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Kim P, Maxwell S, Parijat N, Kim D, McNeely CL. Targeted Tick-Borne Disease Recognition: Assessing Risk for Improved Public Health. Healthcare (Basel) 2024; 12:984. [PMID: 38786395 PMCID: PMC11121250 DOI: 10.3390/healthcare12100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Tick-borne diseases (TBDs) pose a rapidly growing threat to public health. The incidence of TBDs is on the rise, necessitating a comprehensive understanding of the risk factors beyond demographic considerations. This brief report combines a preliminary review of the literature with geographical case mapping to identify the various factors influencing TBD risk. The report highlights the vulnerability of outdoor workers, the importance of outdoor activities, and the role of education in adopting preventive behaviors. Pet ownership and interactions with animals are also associated with an increased risk. The state of Illinois is used as a case study for this report, revealing regional variations in TBD incidence, and linking them to agricultural practices, forested areas, and park accessibility. These findings inform recommendations for targeted prevention strategies, emphasizing the need for detailed geographical data to enhance public health efforts in curbing TBD incidence and risk.
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Affiliation(s)
- Pyung Kim
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Sarah Maxwell
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Nabila Parijat
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Dohyeong Kim
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Connie L. McNeely
- Schar School of Policy and Government, George Mason University, Fairfax, VA 22030, USA
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Azagi T, Harms M, Swart A, Fonville M, Hoornstra D, Mughini-Gras L, Hovius JW, Sprong H, van den Wijngaard C. Self-reported symptoms and health complaints associated with exposure to Ixodes ricinus-borne pathogens. Parasit Vectors 2022; 15:93. [PMID: 35303944 PMCID: PMC8931963 DOI: 10.1186/s13071-022-05228-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of infections with tick-borne pathogens (TBPs) other than Borrelia burgdorferi (s.l.) and tick-borne encephalitis virus (TBEV) on public health in Europe remains unclear. Our goal is to evaluate whether the presence of these TBPs in ticks can be associated with self-reported health complaints. METHODS We enrolled individuals who were bitten by I. ricinus between 2012 and 2015 and collected their relevant demographic and clinical information using a self-administered online questionnaire. A total of 4163 I. ricinus ticks sent by the participants were subject to molecular analyses for detection of specific TBPs. Associations between the presence of TBPs in ticks and self-reported complaints and symptoms were evaluated by means of a stepwise approach using a generalized linear model (GLM). RESULTS Of 17 self-reported complaints and symptoms significant in the univariate analyses, 3 had a highly significant association (P < 0.01) with at least one TBP in the multivariate analysis. Self-reported Lyme borreliosis was significantly associated (P < 0.001) with B. burgdorferi (s.l.) infection. Facial paralysis was associated (P < 0.01) with infection with B. miyamotoi, N. mikurensis and R. helvetica. Finally, a significant association (P < 0.001) was found between nocturnal sweating and A. phagocytophilum. CONCLUSIONS We found associations between the presence of TBPs in ticks feeding on humans and self-reported symptoms. Due to the subjective nature of such reports and the fact that infection was determined in the ticks and not in the patient samples, further prospective studies utilizing diagnostic modalities should be performed before any clinical outcome can be causally linked to infection with TBPs.
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Affiliation(s)
- Tal Azagi
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
| | - Margriet Harms
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Arno Swart
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Manoj Fonville
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lapo Mughini-Gras
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hein Sprong
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Cees van den Wijngaard
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
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Tick bite risk resulting from spatially heterogeneous hazard, exposure and coping capacity. ECOLOGICAL COMPLEXITY 2021. [DOI: 10.1016/j.ecocom.2021.100967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Jore S, Vanwambeke SO, Slunge D, Boman A, Krogfelt KA, Jepsen MT, Vold L. Spatial tick bite exposure and associated risk factors in Scandinavia. Infect Ecol Epidemiol 2020; 10:1764693. [PMID: 32922687 PMCID: PMC7448850 DOI: 10.1080/20008686.2020.1764693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tick-borne diseases are emerging and re-emerging threats causing public health concerns in Europe and North America. Prevention and control requires understanding of human exposure and behaviour. The aim was to measure exposure to tick bites across Scandinavia, its spatial distribution and the associated risk factors. Methods We sent a web-based survey to a randomly chosen population and analysed answers by Principal Component Analysis and Chi-Square. Individual responses were aggregated at the municipality level to assess the spatial distribution of bites. Results Nearly 60% of adults reported bites at low levels (1-5 bites); however, the majority were not in their resident municipality. We found two spatial profiles: In their home municipalities, people were most often bitten in less, but not the least, urbanized areas. When visiting other municipalities, people were most frequently bitten in peri-urban areas. Running/walking in the forest, gardening, and paddling/rowing were activities most strongly associated with bites. Conclusion Tick bites affect the entire Scandinavian population, with a higher risk in Sweden compared to Denmark and Norway. The frequency of observation of ticks in the environment or on pets might be used as a proxy for the actual risk of exposure to tick bites. Our results indicates that urban-dwelling outdoor enthusiasts and inhabitants of rural areas must be equally targeted for prevention campaigns.
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Affiliation(s)
- Solveig Jore
- Department of Infection Prevention & Preparedness, Norwegian Public Health Institute, Oslo, Norway
| | - Sophie O Vanwambeke
- Georges Lemaître Centre for Earth and Climate Research, Earth & Life Institute, Louvain-la-Neuve, Belgium
| | - Daniel Slunge
- Center for Sustainable Development, GMV, University of Gothenburg, Gothenburg, Sweden
| | - Anders Boman
- Department of Economics, University of Gothenburg, Gothenburg, Sweden
| | - Karen A Krogfelt
- Department of Virus and Microbiological Diagnostics, Statens Serum Institut, Copenhagen, Denmark.,Dept of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Martin Tugwell Jepsen
- Department of Virus and Microbiological Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Line Vold
- Department of Infection Prevention & Preparedness, Norwegian Public Health Institute, Oslo, Norway
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Cull B, Pietzsch ME, Gillingham EL, McGinley L, Medlock JM, Hansford KM. Seasonality and anatomical location of human tick bites in the United Kingdom. Zoonoses Public Health 2019; 67:112-121. [PMID: 31705595 DOI: 10.1111/zph.12659] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/17/2019] [Accepted: 10/11/2019] [Indexed: 12/15/2022]
Abstract
Tick bites on humans can occur in a variety of habitats and may result in the transmission of tick-borne pathogens, such as the causative agent of Lyme borreliosis (LB), Borrelia burgdorferi sensu lato. As the risk of transmission of this pathogen to the host increases with the duration of tick feeding, the recognition and removal of ticks as soon as possible following attachment is important for reducing the risk of infection. Performing a thorough body examination for ticks following potential exposure is recommended by tick awareness campaigns. Knowledge of where on the body feeding ticks are frequently found, and at which times of year peak tick exposure occurs, provides important information for public health messaging and may aid those bitten by ticks to engage more effectively with tick-checking behaviour. This paper summarizes human tick bites in the United Kingdom (UK) during 2013-2018 reported to Public Health England's passive Tick Surveillance Scheme and further examines the anatomical location and seasonality of bites from the most commonly encountered tick and LB vector Ixodes ricinus. A total of 1,328 tick records from humans were received of which 93% were I. ricinus. Humans were most commonly bitten by I. ricinus nymphs (70% bites). Tick bites were recorded on all parts of the body, but there were significant differences in their anatomical location on adults and children. Most tick bites on adults occurred on the legs (50%), whereas on children tick bites were mostly on the head and neck (43%). Bites from I. ricinus were recorded throughout the year but were most numerous during May to August. This study adds to the body of research on the seasonality and anatomical location of human tick bites in temperate Europe and highlights the importance of data collected through passive surveillance in addition to research and epidemiological studies.
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Affiliation(s)
- Benjamin Cull
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK
| | - Maaike E Pietzsch
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK
| | - Emma L Gillingham
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK.,NIHR Health Protection Research Unit in Environmental Change and Health, London, UK
| | - Liz McGinley
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK
| | - Jolyon M Medlock
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK.,NIHR Health Protection Research Unit in Environmental Change and Health, London, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
| | - Kayleigh M Hansford
- Medical Entomology and Zoonoses Ecology Group, Emergency Response Department, Public Health England, Salisbury, UK.,NIHR Health Protection Research Unit in Environmental Change and Health, London, UK
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Li S, Juhász-Horváth L, Trájer A, Pintér L, Rounsevell MDA, Harrison PA. Lifestyle, habitat and farmers' risk of exposure to tick bites in an endemic area of tick-borne diseases in Hungary. Zoonoses Public Health 2017; 65:e248-e253. [PMID: 29044996 DOI: 10.1111/zph.12413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Indexed: 11/28/2022]
Abstract
Controlling tick bites on farmers is important to the management of tick-borne diseases and occupational health risks in agriculture. Based on an extensive household survey conducted between June and August 2015 with 219 farmers from western Hungary where tick-borne diseases are endemic, we analysed the pattern of farmers' self-reported contacts with ticks and investigated the potential interactions between farmers, landscape and the risk of exposure to tick bites. We developed a lifestyle typology based on farmers' socioeconomic profiles, farming objectives and time use patterns, and a habitat typology describing different configurations of tick habitats and agricultural areas in place of farming. We found no relationship between tick exposure risk and self-prevention. The lifestyle typology could be used to classify the risk of tick bites and the adoption of prevention measures into different levels, the difference between which could further be modified by the habitat typology. Our results suggest that (i) farmers who are frequently engaged in outdoor recreations and (ii) part-time and inexperienced farmers who have lower rate of preventive actions are likely to experience greater exposure to tick bites either in less cultivated, semi-natural habitats or in agricultural landscape with highly diverse land uses. Future disease prevention practices should take into consideration the interaction of lifestyle and habitat and the need to associate different farmer groups with different landscape configurations.
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Affiliation(s)
- S Li
- Environmental Change Institute, University of Oxford, Oxford, UK
| | - L Juhász-Horváth
- Department of Environmental Sciences and Policy, Central European University, Budapest, Hungary
| | - A Trájer
- MTA-PE, Limnoecology Research Group, Veszprém, Hungary
| | - L Pintér
- Department of Environmental Sciences and Policy, Central European University, Budapest, Hungary.,International Institute for Sustainable Development, Winnipeg, MB, Canada
| | - M D A Rounsevell
- IMK-IFU, Karlsruhe Institute of Technology, Garmisch-Partenkirchen, Germany.,School of GeoSciences, University of Edinburgh, Edinburgh, UK
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Affiliation(s)
- Fedor Gassner
- Gassner Biological Risk Consultancy, Jachthoeve 22, 3992 NV Houten, the Netherlands
| | - Kayleigh M. Hansford
- Medical Entomology & Zoonoses Ecology, Emergency Response Department – Science & Technology, Health Protection Directorate, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
- NIHR Health Protection Research Unit in Environmental Change and Health, Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
| | - Jolyon M. Medlock
- Medical Entomology & Zoonoses Ecology, Emergency Response Department – Science & Technology, Health Protection Directorate, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
- NIHR Health Protection Research Unit in Environmental Change and Health, Porton Down, Salisbury, Wiltshire SP4 0JG, United Kingdom
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The use of syndromic surveillance to monitor the incidence of arthropod bites requiring healthcare in England, 2000-2013: a retrospective ecological study. Epidemiol Infect 2016; 144:2251-9. [PMID: 27068133 DOI: 10.1017/s0950268816000686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Climate change experts predict the number of nuisance-biting arthropods in England will increase but there is currently no known surveillance system in place to monitor or assess the public health impact of arthropod bites. This retrospective ecological study utilized arthropod bites requiring healthcare from five national real-time syndromic surveillance systems monitoring general practitioner (GP) consultations (in-hours and out-of-hours), emergency department (ED) attendances and telephone calls to remote advice services to determine baseline incidence in England between 2000 and 2013 and to assess the association between arthropod bites and temperature. During summer months (weeks 20-40) we estimated that arthropod bites contribute a weekly median of ~4000 GP consultations, 750 calls to remote advice services, 700 ED and 1300 GP out-of-hours attendances. In all systems, incidence was highest during summer months compared to the rest of the year. Arthropod bites were positively associated with temperature with incidence rate ratios (IRRs) that ranged between systems from 1·03 [95% confidence interval (CI) 1·01-1·06] to 1·14 (95% CI 1·11-1·16). Using syndromic surveillance systems we have established and described baseline incidence of arthropod bites and this can now be monitored routinely in real time to assess the impact of extreme weather events and climate change.
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Hjetland R, Reiso H, Ihlebæk C, Nilsen RM, Grude N, Ulvestad E. Subjective health complaints are not associated with tick bites or antibodies to Borrelia burgdorferi sensu lato in blood donors in western Norway: a cross-sectional study. BMC Public Health 2015; 15:657. [PMID: 26169496 PMCID: PMC4499943 DOI: 10.1186/s12889-015-2026-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
Background There is controversy about chronic health consequences of tick-borne infections, especially Lyme borreliosis. This study aims to assess whether general function, physical fitness and subjective health complaints are associated with tick bites or antibodies to Borrelia burgdorferi sensu lato in blood donors. Methods Sera from 1,213 blood donors at four different blood banks in Sogn and Fjordane county in western Norway were obtained during January to June 2010, and analysed for specific IgG and IgM antibodies. A questionnaire including questions on tick bites, subjective health complaints, general function and physical fitness was completed. Results Tick bites had been experienced by 65.7 % of the study population. 78 (6.4 %) were positive for IgG (9.7 % in men, 2.4 % in women), and 69 (5.7 %) for IgM (6.1 % in men, 5.1 % in women), verified by immunoblot. No association between number of experienced tick bites or seropositivity for Borrelia antibodies and subjective health complaints, reduced general function or reduced physical fitness was found. Conclusion The results do not support any association between tick bites or Borrelia antibodies and subjective health complaints in blood donors in an endemic area for Lyme borreliosis. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2026-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Reidar Hjetland
- Department of Microbiology, Førde General Hospital, Helse Førde Hospital Trust, PO Box 1000, NO-6807, Førde, Norway.
| | - Harald Reiso
- Institute of Health and Society, Department of General Practice, University of Oslo, Oslo, Norway.
| | - Camilla Ihlebæk
- Section of public health, ILP, Norwegian University of Life Sciences, Aas, Norway.
| | - Roy M Nilsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
| | - Nils Grude
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Elling Ulvestad
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
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Hjetland R, Henningsson AJ, Vainio K, Dudman SG, Grude N, Ulvestad E. Seroprevalence of antibodies to tick-borne encephalitis virus and Anaplasma phagocytophilum in healthy adults from western Norway. Infect Dis (Lond) 2014; 47:52-6. [PMID: 25342575 DOI: 10.3109/00365548.2014.959044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to assess the seroprevalence of antibodies to tick-borne encephalitis virus (TBEV) and Anaplasma phagocytophilum in a healthy adult population from Sogn and Fjordane county in western Norway. Sera from 1, 213 blood donors were analysed for IgG-antibodies to TBEV, and a random subgroup of 301 donors for IgG to A. phagocytophilum. In the TBEV ELISA, five (0.4%) sera were positive. These were all interpreted as "false" positives, as four had received vaccines against flaviviruses, and the remaining was negative for neutralizing antibodies to TBEV. Antibodies to A. phagocytophilum were detected by indirect immunofluorescence in 49 (16.2%) subjects (titer range 80-1280). The results indicate that TBE currently is not endemic in this part of western Norway. However, there is serological evidence of the existence of human granulocytic anaplasmosis in the population.
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Affiliation(s)
- Reidar Hjetland
- Department of Microbiology, General Hospital of Førde , Førde , Norway
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Hjetland R, Nilsen RM, Grude N, Ulvestad E. Seroprevalence of antibodies to Borrelia burgdorferi sensu lato in healthy adults from western Norway: risk factors and methodological aspects. APMIS 2014; 122:1114-24. [PMID: 24730472 DOI: 10.1111/apm.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the seroprevalence of antibodies to Borrelia burgdorferi sensu lato in a healthy adult population from Sogn and Fjordane county in western Norway by different assays. Sera from 1213 blood donors at four different blood banks were analysed in Enzygnost Lyme link VlsE/IgG (IgG), Enzygnost Borreliosis IgM (IgM), and Immunetics C6 Lyme ELISA kit (C6). Sera showing positive or grey-zone reactivities were further examined with Borrelia-EUROLine-RN-AT IgG blot and Borrelia-EUROLine-RN-AT IgM blot. The seroprevalences were 9.6%, 8.2%, 8.4%, 6.4% and 5.7%, respectively. The seroprevalence for IgG was lower in the eastern part of the county and in owners of pet animals. It was higher in men, and increased with age and number of tick bites. C6 and IgG gave comparable results. IgM only was found in 4.5%, more often in women, did not increase with age, and showed no relationship with geography, and 56.4% were positive in IgM blot. In conclusion, antibodies to B. burgdorferi s.l. are common in blood donors in western Norway. The results may be used for evaluation of predictive values of test results in patients, as well as a basis for test algorithms in the laboratory.
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Affiliation(s)
- Reidar Hjetland
- Department of Microbiology, General Hospital of Førde, Førde, Norway
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Beaujean D, van Velsen L, van Gemert-Pijnen JE, Maat A, van Steenbergen JE, Crutzen R. Using risk group profiles as a lightweight qualitative approach for intervention development: an example of prevention of tick bites and lyme disease. JMIR Res Protoc 2013; 2:e45. [PMID: 24172875 PMCID: PMC3841373 DOI: 10.2196/resprot.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many public health campaigns use a one-size-fits-all strategy to achieve their desired effect. Public health campaigns for tick bites and Lyme disease (LD) in many countries convey all relevant preventive measures to all members of the public. Although preventing tick bites (eg, by wearing protective clothing or using repellants) and checking for tick bites after visiting a risk area are effective and cost-efficient methods to prevent an individual from contracting a tick-borne disease, public compliance to these methods is low. OBJECTIVE We aimed to identify the group of individuals within the general Dutch population that are at high risk of being bitten by a tick or developing LD and to describe their characteristics, knowledge, and perceptions. The incidence of patients visiting their general practitioner for tick bites and erythema migrans (the first sign of LD) has increased tremendously in the last decades in the Netherlands and other European countries; therefore, our efforts can be used to counter this troubling trend. METHODS We conducted in-depth semi-structured interviews to identify individuals belonging to the average risk group. Participants were recruited in two ways. Patients who visited two municipal health services travel health clinics (one in a high-endemic area and one in a low-endemic area) were asked to participate. This resulted in 18 interviews. Further, parents were recruited using the convenience sampling method, which resulted in 7 interviews. We discontinued interviewing when the point of data saturation was reached. We analyzed the results immediately after each interview to identify the point of data saturation. Data saturation is when the new interviews provided no new information compared to the previous interviews. The interviews were transcribed and analyzed using inductive thematic analysis. RESULTS We identified four groups at risk of being bitten by ticks and developing LD among the general Dutch population. The groups were as follows: (1) outdoor people that check for tick bites, (2) outdoor people that do not check for tick bites, (3) parents that check their children for tick bites, and (4) parents that do not check their children for tick bites. Previous experience with ticks or LD was the main denominator between the groups. Checking for tick bites is a more easily adopted measure than preventing tick bites. Therefore, for all groups, public health efforts in the future should primarily emphasize on the importance of checking for tick bites. CONCLUSIONS The lightweight qualitative approach presented in this paper is highly relevant in tailoring public health efforts toward specific groups. The profiles of members in each risk group and the motivations underlying the behaviors of the members in each risk group can be used to determine the features and content of a targeted communication strategy about ticks and LD.
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Affiliation(s)
- Desiree Beaujean
- National Institute for Public Health and the Environment, National Coordination Centre for Outbreak Management (LCI), Bilthoven, Netherlands.
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