lyme disease tracking and prevention in virginia

Lyme Disease Tracking & Lyme Disease Tracking & PreventionPrevention

Virginia Department of Virginia Department of HealthHealth

What is Lyme Disease?What is Lyme Disease?

3 Stages of Infection 3 Stages of Infection

Early Localized Infection (3-30 days)Early Localized Infection (3-30 days)Bull’s-eye rash, muscle or joint aches, Bull’s-eye rash, muscle or joint aches, fever, headache fever, headache

Early Disseminated Infection (1- 4 months)Early Disseminated Infection (1- 4 months)Severe headaches, pain, Severe headaches, pain, neurological symptomsneurological symptoms

Late Disseminated Infection (3 months to years)Late Disseminated Infection (3 months to years)Severe arthritis and swelling of large joints, pain, Severe arthritis and swelling of large joints, pain, neurological and cognitive disordersneurological and cognitive disorders

A Tick-borne bacterial diseaseA Tick-borne bacterial disease

Lone Star Tick American Dog TickBlacklegged Tick

Common Virginia Ticks

Blacklegged Ticks

Inch (fractions)

1/16

Lyme Disease Transmission – Two Year CycleLyme Disease Transmission – Two Year Cycle

Lyme Disease in U.S. - 2006Lyme Disease in U.S. - 2006

Role of the Virginia Department of HealthRole of the Virginia Department of Health

Preventing disease through EducationPreventing disease through Education

Tracking Tracking Monitoring the annual number and Monitoring the annual number and geographic distribution of newly identified geographic distribution of newly identified Lyme disease cases in VALyme disease cases in VA

Tracking Lyme diseaseTracking Lyme disease

1.1. Reporting cases to local Reporting cases to local health departments by health departments by healthcare providers.healthcare providers.

2. Reporting positive test 2. Reporting positive test results to VDH by private results to VDH by private laboratories.laboratories.

3. Use of the CDC’s Lyme 3. Use of the CDC’s Lyme disease case definition to disease case definition to identify new cases.identify new cases.

4. Entering identified cases in 4. Entering identified cases in a database.a database.

State Reporting Requirements for State Reporting Requirements for Lyme DiseaseLyme Disease

Virginia State Law requires that healthcare providers Virginia State Law requires that healthcare providers report Lyme disease cases to the local health report Lyme disease cases to the local health department department ((Code of Virginia 32.1-36Code of Virginia 32.1-36).).

Contact information for local health departments Contact information for local health departments can be found at: can be found at: http://www.vdh.virginia.gov/lhd/http://www.vdh.virginia.gov/lhd/

Lyme Disease Case ReportingLyme Disease Case Reporting

Lyme-associated symptoms including erythema migrans Lyme-associated symptoms including erythema migrans (EM) rash (a.k.a., bull’s eye rash) if present(EM) rash (a.k.a., bull’s eye rash) if present

Necessary laboratory results:Necessary laboratory results:

VDH uses the CDC’s Lyme Disease Surveillance Case Definition VDH uses the CDC’s Lyme Disease Surveillance Case Definition which requires: which requires:

Positive or equivocal results from ELISA (or IFA) Positive or equivocal results from ELISA (or IFA) serology as well as positive Western Blot IgM serology serology as well as positive Western Blot IgM serology if the blood was drawn within 30 days of onset, or if the blood was drawn within 30 days of onset, or

Positive Western Blot IgG serology, if blood was drawn Positive Western Blot IgG serology, if blood was drawn more than 30 days after onset. more than 30 days after onset.

Necessary case information:Necessary case information:

Date of onsetDate of onset

Complete laboratory testing resultsComplete laboratory testing results

Lyme Disease Cases in Virginia, 1989 - 2009Lyme Disease Cases in Virginia, 1989 - 2009

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8

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12

14

198

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199

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199

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199

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199

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199

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Newly Identified Lyme Disease Cases by CountyNewly Identified Lyme Disease Cases by County

0.1 to 4.9 5 to 9.9 10 to 24.9 25 to 49.9 50 to 99.9 100+

Confirmed and Probable cases per 100,000 population

Lyme Disease PreventionLyme Disease Prevention

1. Avoid tick1. Avoid tick habitatshabitats. .

2. Dress appropriately.2. Dress appropriately.

3. Use3. Use repellentsrepellents..

4. Do tick checks.4. Do tick checks.

5. Remove ticks.5. Remove ticks.

6. Know the early signs of 6. Know the early signs of Lyme disease.Lyme disease.

1.Avoid Tick Habitats

2. Dress Appropriately

• Light colors• Tucked and buttoned• Prompt clothing

removal• Launder

3. Use insect repellents

4. Do a tick check

Use pointed tweezers to grasp Use pointed tweezers to grasp the tick by the head; do not the tick by the head; do not squeeze its body! squeeze its body!

Pull slowly and steadily until Pull slowly and steadily until the tick releases; do not jerk or the tick releases; do not jerk or twist the tick. twist the tick.

5. Remove ticks promptly

6. Know the early signs of Lyme

• Bull’s Eye rash• Fatigue• Fever• Joint or muscle aches• Headache• Swollen glands

Other Tick-borne DiseasesOther Tick-borne Diseases

• Ehrlichiosis/Anaplasmosis (tick must be attached 24 hrs)

• Babesiosis (tick must be attached for 36 hrs)

• Rocky Mountain Spotted Fever (tick must be attached only 4-6 hrs)

Virginia Department of HealthVirginia Department of Health

For more information…For more information…

Centers for Disease Control and Centers for Disease Control and PreventionPrevention

http://www.vdh.virginia.gov

http://www.vdh.virginia.gov/epidemiology/http://www.vdh.virginia.gov/epidemiology/DEE/Vectorborne/TickBrochure.pdfDEE/Vectorborne/TickBrochure.pdf

http://www.cdc.gov/ncidod/dvbid/lyme/

Acknowledgements• David Gaines, Ph.D., Public Health Entomologist, Virginia

Department of Health• Division of Environmental Epidemiology, VDH• U.S. Centers for Disease Control and Prevention• CDC Public Health Images Library• American Lyme Disease Foundation• Google Images

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