiology (128). Retrieved from: Nation Collaborating Centre for Infectious Diseases. https://nccid.ca/publications/lyme-disease-in-canada-an-update-on-the-epidemiology/?hilite=%27lyme%27%2C%27disease%27%2C%27canada%27

18. Bouchard C, Dibernardo A, Koffi J, Wood H, Leighton PA, Lindsay LR. Increased risk of tick-borne diseases with climate and environmental changes. Can Co9mmun Dis Rep 2019; 45(4):83–9. https://doi.org/10.14745/ccdr.v45i04a02

19. Coburn, M. Wellington-Dufferin-Guelph Public Health (2018). Common Ticks of Ontario: North Bay Parry Sound District Health Unit-Tick Identification Workshop.

20. CDC Centers for Disease Control and Prevention (2019). Lyme disease-Signs and Symptoms. Retrieved from: https://www.cdc.gov/lyme/signs_symptoms/index.html

25 Photo Credits

1) Deer Tick (2017) ORKIN. (Digital Image). Retrieved from https://www.orkin.com/other/ticks/deer-ticks/

2) Power, J. Forest Path. Flickr.(Digital Image). Retrieved from https://www.flickr.com/photos/gruesome/2551405230/

3) Centers of Disease Control & Prevention (2011). Blacklegged Tick Lifecycle. (Digital Image). Retrieved from https://www.cdc.gov/lyme/transmission/blacklegged.html

4) California Department of Public Health (n.d.) Blacklegged Tick-small, but mighty. (Digital Image). Retrieved from https://insideclimatenews.org/species/insects/deer-tick

5) Province of Manitoba. (2017). Blacklegged tick habitat. (Digital Image). Retrieved from https://www.gov.mb.ca/health/publichealth/cdc/tickborne/about.html

6) Davidson, J. (2017). Tick in questing behavior. (Digital Image). Retrieved from http://drjaydavidson.com/tick-lyme-prevention/

7) New Health Advisor. (2017). Classic “Bullseye Rash”. (Digital Image). Retrieved from http://www.newhealthadvisor.com/Lyme-Disease-Rash.html

8) Public Health Ontario-Ontario Agency for Health Protection and Promotion. (2019). Ontario Lyme Disease Estimated Risk Areas Map. Toronto, ON: Queen’s Printer for Ontario.

9) Government of Canada (2019) Tick Check Wallet Card-How to Check for Ticks. Retrieved from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/how-to-check-for-ticks-wallet-card.html

10) Tick Encounter Resources-The University of Rhode Island. Tick Growth Comparison. Retrieved from: https://tickencounter.org/tick_identification/tick_growth_comparison

11) The University of Maine. Ticks of Maine. Retrieved from: https://extension.umaine.edu/ticks/maine-ticks/

12) Pet Coach. (2019). Identity Ticks. Retrieved from: https://www.petcoach.co/article/how-to-remove-a-tick-from-your-dog-or-cat/

13) CTV News Ottawa. (2018). Signs Warning of Ticks Carrying Lyme disease posted on walking paths by DND. Retrieved from: https://ottawa.ctvnews.ca/signs-warning-of-ticks-carrying-lyme-disease-posted-on-walking-paths-by-dnd-1.4015492

14) Government of Canada (2015). Typical Habitat that would support Blacklegged Ticks (figure 1). Retrieved from: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2015-41/ccdr-volume-41-06-june-4-2015/ccdr- volume-41-06-june-4-2015-3.html

15) University of Minnesota Extension. (2019). Ticks-How to Identify Ticks. Retrieved from: https://extension.umn.edu/yard-and-garden-insects/ticks

16) CDC Centers for Disease Control and Prevention (2018). How to Check Your Pet for Ticks. Retrieved from: https://www.cdc.gov/healthypets/publications/check-pet-for-ticks.html

17) Tick Spotters (2017). Is it a Tick?. Retrieved from: http://tickspotters.org/is-it-a-tick

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