Warmer Weather, Sunny Skies and Bugs!

What’s New in Vectorborne Diseases Shereen Semple, MS Vectorborne Disease Program Coordinator Vectorborne Diseases

MOSQUITO-BORNE -BORNE • Endemic: • Endemic: – Eastern equine – – West Nile – Babesiosis – Ehrlichiosis • Imported/Emerging: – – Rocky mountain spotted fever – – Tularemia – Dengue – LaCrosse virus • Emerging: – Malaria – Borrelia miyamotoi – St. Louis encephalitis – – – Heartland virus – Powassan virus Chikungunya Virus • First described in 1953 •Vector: Mosquitoes • Geographic area*: Africa, Asia, Caribbean • Incubation period: 2-12 days • Symptoms: Fever and joint pain • Treatment: Supportive only •At risk: Areas where local transmission and vector are found *Outbreaks and isolated autochthonous cases have been reported from other regions. What is the reservoir for Chikungunya virus? 1. 2. Fruit bats 3. Chickens 4. Humans 5. Arabian camels Chikungunya Virus • Reportable in NJ: Yes • Source of reports: Provider/lab • Category in CDRSS: Yes • Priority of investigation: High in July-Oct • What to get: Symptoms, onset date, exposure, testing for dengue • Other: Consider for persons who are dengue negative with travel history Chikungunya Virus

• Persons symptomatic in the summer – Viremia – Avoid mosquitoes • Persons traveling to outbreak areas – Use repellent – Use mosquito netting and keep windows closed • Bloodborne transmission Powassan Virus • First described in 1958 •Vector: • Geographic area*: NE and Great Lakes region • Incubation period: 1 week – 1 month • Symptoms: None to encephalitis/meningitis • Treatment: Supportive only •At risk: Outdoors

*Isolated cases may be found in other parts of the United States where the vector is found. How quickly can an infected tick transmit Powassan?

1. 15 minutes 2. 2-6 hours 3. 24-36 hours 4. We don’t know yet Powassan Virus • Reportable in NJ: Yes • Source of reports: Provider or NJDOH • Category in CDRSS: Yes • Priority of investigation: Low • What to get: Symptoms, onset date, exposure, current health status • Other: Consider for persons who are WNV negative Borellia Miyamotoi • First described in 1995 •Vector:Deer tick • Geographic area*: NE • Incubation period: 1 week – 1 month • Symptoms: Fever, headache and muscle ache • Treatment: Doxy • At risk: Outdoors

*Unknown if virus may be found in other parts of the United States. Borrelia miyamotoi is reportable in New Jersey under… 1. The category “Arboviral diseases” 2. The category “Lyme disease” 3. The category “” 4. The Emergency Health Powers Act 5. None of the above Borrelia Miyamotoi • Reportable in NJ: • Source of reports: Provider seeking testing or IMUGEN commercial lab • Category in CDRSS: No • Priority of investigation: Low • What to get: Symptoms, onset date, exposure, test results for Lyme disease, treatment • Other: Ensure treatment has been started Heartland Virus

• First described in 2012 •Vector: Lone star tick • Geographic area*: Missouri and Tennessee • Incubation period: Unknown • Symptoms: Flu-like symptoms and n/d • Treatment: Supportive only •At risk: Outdoors

*Unknown if virus may be found in other parts of the United States. Heartland Virus • Reportable in NJ: Yes • Source of reports: Provider seeking testing • Category in CDRSS: No • Priority of investigation: Depends • What to get: Age, symptoms, onset date, exposure, test results for other tickborne diseases, WBC and platelets, other illnesses • Other: Call NJDOH for testing approval Bourbon virus is transmitted by this insect. 1. Mosquito 2. Deer tick 3. Lone star tick 4. Dog tick 5. We don’t know yet Bourbon Virus • First described in 2014 •Vector: • Geographic area*: Kansas • Incubation period: Unknown • Symptoms: Flu-like symptoms, n/v and rash • Treatment: Supportive only • High risk groups: Outdoors

*Unknown if virus may be found in other parts of the United States. Bourbon Virus • Reportable in NJ: Yes • Source of reports: Provider seeking testing • Category in CDRSS: No • Priority of investigation: Depends • What to get: Symptoms, onset date, exposure, test results for other tickborne diseases* • Other: Call NJDOH for testing approval

*Investigational test protocol being developed by CDC. --Reminders • Investigation needed for: – IgM positive labs – IgM > IgG positive labs – IgM and IgG total AB positive labs • Communication – County level data only • Blood donor / organ donor – New screening being done Birds we will NOT accept for WNV testing at PHEL 1. Indoor pets 2. Geese 3. Decomposed birds 4. All of the above Mosquito-borne Disease Prevention • DEET • Long sleeves and pants • Remove standing water • Maintain gutters • Maintain screens • Call your local mosquito control agency 1-888-NO NJ WNV The best thing to use to protect against ticks is… 1. DEET applied to exposed skin 2. Permethrin applied to clothing 3. Oil of lemon eucalyptus PMD 4. Both 1 and 2 5. Both 1 and 3 Tick-borne Disease Prevention Personal Protection • Repellent • Long sleeves and pants tucked into clothing • Light colored clothing • Hike on trail • Perform frequent tick checks • Promptly remove ticks • Monitor for symptoms Tick-borne Disease Prevention Environmental Measures • Keep grass mowed short • Woodchip/mulch borders • Picnic/playground equipment away from woods • Treat dogs • Keep birdfeeders clean Questions? • Contact the NJDOH Vectorborne Disease Program* – Shereen Semple – Lindsay Lowe – Krista Reale – Kristin Innes – Sandy Van Sant (part-time only) Phone: 609-826-5964 Email: [email protected]

*Please cc your regional epidemiologist on all communication!