Tick-Borne Diseases Dutchess County, New York Geographic distribution of tick-borne disease in the United States Overview Tick-borne disease in Dutchess County, NY Recently recognized tick-borne diseases Infectious Tick-borne Diseases in the United States Endemic to Dutchess County, NY Endemic in other parts of the USA • Lyme disease (borreliosis) • Colorado tick fever • Anaplasmosis • Southern tick-associated rash • Babesiosis illness (STARI) • Ehrlichiosis • Tickborne relapsing fever • Powassan disease • Rickettsia parkeri rickettsiosis • Rocky Mountain Spotted Fever • 364D rickettsiosis • Tularemia • Heartland virus • Borrelia miyamotoi * • Borrelia mayonii Reference: http://www.cdc.gov/ticks/diseases/index.html Tick Paralysis Non-infectious Tick-Borne Syndrome Tick Paralysis The illness is caused by a neurotoxin produced in the tick's salivary gland. After prolonged attachment, the engorged tick transmits the toxin to its host Tick Paralysis Symptoms 2- 7 days after attachment Acute, ascending flaccid paralysis that is confused with other neurologic disorders The condition can worsen to respiratory failure and death in about (10%) of the cases Pathogenesis of Tick Paralysis Tick paralysis is chemically induced by the tick and therefore usually only continues in its presence. Once the tick is removed, symptoms usually diminish rapidly. However, in some cases, profound paralysis can develop and even become fatal before anyone becomes aware of a tick's presence Only 2 Human Cases Reported in Dutchess County Since 1995 Ticks that cause tick paralysis are found in almost every region of the world. In the United States, most reported cases have occurred in the Rocky Mountain states, the Pacific Northwest and parts of the South. The five North American species of ticks thought to cause tick paralysis are widely distributed throughout the United States; therefore, the potential for contact with such ticks exists in every state Ticks that Transmit Disease in Dutchess County, NY Tick Female Male Geographic Possible Pathogens Distribution they carry Black-legged Tick Lyme disease Anaplasmosis nickname: Deer Tick Babesiosis Ixodes scapularis Borrelia miyamotoi Powassan disease (Deer tick virus) Tick paralysis American Dog Tick Rocky Mountain Spotted Fever Dermacentor variabilis Tularemia Tick Paralysis Lone Star Tick Ehrlichiosis Amblyomma STARI Tularemia americanum Heartland virus? Tick paralysis Woodchuck Tick Powassan disease* Ixodes cookei *I. cookei carries POW virus, but rarely bites humans Asian Longhorn Tick A New Tick-Borne Disease Threat? • Not normally found in the Western Hemisphere, these ticks were reported for the first time in the United States in 2017. • Asian longhorned ticks have been found on pets, livestock, wildlife, and people. • The female ticks can lay eggs and reproduce without mating. • Up to thousands of ticks may be found at a time, or on an Asian Longhorned Tick animal. What You Need To Know Where have they been found? The species was not known to be present on the mainland United States until November 9, 2017, when it was first discovered on a sheep farm in Hunterdon County, New Jersey Threats to Livestock The longhorned tick can transmit an animal disease called theileriosis to cattle, which can cause considerable blood loss and occasional death of calves, but mainly is important to dairy farmers because of decreased milk production and sheep farmers because of decreased wool quantity and quality Diseases in Humans • It has been associated with - Russian spring-summer encephalitis - Powassan virus - Khasan virus - Tick-borne encephalitis virus - Japanese spotted fever - Severe fever/thrombocytopenia syndrome. • Human diseases such as Lyme spirochetes, spotted fever group rickettsiae, Ehrlichia chaffeensis, and Anaplasma bovis have been detected in H. longicornis. Can this tick transmit pathogens to humans Human pathogens have not so far been detected in the long- horned tick in the US Established Tick- Borne Diseases Lyme disease Lyme Disease Surveillance Data Lyme disease has been a nationally notifiable condition in the United States since 1991. Reports of Lyme disease are collected and verified by state and local health departments in accordance with their legal mandate and surveillance practices. 1.Under-reporting and misclassification are features common to all surveillance systems. Not every case of Lyme disease is reported to CDC, and some cases that are reported may be due to another cause. Under-reporting is more likely to occur in highly endemic areas, whereas over-reporting is more likely to occur in non-endemic areas. Limitations to 2.Surveillance data are subject to each state’s abilities to capture and classify cases, which are dependent upon budget and personnel and varies not only between states, but also from year to year within a given state. Consequently, a sudden or Lyme Disease marked change in reported cases does not necessarily represent a true change in disease incidence, and should not be construed as such without knowledge of that Surveillance state’s historical surveillance practices. 3.Surveillance data are captured by county of residence, not county of exposure. 4.States may close their annual surveillance dataset at a different time than CDC. Thus, the final case counts published by CDC may not exactly match numbers published by each state agency for a given year. 5.Following its implementation in 1991, the national surveillance case definition for Lyme disease was modified in 1996, 2008, 2011, and again in 2017. Changes were generally minor but may have had some impact on surveillance and must be considered when attempting to interpret trends. Case definitions for each period are available. Clinical Manifestations of Confirmed Lyme Disease Cases-- United States, 2008 to 2017 The Surveillance Burden on Public Health Lyme disease Each year, approximately 30,000 cases of Lyme disease are reported to CDC by state health departments and the District of Columbia. However, this number does not reflect every case of Lyme disease that is diagnosed in the United States every year. Standard national surveillance is only one way that public health officials can track where a disease is occurring and with what frequency. Recent estimates using other methods suggest that approximately 300,000 people may get Lyme disease each year in the United States. Source: Centers for Disease Control and Prevention Lyme Disease Statistics Reported Cases of Lyme Disease by Year, United States, 1995-2017 Source: Centers for Disease Control and Prevention Lyme Disease Statistics Lyme disease cases by age and sex--United States, 2001- 2017 Source: Centers for Disease Control and Prevention Lyme Disease Statistics Estimated incidence of Lyme Disease NYS & Dutchess County, NY 2010-2017 Lyme Disease Rates in Dutchess County & NYS excluding NYC 250 There were an 200 estimated 581 cases of Lyme disease in 150 Dutchess County in 2017. 100 Rate per Rate 100,000 50 0 2010 2011 2012 2013 2014 2015 2016 2017 Dutchess County NYS excluding NYC Note: In 2009, Dutchess County became a sentinel surveillance county; annual numbers are estimated by the New York State Department of Health. Data Source: New York State Department of Health Communicable Disease Registry Annual Lyme Disease Rates 400 Lyme Disease 350 in 300 The Hudson 250 200 Valley Region 150 Rate per 100,000 residents Rate 100 50 0 2010 2011 2012 2013 2014 2015 2016 2017 Dutchess Orange Putnam Rockland Sullivan Ulster Westchester NYS excluding NYC Early Signs and Symptoms (3 to 30 days after tick bite) •Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes •Erythema migrans (EM) rash: • Occurs in approximately 70 to 80 percent of infected persons • Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days) • Expands gradually over a period of days reaching up to 12 inches or more (30 cm) across • May feel warm to the touch but is rarely itchy or painful • Sometimes clears as it enlarges, resulting in a target or “bull’s-eye” appearance • May appear on any area of the body •Severe headaches and neck stiffness •Additional EM rashes on other areas of the body •Arthritis with severe joint pain and swelling, particularly the knees and other large joints. •Facial palsy (loss of muscle tone or droop on one or both sides of the face) •Intermittent pain in tendons, muscles, joints, Later Signs and and bones •Heart palpitations or an irregular heart beat (Lyme carditis) Symptoms (days to •Episodes of dizziness or shortness of breath •Inflammation of the brain and spinal cord months after tick bite) •Nerve pain •Shooting pains, numbness, or tingling in the hands or feet •Problems with short-term memory Anaplasmosis & Ehrlichiosis Human Granulocytic Anaplasmosis Human Monocytic Ehrlichiosis Causative Agent Anaplasma phagocytophilum Ehrlichia chaffeensis and ewingii and muris-like Incubation Period 1-30 days (average 7-14 days) 1-30 days (average 7-14 days) Classic Fever, Headache, Constitutional Symptoms, Fever, Headache, Constitutional Symptoms, Symptoms GI symptoms, Cough, GI Symptoms, Conjunctival injection, Rash is rare with anaplasmosis Rash (60% children, 30% adults) Risk Factors Increased incidence as age increases Increased incidence as age increases Outcomes Case Fatality rate <1% Case Fatality Rate of 1.8% CBC & Chemistry Thrombocytopenia Thrombocytopenia Leukopenia Leukopenia Elevated Liver Enzymes Elevated Liver Enzymes Treatment Doxycycline Doxycycline Lab Detection of Anaplasmosis and Ehrlichiosis