Knowledge, attitudes, and practices of Illinois medical professionals related to ticks and tick-borne disease

Incidence of hospitalizations related to Lyme disease and other tick-borne diseases using Discharge Abstract Database, Canada, 2009-2021

To estimate rates of hospitalizations for tick-borne diseases (TBDs) in Canada, retrospective analysis was conducted to determine the incidence of patients diagnosed with TBDs during their hospital stay in Canada, and describe demographic characteristics, temporal trends and geographic distributions, from 2009 through 2021. Codes from the International Classification of Diseases, Tenth Revision (ICD-10-CA) were used to capture diagnoses of TBDs in the Discharge Abstract Database (DAD) in Canadian hospitals. From 2009 through 2021, 1,626 patients were diagnosed with TBDs during their hospital stay. Of these, 1,457 were diagnosed with Lyme disease (LD), 162 with other TBDs, and seven were diagnosed with more than one TBD. Annual hospitalization counts for LD showed a significant increase from 50 in 2009 to 259 in 2021 (incidence rate per 100,000 population of 0.1 and 0.7, respectively). Epidemiologic patterns for hospitalized LD cases, including increases and variation in annual incidences, seasonality, demographics and geographic distribution, are consistent with those elucidated in national LD surveillance data. Amongst 162 patients diagnosed with other tick-borne diseases, discharge diagnoses were: rickettsiosis (32.7%), spotted fever due to rickettsia rickettsii (23.5%), tularemia (21.0%), babesiosis (8.6%), other tick-borne viral encephalitis (6.2%), tick-borne relapsing fever (4.9%), and Colorado tick fever (0.6%). Annual incidence increased only for rickettsiosis from 3 to 12 patients over the study period. Monitoring the data of hospitalizations using the DAD provided insights into the burden of emerging TBDs, the severity of illnesses and the population most at risk.

Unveiling Misconceptions among Small-Scale Farmers Regarding Ticks and Tick-Borne Diseases in Balochistan, Pakistan

Ticks and tick-borne diseases (TBDs) pose potential health threats to small-scale farmers of grazing animals in the upper highlands of Balochistan, Pakistan. This study was conducted based on a questionnaire survey involving 153 farmers of grazing animals in seven districts to access their knowledge, attitudes, and practices regarding ticks and TBDs. Odds ratios and 95% confidence intervals, based on Fisher's test, were used to assess risk factors for determining preventive measures. The findings revealed a low level of knowledge among the participants. For instance, there was a lack of awareness of the effects of climate change and the economic impact of ticks on animal health. The essential precautions, such as the non-indiscriminate use of acaricides, wearing dark-colored clothing, and limiting children's interaction with grazing animals, were often overlooked. However, the farmers had a positive attitude towards tick control, but they mostly relied on the knowledge of local communities. The neglect of such measures places these farmers and their children at risk of contracting TBDs. This study also indicates minimal involvement from the government in educating farmers and controlling ticks. The role of stakeholders, including the government, non-governmental organizations, veterinary doctors, and local farmer communities, is crucial to address these issues and to implement effective training programs that address misconceptions about ticks and TBDs. Overall, this study highlights the importance of implementing awareness and education programs to address the misconceptions about ticks and TBDs among farmers.

Emerging Trends in Information-Seeking Behavior for Alpha-Gal Syndrome: Infodemiology Study Using Time Series and Content Analysis

BACKGROUND

Alpha-gal syndrome is an emerging allergy characterized by an immune reaction to the carbohydrate molecule alpha-gal found in red meat. This unique food allergy is likely triggered by a tick bite. Cases of the allergy are on the rise, but prevalence estimates do not currently exist. Furthermore, varying symptoms and limited awareness of the allergy among health care providers contribute to delayed diagnosis, leading individuals to seek out their own information and potentially self-diagnose.

OBJECTIVE

The study aimed to (1) describe the volume and patterns of information-seeking related to alpha-gal, (2) explore correlations between alpha-gal and lone star ticks, and (3) identify specific areas of interest that individuals are searching for in relation to alpha-gal.

METHODS

Google Trends Supercharged-Glimpse, a new extension of Google Trends, provides estimates of the absolute volume of searches and related search queries. This extension was used to assess trends in searches for alpha-gal and lone star ticks (lone star tick, alpha gal, and meat allergy, as well as food allergy for comparison) in the United States. Time series analyses were used to examine search volume trends over time, and Spearman correlation matrices and choropleth maps were used to explore geographic and temporal correlations between alpha-gal and lone star tick searches. Content analysis was performed on related search queries to identify themes and subcategories that are of interest to information seekers.

RESULTS

Time series analysis revealed a rapidly increasing trend in search volumes for alpha-gal beginning in 2015. After adjusting for long-term trends, seasonal trends, and media coverage, from 2015 to 2022, the predicted adjusted average annual percent change in search volume for alpha-gal was 33.78%. The estimated overall change in average search volume was 627%. In comparison, the average annual percent change was 9.23% for lone star tick, 7.34% for meat allergy, and 2.45% for food allergy during this time. Geographic analysis showed strong significant correlations between alpha-gal and lone star tick searches especially in recent years (ρ=0.80; P<.001), with primary overlap and highest search rates found in the southeastern region of the United States. Content analysis identified 10 themes of primary interest: diet, diagnosis or testing, treatment, medications or contraindications of medications, symptoms, tick related, specific sources of information and locations, general education information, alternative words for alpha-gal, and unrelated or other.

CONCLUSIONS

The study provides insights into the changing information-seeking patterns for alpha-gal, indicating growing awareness and interest. Alpha-gal search volume is increasing at a rapid rate. Understanding specific questions and concerns can help health care providers and public health educators to tailor communication strategies. The Google Trends Supercharged-Glimpse tool offers enhanced features for analyzing information-seeking behavior and can be valuable for infodemiology research. Further research is needed to explore the evolving prevalence and impact of alpha-gal syndrome.

Assessing knowledge gaps and empowering Extension workers in Illinois with information on ticks and tickborne diseases through KAP surveys

Tickborne diseases (TBDs) are increasingly prevalent in Illinois and the Upper Midwest region. People who work in occupations that require time outdoors in agricultural or natural settings, such as some Extension workers, are at risk of tick bites and TBDs. Additionally, Extension workers are often a primary source of information about ticks and TBDs in rural communities. However, there is limited information on the level of awareness about ticks and TBDs in the Extension community. The goals of this study were to sequentially i) determine the baseline awareness of Extension workers in Illinois about ticks and TBDs using a knowledge, attitudes, and practices (KAP) survey tool, ii) provide comprehensive training on ticks and TBDs to this demographic, and iii) measure the uptake of knowledge after the training intervention through a post-training survey. The study period was from June 2022 until May 2023. We received 233 pre-training and 93 paired post-training survey responses. Most survey respondents were Extension volunteers, identified as women, and were over 50 years old. Knowledge about ticks and TBDs varied. We identified several gaps in their current tick awareness, most importantly, in tick prevention measures, tick identification, and TBDs in general. TBD knowledge, attitude, and practice scores all significantly improved after training (p < 0.001), with a mean difference of 10.47, 1.49, and 2.64 points, respectively. Additionally, both Extension professionals (79.2 %) and Extension volunteers (66.7 %) were more likely to feel confident in engaging with their stakeholders on ticks and TBDs after participating in training. Poisson models revealed that higher attitude and practice scores and greater self-reported knowledge were the factors most significantly associated with higher TBD knowledge. We found that greater concern for ticks and TBD (attitudes) and adherence to science-based prevention and management methods (practices) were also associated with higher knowledge scores. To our knowledge, this is the first study in Illinois to capture Extension workers' awareness of ticks and TBDs. The results highlight Extension workers' interest in filling knowledge gaps through learning, and the importance of training Extension workers to disseminate reliable and updated information on ticks and TBDs to their constituents, a critical step in preventing TBDs.

A survey of knowledge, attitudes, and practices of veterinary professionals regarding ticks and tick-borne diseases: Insights from Ohio, USA

Globally, ticks are becoming more problematic as agricultural pests and vectors of tick-borne diseases (TBDs), many of which are shared between animals and people. Veterinary professionals, including veterinarians and non-veterinarians, are considered a vulnerable group through occupational exposure. To inform educational interventions at the intrapersonal level, a common approach is to first assess knowledge, attitudes, and practices (KAP) of target populations. Thus, our objective was to assess KAP of veterinary professionals in Ohio, a state faced with expanding and invading ticks of medical and veterinary concern. Using a convenience sample, we surveyed 178 veterinary professionals across Ohio with an electronic questionnaire that covered knowledge, attitudes, practices, exposures, demography, education, and surveillance regarding ticks and TBDs. We found that veterinary professionals had cautionary attitudes towards ticks and TBDs and practiced prevention for themselves and their patients, even when tick exposures were infrequently reported. However, veterinary professionals significantly lacked in knowledge regarding tick biology and local TBD epidemiology. Furthermore, we found that knowledge regarding tick biology and attitudes towards ticks and TBDs did not associate with practices. Instead, we found that veterinarian status and routine tick checks of patients were associated with frequent discussions of tick prevention with clients. Our findings emphasize that most tick exposures of veterinary professionals are occupational, and thus prevention should start at the workplace. Cultivating knowledge of veterinary professionals regarding tick biology and local TBD epidemiology may lead to greater motivation and confidence with identifying ticks and testing for TBDs, which may also increase the diagnostic capacity of veterinary professionals for tick and TBD surveillance. Because veterinary professionals typically interact with both animals and their owners, improving their KAP regarding ticks and TBDs, can in turn promote animal, human, and environmental health within a "One Health" context.

Lyme Disease Knowledge, Practices, and Vaccine Acceptability Among Nurse Practitioners in Pediatric Practice

INTRODUCTION

Lyme disease (LD) is a major public health problem in the United States. Given its incidence and geographic expansion, nurse practitioners (NPs) will likely encounter patients with this condition.

METHOD

NPs were invited to participate in an electronic survey via email, newsletter, and social media posts. The 31-question survey collected information on provider characteristics, clinical scenario decisions, resources used, and vaccine sentiment for LD.

RESULTS

Survey participants (n = 606) were primarily cisgender female (75%) and aged 30-49 years (62%). Responding to six hypothetical clinical scenarios, only 31% of participants answered most questions correctly. If an LD vaccine becomes available, 39% said they would incorporate it into practice; 48% would seek further information before deciding.

DISCUSSION

Additional education on LD prevention, diagnosis, and treatment is needed for NPs. Increasing provider awareness of current guidelines and developing tailored resources for NPs may improve patient care.

Farmers' Knowledge and Practices About Ticks and Tickborne Diseases in Illinois

OBJECTIVE

Tickborne diseases (TBDs) in Illinois have increased in recent years. A growing body of literature indicates that the risk of exposure to ticks and tickborne diseases is higher among outdoor workers, including farmers. However, information is lacking on awareness of ticks and tickborne diseases among this demographic. This study aimed to determine the knowledge and awareness among Illinois farmers regarding ticks and tickborne diseases.

METHODS

A Knowledge, Attitudes & Prevention practices (KAP) survey was developed and administered to capture information regarding farmers' knowledge and attitudes about ticks and TBDs. Tick drags were conducted on a subset of properties as an incentive to complete the survey and to compare farmers' knowledge or expectations of ticks on their land with ticks collected.

RESULTS

Fifty farmers participated in the survey, and 17 allowed tick drags. Only 60% of respondents had at least moderate knowledge about ticks gained through family and friends (56%), medical and healthcare personnel (48%), and the internet (44%). Responses varied by the type of commodity produced by the farmer. Fifty percent of participants reported knowledge about the blacklegged tick, 34% for the American dog tick, and 42% for the lone star tick; this knowledge also varied by farm type. Most farmers (54%) agreed that preventative behaviors could protect against tickborne diseases. Self-reported knowledge was significantly and directly associated with knowledge scores (p < .001).

CONCLUSION

Knowledge of ticks and TBDs was lower among crop farmers than beef or mixed commodity farmers, but farmers generally have moderate knowledge of tick species in Illinois. Many participants expressed low concern over contracting a TBD, but many were also dissatisfied with the level of tick prevention measures that they follow. These results can be utilized to fill in knowledge gaps and develop informational materials to help farmers protect themselves against ticks and TBDs.

Health Care Provider Knowledge Regarding Alpha-gal Syndrome - United States, March-May 2022

Alpha-gal syndrome (AGS) is an emerging, tick bite-associated immunoglobulin E-mediated allergic condition characterized by a reaction to the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal), which is found in mammalian meat and products derived from mammals, including milk, other dairy products, and some pharmaceutical products. Symptoms range from mild (e.g., a rash or gastrointestinal upset) to severe (anaphylaxis); onset typically occurs ≥2 hours after exposure to alpha-gal. No treatment or cure is currently available. Despite the potential life-threating reactions associated with AGS, most patients perceive that health care providers (HCPs) have little or no knowledge of AGS. A U.S. web-based survey of 1,500 HCPs revealed limited knowledge of AGS, identified areas for continuing medical education, and described self-reported diagnostic and management practices. Overall, 42% of surveyed HCPs had never heard of AGS, and among those who had, fewer than one third knew how to diagnose the condition. Two thirds of respondents indicated that guidelines for the diagnosis and management of AGS would be useful clinical resources. Limited awareness and knowledge of AGS among HCPs likely contributes to underdiagnosis of this condition and inadequate patient management, and underestimates of the number of AGS patients in the United States, which currently relies on laboratory testing data alone.

Ticks and Tick-Borne Pathogens in Recreational Greenspaces in North Central Florida, USA

Tick-borne infections are an increasing medical and veterinary concern in the southeastern United States, but there is limited understanding of how recreational greenspaces influence the hazard of pathogen transmission. This study aimed to estimate the potential human and companion animal encounter risk with different questing tick species, and the bacterial or protozoal agents they carry in recreational greenspaces. We collected ticks bimonthly along trails and designated recreational areas in 17 publicly accessible greenspaces, in and around Gainesville, Florida, USA. We collected Amblyomma americanum, Ixodes scapularis, Amblyomma maculatum, Dermacentor variabilis, Ixodes affinis, and Haemaphysalis leporispalustris. Across the six tick species collected, we detected 18 species of bacteria or protozoa within the Babesia, Borrelia, Cytauxzoon, Cryptoplasma (Allocryptoplasma), Ehrlichia, Hepatozoon, Rickettsia, and Theileria genera, including pathogens of medical or veterinary importance. While tick abundance and associated microorganism prevalence and richness were the greatest in natural habitats surrounded by forests, we found both ticks and pathogenic microorganisms in manicured groundcover. This relationship is important for public health and awareness, because it suggests that the probability of encountering an infected tick is measurable and substantial even on closely manicured turf or gravel, if the surrounding landcover is undeveloped. The presence of medically important ticks and pathogenic microorganisms in recreational greenspaces indicates that public education efforts regarding ticks and tick-borne diseases are warranted in this region of the United States.

Current and Future Habitat Suitability Models for Four Ticks of Medical Concern in Illinois, USA

The greater U.S. Midwest is on the leading edge of tick and tick-borne disease (TBD) expansion, with tick and TBD encroachment into Illinois occurring from both the northern and the southern regions. To assess the historical and future habitat suitability of four ticks of medical concern within the state, we fit individual and mean-weighted ensemble species distribution models for Ixodes scapularis, Amblyomma americanum, Dermacentor variabilis, and a newly invading species, Amblyomma maculatum using a variety of landscape and mean climate variables for the periods of 1970-2000, 2041-2060, and 2061-2080. Ensemble model projections for the historical climate were consistent with known distributions of each species but predicted the habitat suitability of A. maculatum to be much greater throughout Illinois than what known distributions demonstrate. The presence of forests and wetlands were the most important landcover classes predicting the occurrence of all tick species. As the climate warmed, the expected distribution of all species became strongly responsive to precipitation and temperature variables, particularly precipitation of the warmest quarter and mean diurnal range, as well as proximity to forest cover and water sources. The suitable habitat for I. scapularis, A. americanum, and A. maculatum was predicted to significantly narrow in the 2050 climate scenario and then increase more broadly statewide in the 2070 scenario but at reduced likelihoods. Predicting where ticks may invade and concentrate as the climate changes will be important to anticipate, prevent, and treat TBD in Illinois.

Review of Continuing Medical Education in Tick-Borne Disease for Front-Line Providers

Introduction

Considering increasing rates of tick-borne diseases (TBDs) in the United States, we investigated the scope of continuing medical education (CME) available to physicians on these infections.

Methods

We surveyed online medical board and society databases serving front-line primary and emergency/urgent care providers for the availability of TBD-specific CME between March 2022 and June 2022. We recorded and analyzed opportunity title, author, web address, publication year, learning objectives, CME credit values, and CME credit type.

Results

We identified 70 opportunities across seven databases. Thirty-seven opportunities focused on Lyme disease; 17 covered nine non-Lyme TBDs, and 16 covered general topics on TBDs. Most activities were hosted through family medicine and internal medicine specialty databases.

Conclusion

These findings suggest limited availability of continuing education for multiple life-threatening TBDs of increasing importance in the United States. Increasing the availability of CME materials covering the broad scope of TBDs in targeted specialty areas is essential for increased content exposure and a necessary step to ensure our clinical workforce is adequately prepared to address this growing public health threat.