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Gould LH, Fathalla A, Moïsi JC, Stark JH. Racial and ethnic disparities in Lyme disease in the United States. Zoonoses Public Health 2024; 71:469-479. [PMID: 38659178 DOI: 10.1111/zph.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Lyme disease (LD), caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States. Although most surveillance-reported cases are in people who are White, data suggest worse outcomes among people from racial and ethnic minority groups. METHODS We conducted a systematic literature review to describe racial disparities in LD. We described the epidemiology of LD by race and ethnicity, including clinical presentation at diagnosis, and summarised the literature on knowledge, attitudes and practices related to LD and ticks by race and ethnicity. RESULTS Overall, the incidence and prevalence of LD were 1.2-3.5 times higher in White persons than in persons who identified as Asian or Pacific Islander and 4.5-6.3 times higher in White persons than in persons who identified as Black. Across multiple studies, people from racial and ethnic minority groups were more likely than White people to have disseminated manifestations of LD, including neurological manifestations and arthritis, and less likely to have erythema migrans. People from racial and ethnic minority groups were also more likely to report disease onset in the fall and less likely to report disease onset in the summer. Possible reasons for these disparities include lack of recognition of the disease in people with darker skin tones, lack of knowledge of disease risk for some groups and differences in exposure risk. CONCLUSIONS Taken together, these results reinforce that all people residing in high-incidence areas are at risk of LD, regardless of race or ethnicity. Future prevention measures should be broadly targeted to reach all at-risk populations.
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Affiliation(s)
- L Hannah Gould
- Global Medical Affairs, Vaccines and Antivirals, Pfizer Biopharma Group, New York, New York, USA
| | - Adam Fathalla
- Global Medical Affairs, Vaccines and Antivirals, Pfizer Biopharma Group, New York, New York, USA
| | - Jennifer C Moïsi
- Global Vaccines and Antivirals, Pfizer Biopharma Group, Paris, France
| | - James H Stark
- Global Vaccines and Antivirals, Pfizer Biopharma Group, Cambridge, Massachusetts, USA
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Burtis JC, Ford SL, Parise CM, Eisen RJ, Eisen L. Efficacy of unregulated minimum risk tick repellent products evaluated with Ixodes scapularis nymphs in a human skin bioassay. Parasit Vectors 2024; 17:50. [PMID: 38303091 PMCID: PMC10835920 DOI: 10.1186/s13071-024-06146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The majority of vector-borne disease cases in the USA are caused by pathogens spread by ticks, most commonly the blacklegged tick, Ixodes scapularis. Personal protection against tick bites, including use of repellents, is the primary defense against tick-borne diseases. Tick repellents registered by the Environmental Protection Agency (EPA) are well documented to be safe as well as effective against ticks. Another group of tick repellent products, 25(b) exempt or minimum risk products, use alternative, mostly botanically derived, active ingredients. These are considered to pose minimal risk to human health and therefore are exempt from EPA registration; efficacy testing is not mandated for these products. METHODS We used a finger bioassay to evaluate the repellency against I. scapularis nymphs for 11 formulated 25(b) exempt products together with two positive control DEET-based EPA registered products. Repellency was assessed hourly from 0.5 to 6.5 h after product application. RESULTS The DEET-based products showed ≥ 97% repellency for all examined timepoints. By contrast, an average of 63% of ticks were repelled in the first 1.5 h after application across the 11 25(b) exempt products, and the average fell to 3% repelled between 2.5 and 6.5 h. Ten of the 11 25(b) exempt products showed statistically similar efficacy to DEET-based products at 30 min after application (repellency of 79-97%). However, only four 25(b) exempt products maintained a level of repellency similar to DEET-based products (> 72%) at the 1.5-h mark, and none of these products were effective in repelling ticks at the timepoints from 2.5 to 6.5 h after application. CONCLUSIONS Neither the claims on the labels nor specific active ingredients and their concentrations appeared to predict the duration of efficacy we observed for the 25(b) exempt products. These products are not registered with the EPA, so the methods used to determine the application guidelines on their labels are unclear. Consumers should be aware that both the level of efficacy and the duration of repellency may differ among unregulated 25(b) exempt repellent products labeled for use against ticks. We encourage more research on these products and the 25(b) exempt active ingredients they contain to help determine and improve their efficacy as repellents under different conditions.
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Affiliation(s)
- James C Burtis
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.
| | - Shelby L Ford
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Christina M Parise
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Rebecca J Eisen
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Lars Eisen
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Wilson N, Vahey GM, McDonald E, Fitzpatrick K, Lehman J, Clark S, Lindell K, Pastula DM, Perez S, Rhodes H, Gould CV, Staples JE, Martin SW, Cervantes K. Tick bite risk factors and prevention measures in an area with emerging Powassan virus disease. PUBLIC HEALTH CHALLENGES 2023; 2:10.1002/puh2.136. [PMID: 38800642 PMCID: PMC11118757 DOI: 10.1002/puh2.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 05/29/2024]
Abstract
Background In the United States (U.S.), Powassan virus is primarily transmitted to humans by the black-legged tick (Ixodes scapularis). Rarely, infections can present as severe neuroinvasive disease. In 2019, four neuroinvasive disease cases were reported in Sussex County, New Jersey, U.S. We administered a survey to county residents to better understand tick bite risk factors and the performance of personal prevention measures. Methods A survey was administered in October 2019 to adult residents of randomly selected households. Questions focused on tick bite prevention and risk factors. Crude and adjusted odds ratios (ORs) and 95% confidence intervals were calculated for various outcomes. Results Of 274 participants, 25% were previously diagnosed with a tick-borne disease, and 42% reported finding an attached tick in 2019. Yardwork and gardening (OR = 7.38) and spending >50 hours outdoors per week (OR = 8.15) were associated with finding an attached tick. Finding an attached tick was inversely associated with the number of prevention measures used, indicating that a layered approach could reduce the risk of tick bites. Those who performed post-outdoor activity prevention measures (e.g., tick checks) were less likely to have a tick attached compared to finding a crawling tick. Conclusion Compliance with prevention recommendations was low, despite a high prevalence of reported tick bites and significant outdoor exposures. Older adults and persons who spend significant time outdoors or engage in yardwork or gardening were at the highest risk of tick bites. Additional research is needed to further understand the barriers to tick bite prevention.
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Affiliation(s)
- Nicolette Wilson
- New Jersey Department of Health, Communicable Disease Service, Trenton, New Jersey, USA
- CSTE Applied Epidemiology Fellowship Program, Council of State and Territorial Epidemiologists, Atlanta, Georgia, USA
| | - Grace M. Vahey
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Emily McDonald
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Kelly Fitzpatrick
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Jennifer Lehman
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Sandhya Clark
- New Jersey Department of Health, Communicable Disease Service, Trenton, New Jersey, USA
| | - Kristine Lindell
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Daniel M. Pastula
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Stephen Perez
- New Jersey Department of Health, Communicable Disease Service, Trenton, New Jersey, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Rhodes
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn V. Gould
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - J. Erin Staples
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Stacey W. Martin
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Fort Collins, Colorado, USA
| | - Kim Cervantes
- New Jersey Department of Health, Communicable Disease Service, Trenton, New Jersey, USA
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de la Fuente J, Estrada-Peña A, Rafael M, Almazán C, Bermúdez S, Abdelbaset AE, Kasaija PD, Kabi F, Akande FA, Ajagbe DO, Bamgbose T, Ghosh S, Palavesam A, Hamid PH, Oskam CL, Egan SL, Duarte-Barbosa A, Hekimoğlu O, Szabó MPJ, Labruna MB, Dahal A. Perception of Ticks and Tick-Borne Diseases Worldwide. Pathogens 2023; 12:1258. [PMID: 37887774 PMCID: PMC10610181 DOI: 10.3390/pathogens12101258] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
In this comprehensive review study, we addressed the challenge posed by ticks and tick-borne diseases (TBDs) with growing incidence affecting human and animal health worldwide. Data and perspectives were collected from different countries and regions worldwide, including America, Europe, Africa, Asia, and Oceania. The results updated the current situation with ticks and TBD and how it is perceived by society with information bias and gaps. The study reinforces the importance of multidisciplinary and international collaborations to advance in the surveillance, communication and proposed future directions to address these challenges.
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Affiliation(s)
- José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC-CSIC-UCLM-JCCM, Ronda de Toledo 12, 13005 Ciudad Real, Spain;
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA
| | - Agustín Estrada-Peña
- Department of Animal Health, Faculty of Veterinary Medicine, University of Zaragoza, 50013 Zaragoza, Spain
- Research Group in Emerging Zoonoses, Instituto Agroalimentario de Aragón-IA2, Universidad de Zaragoza-CITA, 50013 Zaragoza, Spain
| | - Marta Rafael
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC-CSIC-UCLM-JCCM, Ronda de Toledo 12, 13005 Ciudad Real, Spain;
| | - Consuelo Almazán
- Facultad de Ciencias Naturales, Universidad Autonóma de Querétaro, Avenida de las Ciencias S/N Juriquilla, Querétaro 76230, Mexico;
| | - Sergio Bermúdez
- Medical Entomology Research Department, Gorgas Memorial Institute for Health Research, Panama City 0816-02593, Panama;
| | - Abdelbaset E. Abdelbaset
- Laboratory of Parasitology, Graduate School of Infectious Diseases, Faculty of Veterinary Medicine, Hokkaido University, Kita-18, Nishi-9, Sapporo 060-0818, Hokkaido, Japan;
| | - Paul D. Kasaija
- National Livestock Resources Research Institute (NaLIRRI/NARO), Kampala P.O. Box 5704, Uganda; (P.D.K.); (F.K.)
| | - Fredrick Kabi
- National Livestock Resources Research Institute (NaLIRRI/NARO), Kampala P.O. Box 5704, Uganda; (P.D.K.); (F.K.)
| | - Foluke Adedayo Akande
- Department of Veterinary Parasitology and Entomology, College of Veterinary Medicine, Federal University of Agriculture, Abeokuta 111101, Ogun State, Nigeria;
| | - Dorcas Oluwakemi Ajagbe
- Department of Pure and Applied Zoology, College of Biological Sciences, Federal University of Agriculture, Abeokuta 111101, Ogun State, Nigeria;
| | - Timothy Bamgbose
- Department of Biological Sciences, Microbiology Unit, Faculty of Science, Kings University, Ode-Omu City 221102, Osun State, Nigeria;
| | - Srikant Ghosh
- Entomology Laboratory, Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
- IVRI-Eastern Regional Station, 37, Belgachia Road, Kolkata 700037, West Bengal, India
| | - Azhahianambi Palavesam
- Translational Research Platform for Veterinary Biologicals, Centre for Animal Health Studies, Tamil Nadu Veterinary and Animal Sciences University, Chennai 600051, Tamil Nadu, India;
| | - Penny H. Hamid
- Department of Animal Science, Universitas Sebelas Maret, Surakarta 57126, Indonesia;
| | - Charlotte L. Oskam
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Perth, WA 6150, Australia; (C.L.O.); (S.L.E.)
- Centre for One Health and Biosecurity, Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia;
| | - Siobhon L. Egan
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Perth, WA 6150, Australia; (C.L.O.); (S.L.E.)
- Centre for One Health and Biosecurity, Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia;
| | - Amanda Duarte-Barbosa
- Centre for One Health and Biosecurity, Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia;
- School of Veterinary Medicine, Murdoch University, Perth, WA 6150, Australia
| | - Olcay Hekimoğlu
- Division of Ecology, Faculty of Science, Hacettepe University, Beytepe, Ankara 06800, Turkey;
| | - Matias P. J. Szabó
- Laboratório de Ixodologia, Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Av. Pará, 1720/Campus Umuarama-Bloco 2T, Uberlândia 38400-902, Brazil;
| | - Marcelo B. Labruna
- Faculty of Veterinary Medicine and Animal Science, University of São Paulo, Sao Paulo 05508-220, Brazil;
| | - Ananta Dahal
- Department of Microbiology and Parasitology, Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Chitwan 44200, Nepal;
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Wen S, Xu X, Kong J, Luo L, Yue P, Cao W, Zhang Y, Liu M, Fan Y, Chen J, Ma M, Tao L, Peng Y, Wang F, Dong Y, Li B, Luo S, Zhou G, Chen T, Li L, Liu A, Bao F. Comprehensive analyses of transcriptomes induced by Lyme spirochete infection to CNS model system. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 103:105349. [PMID: 35964914 DOI: 10.1016/j.meegid.2022.105349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 06/12/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lyme disease is a zoonotic disease caused by infection with Borrelia burgdorferi (Bb), the involvement of the nervous system in Lyme disease is usually referred to as Lyme neuroborreliosis (LNB). LNB has diverse clinical manifestations, most commonly including meningitis, Bell's palsy, and encephalitis. However, the molecular pathogenesis of neuroborreliosis is still poorly understood. Comprehensive transcriptomic analysis following Bb infection could provide new insights into the pathogenesis of LNB and may identify novel biomarkers or therapeutic targets for LNB diagnosis and treatment. METHODS In the present study, we pooled transcriptomic dataset of Macaca mulatta (rhesus) from our laboratory and the human astrocyte dataset GSE85143 from the Gene Expression Omnibus database to screen common differentially expressed genes (DEGs) in the Bb infection group and the control group. Functional and enrichment analyses were applied for the DEGs. Protein-Protein Interaction network, and hub genes were identified using the Search Tool for the Retrieval of Interaction Genes database and the CytoHubba plugin. Finally, mRNA expression of hub genes was validated in vitro and ex vivo from Bb infected models and normal controls by quantitative reverse transcription PCR (qRT-PCR). RESULTS A total of 80 upregulated DEGs and 32 downregulated DEGs were identified. Among them, 11 hub genes were selected. The pathway enrichment analyses on 11 hub genes revealed that the PI3K-Akt signaling pathway was significantly enriched. The mRNA levels of ANGPT1, TLR6, SREBF1, LDLR, TNC, and ITGA2 in U251 cells and/or rhesus brain explants by exposure to Bb were validated by qRT-PCR. CONCLUSION Our study suggested that TLR6, ANGPT1, LDLR, SREBF1, TNC, and ITGA may be candidate mammal biomarkers for LNB, and the TLR6/PI3K-Akt signaling pathway may play an important role in LNB pathogenesis.
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Affiliation(s)
- Shiyuan Wen
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China; Department of Intensive Care Unit, First People's Hospital of Yunnan Province, Kunming 650500, China
| | - Xin Xu
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Jing Kong
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China
| | - Lisha Luo
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China
| | - Peng Yue
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China
| | - Wenjing Cao
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China
| | - Yu Zhang
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Meixiao Liu
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Yuxin Fan
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Jingjing Chen
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China
| | - Mingbiao Ma
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China; Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children's Hospital of Kunming, Kunming Medical University, Kunming 650030, China
| | - Lvyan Tao
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China; Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children's Hospital of Kunming, Kunming Medical University, Kunming 650030, China
| | - Yun Peng
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Feng Wang
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Yan Dong
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Bingxue Li
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China
| | - Suyi Luo
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Guozhong Zhou
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Taigui Chen
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Lianbao Li
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China
| | - Aihua Liu
- Department of Biochemistry and Molecular Biology, Kunming Medical University, Kunming 650500, China; Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children's Hospital of Kunming, Kunming Medical University, Kunming 650030, China; The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, China; Yunnan Demonstration Base of International Science and Technology Cooperation for Tropical Diseases, Kunming 650500, China.
| | - Fukai Bao
- Department of Microbiology and Immunology, Kunming Medical University, Kunming 650500, China; Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children's Hospital of Kunming, Kunming Medical University, Kunming 650030, China; The Institute for Tropical Medicine, Kunming Medical University, Kunming 650500, China; Yunnan Demonstration Base of International Science and Technology Cooperation for Tropical Diseases, Kunming 650500, China.
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Eisen L. Personal protection measures to prevent tick bites in the United States: Knowledge gaps, challenges, and opportunities. Ticks Tick Borne Dis 2022; 13:101944. [DOI: 10.1016/j.ttbdis.2022.101944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/27/2022] [Accepted: 03/24/2022] [Indexed: 01/07/2023]
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7
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Beck A, Bjork J, Biggerstaff BJ, Eisen L, Eisen R, Foster E, Signs K, Tsao JI, Kough E, Peterson M, Schiffman E, Muganda CP, Osborn R, Wozniak R, Bron GM, Phaneuf D, Smith D, Bartholomay L, Paskewitz S, Hinckley AF. Knowledge, attitudes, and behaviors regarding tick-borne disease prevention in Lyme disease-endemic areas of the Upper Midwest, United States. Ticks Tick Borne Dis 2022; 13:101925. [PMID: 35255349 PMCID: PMC10947721 DOI: 10.1016/j.ttbdis.2022.101925] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
Abstract
Lyme disease and other tick-borne diseases are a major public health threat in the Upper Midwestern United States, including Michigan, Minnesota, and Wisconsin. To prevent tick bites and tick-borne diseases, public health officials commonly recommend personal protective measures and property management techniques. Adoption of tick-borne disease prevention behaviors and practices by individuals are, however, highly variable. We aimed to characterize current tick-borne disease knowledge, attitudes, and prevention behaviors (KAB) practiced by the public in these states, as well as their willingness to use specific tick control methods. We conducted a population-based survey in summer 2019 in 48 high-risk counties (those having a five-year average (2013-2017) Lyme disease incidence of ≥ 10 cases per 100,000 persons per year), in Michigan, Minnesota, and Wisconsin. A total of 2713 surveys were analyzed; survey weights were used to account for household selection probability and post-stratified to match county-level joint age and sex population distributions in population-level inference. An estimated 98% of the population had heard of Lyme disease, with most perceiving it as very or extremely serious (91%); however, only an estimated 25% perceived tick-borne diseases as very or extremely common in their community. Among those who spent time in places with ticks from April through October, an estimated 68% check themselves thoroughly for ticks most of the time or always and 43% use bug repellent on skin or clothing most of the time or always. An estimated 13% of the population had ever treated their property with a pesticide to kill ticks, and 3% had ever used devices that apply pesticide to rodents to kill ticks on their property. Willingness to practice tick bite prevention behaviors, however, was estimated to be much higher; with 82% being willing to perform tick checks at least once a day, and more than 60% willing to use bug repellent, tick control products on pets, or to bathe within two hours of being outdoors. We found that residents would likely be willing to support a county-wide tick control program to reduce the risk of tick-borne disease in their community (81%) or to apply tick control products to their property to reduce the risk of tick-borne disease in their household (79%). Tick checks were more likely to be practiced among participants who perceived tick-borne diseases to be highly prevalent in their community, if they or a household member had been previously diagnosed with a tick-borne disease?, or if they perceived tick exposure to be likely around their home, cabin, or vacation home. In addition, property-based tick control methods were associated with perceived risk of encountering ticks around the home, cabin, or vacation home. Participants who had seen information from state health departments were also more likely to practice preventive measures. The most common reported barriers to using any of these methods were forgetfulness, safety concerns, and lack of awareness. Our survey findings shed light on how residents from these Upper Midwest states may adopt tick control and tick bite prevention measures and how public health outreach may be most effective for this population.
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Affiliation(s)
- Alyssa Beck
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States
| | - Jenna Bjork
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Brad J Biggerstaff
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Lars Eisen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Rebecca Eisen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Erik Foster
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Kimberly Signs
- Michigan Department of Health and Human Services, 333 South Grand Avenue, South Grand Building, Lansing, MI 48933, United States
| | - Jean I Tsao
- Michigan State University, Department of Fisheries and Wildlife and Department of Large Animal Clinical Sciences, 480 Wilson Road, Natural Resources Building, East Lansing, MI 48824, United States
| | - Erin Kough
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Molly Peterson
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Elizabeth Schiffman
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Christine P Muganda
- Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI 53703, United States
| | - Rebecca Osborn
- Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI 53703, United States
| | - Ryan Wozniak
- Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI 53703, United States
| | - Gebbiena M Bron
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Daniel Phaneuf
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Danielle Smith
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Lyric Bartholomay
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Susan Paskewitz
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Alison F Hinckley
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States.
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8
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Devchand R, Koehler L, Hook S, Marx GE, Hooks H, Schwartz A, Hinckley A. Understanding consumer and clinician perceptions of a potential Lyme disease vaccine. HEALTH EDUCATION RESEARCH 2022; 36:494-504. [PMID: 34529775 PMCID: PMC10911045 DOI: 10.1093/her/cyab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
Each year, over 450 000 Lyme disease diagnoses are estimated to occur in the United States, and current preventive measures have been insufficient to stem the rising incidence. An effective human Lyme disease vaccine could be a powerful intervention for population-level impact. In advance of new Lyme disease vaccines coming to market, this study explored barriers to acceptability and motivations for the uptake of a new Lyme disease vaccine. Researchers conducted 9 online focus groups among consumers who may potentially benefit from the vaccine and 30 in-depth interviews among clinician groups who may provide the vaccine. All participants were recruited from three US regions of high Lyme disease incidence. Researchers found that participants shared common motivators to either recommend (clinicians) or accept (consumers) a Lyme disease vaccine, largely driven by perceived benefits of the vaccine, the lack of current effective preventive measures and a greater peace of mind. The concern about the challenges associated with diagnosing and treating Lyme disease is a primary motivator for clinicians to recommend the vaccine, while the concern about getting Lyme disease is a primary motivator for consumers to desire the vaccine.
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Affiliation(s)
| | - Laura Koehler
- Hager Sharp, 1030 15th Street NW, Washington, DC 20005, USA
| | - Sarah Hook
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Grace E. Marx
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Holley Hooks
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Amy Schwartz
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Alison Hinckley
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
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Hook SA, Hansen AP, Niesobecki SA, Meek JI, Bjork JKH, Kough EM, Peterson MS, Schiffman EK, Rutz HJ, Rowe AJ, White JL, Peel JL, Biggerstaff BJ, Hinckley AF. Evaluating public acceptability of a potential Lyme disease vaccine using a population-based, cross-sectional survey in high incidence areas of the United States. Vaccine 2021; 40:298-305. [PMID: 34895785 DOI: 10.1016/j.vaccine.2021.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lyme disease incidence is increasing, despite current prevention options. New Lyme disease vaccine candidates are in development, however, investigation of the acceptability of a Lyme disease vaccine among potential consumers is needed prior to any vaccine coming to market. We conducted a population-based, cross-sectional study to estimate willingness to receive a potential Lyme disease vaccine and factors associated with willingness. METHODS The web-based survey was administered to a random sample of Connecticut, Maryland, Minnesota, and New York residents June-July 2018. Survey-weighted descriptive statistics were conducted to estimate the proportion willing to receive a potential Lyme disease vaccine. Multivariable multinomial logistic regression models were used to quantify the association of sociodemographic characteristics and Lyme disease vaccine attitudes with willingness to be vaccinated. RESULTS Surveys were completed by 3313 respondents (6% response rate). We estimated that 64% of residents were willing to receive a Lyme disease vaccine, while 30% were uncertain and 7% were unwilling. Compared to those who were willing, those who were uncertain were more likely to be parents, adults 45-65 years old, non-White, have less than a bachelor's degree, or have safety concerns about a potential Lyme disease vaccine. Those who were unwilling were also more likely to be non-White, have less than a bachelor's degree, or have safety concerns about a potential Lyme disease vaccine. In addition, the unwilling had low confidence in vaccines in general, had low perceived risk of contracting Lyme disease, and said they would not be influenced by a positive recommendation from a healthcare provider. DISCUSSION Overall, willingness to receive a Lyme disease vaccine was high. Effective communication by clinicians regarding safety and other vaccine parameters to those groups who are uncertain will be critical for increasing vaccine uptake and reducing Lyme disease incidence.
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Affiliation(s)
- Sarah A Hook
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
| | - AmberJean P Hansen
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - Sara A Niesobecki
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - James I Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - Jenna K H Bjork
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | - Erin M Kough
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | - Molly S Peterson
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | | | - Heather J Rutz
- Maryland Department of Health, 201 W. Preston Street, 3rd Floor, Baltimore, MD 21201, USA.
| | - Adam J Rowe
- New York State Department of Health, Empire Plaza, Corning Tower, State St, Albany, NY 12203, USA.
| | - Jennifer L White
- New York State Department of Health, Empire Plaza, Corning Tower, State St, Albany, NY 12203, USA.
| | - Jennifer L Peel
- Colorado State University, Environmental Health Building, 350 W. Lake St., Fort Collins, CO 80523, USA.
| | - Brad J Biggerstaff
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
| | - Alison F Hinckley
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
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Beck A, Solomon J, Hinckley AF, Nelson CA. Tick bite frequency, prevention practices and Lyme disease diagnoses among U.S. Hispanic survey respondents. Zoonoses Public Health 2021; 68:658-665. [PMID: 34160897 DOI: 10.1111/zph.12864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Tick bite prevention practices, knowledge of Lyme disease (LD) symptoms and transmission, and patterns of LD diagnoses among Hispanic persons have been reported but not comprehensively evaluated. In 2014, CDC examined questions from a prospective nationwide survey of U.S. Hispanic adults conducted via the Offerwise QueOpinas panel regarding ticks and LD. From October to November, a total of 2,649 surveys were released and 1,006 completed surveys returned. Overall, 44% of respondents reported routinely practising at least one form of personal protection against tick bites, and wearing repellent was the most commonly reported method (29%). Approximately 6% of respondents reported a tick bite for either themselves or someone in their household during the previous 12 months. An individual or household diagnosis of LD in the previous year was reported by 2% of respondents, with the highest proportion of diagnoses reported by respondents from high LD incidence states. The annual incidence of healthcare provider-diagnosed LD in the survey population was higher than national surveillance estimates for reported LD among U.S. Hispanic persons during 2000-2013. As annual incidence of LD continues to increase, it is important to ensure equitable access to information about LD, including disease transmission, manifestations, and prevention recommendations. Results from this survey can help inform public health outreach focused on effective tick bite prevention methods and early recognition of LD.
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Affiliation(s)
- Alyssa Beck
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.,Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Julia Solomon
- Department of Pediatrics and Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alison F Hinckley
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Christina A Nelson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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