Seasonal Activity, Density, and Collection Efficiency of the Blacklegged Tick (Ixodes scapularis) (Acari: Ixodidae) in Mid-Western Pennsylvania

Comparative reservoir competence of Peromyscus leucopus, C57BL/6J, and C3H/HeN for Borrelia burgdorferi B31

Borrelia burgdorferi, a Lyme disease spirochete, causes a range of acute and chronic maladies in humans. However, a primary vertebrate reservoir in the United States, the white-footed deermouse Peromyscus leucopus, is reported not to have reduced fitness following infection. Although laboratory strains of Mus musculus mice have successfully been leveraged to model acute human Lyme disease, the ability of these rodents to model B. burgdorferi-P. leucopus interactions remains understudied. Here, we compared infection of P. leucopus with B. burgdorferi B31 with infection of the traditional B. burgdorferi murine models-C57BL/6J and C3H/HeN Mus musculus, which develop signs of inflammation akin to human disease. We find that B. burgdorferi was able to reach much higher burdens (10- to 30-times higher) in multiple M. musculus skin sites and that the overall dynamics of infection differed between the two rodent species. We also found that P. leucopus remained transmissive to larval Ixodes scapularis for a far shorter period than either M. musculus strain. In line with these observations, we found that P. leucopus does launch a modest but sustained inflammatory response against B. burgdorferi in the skin, which we hypothesize leads to reduced bacterial viability and rodent-to-tick transmission in these hosts. Similarly, we also observe evidence of inflammation in infected P. leucopus hearts. These observations provide new insight into reservoir species and the B. burgdorferi enzootic cycle.IMPORTANCEA Lyme disease-causing bacteria, Borrelia burgdorferi, must alternate between infecting a vertebrate host-usually rodents or birds-and ticks. In order to be successful in that endeavor, the bacteria must avoid being killed by the vertebrate host before it can infect a new larval tick. In this work, we examine how B. burgdorferi and one of its primary vertebrate reservoirs, Peromyscus leucopus, interact during an experimental infection. We find that B. burgdorferi appears to colonize its natural host less successfully than conventional laboratory mouse models, which aligns with a sustained seemingly anti-bacterial response by P. leucopus against the microbe. These data enhance our understanding of P. leucopus host-pathogen interactions and could potentially serve as a foundation to uncover ways to disrupt the spread of B. burgdorferi in nature.

Seasonal activity patterns of host-seeking Ixodes scapularis (Acari: Ixodidae) in Minnesota, 2015-2017

As the primary vector of Lyme disease spirochetes and several other medically significant pathogens, Ixodes scapularis presents a threat to public health in the United States. The incidence of Lyme disease is growing rapidly in upper midwestern states, particularly Michigan, Minnesota, and Wisconsin. The probability of a tick bite, acarological risk, is affected by the phenology of host-seeking I. scapularis. Phenology has been well-studied in northeastern states, but not in the Upper Midwest. We conducted biweekly drag sampling across 4 woodland sites in Minnesota between April and November from 2015 to 2017. The majority of ticks collected were I. scapularis (82%). Adults were active throughout our entire 8-month collection season, with sporadic activity during the summer, larger peaks in activity observed in April, and less consistent and lower peaks observed in October. Nymphs were most active from May through August, with continuing low-level activity in October, and peak activity most commonly observed in June. The observed nymphal peak corresponded with the typical peak in reported human Lyme disease and anaplasmosis cases. These findings are consistent with previous studies from the Upper Midwest and highlight a risk of human exposure to I. scapularis at least from April through November. This information may aid in communicating the seasonality of acarological risk for those living in Minnesota and other upper midwestern states as well as being relevant to the assessment of the ecoepidemiology of Lyme disease and the modeling of transmission dynamics.

Single Mowing Event Does Not Reduce Abundance of Ixodes scapularis (Acari: Ixodidae) and Dermacentor variabilis (Acari: Ixodidae) on Recreational Hiking Trails

Nuisance and medically important ticks can be abundant in a variety of forested landscapes, including recreational parks. Strategies to reduce the abundance of host-seeking ticks in high-use areas within parks are limited. Mowing vegetation is a recommended method to control ticks, but few studies have evaluated the efficacy of this practice. The goal of this study was to determine if a single mowing event could reduce the abundance of host-seeking ticks on recreational trails. Ticks were collected by dragging trails at three recreational parks in northern Minnesota during June and July, 2021. A pre-intervention sample was taken followed by six consecutive weeks of tick sampling. We encountered a total of 3,456 ticks (2,459 Ixodes scapularis Say and 997 Dermacentor variabilis L.) during the 7-week study period. There were no significant differences in the abundance of I. scapularis (adults) or D. variabilis (adults only) between control and mown trail sections. Mowing was a significant predictor of nymphal I. scapularis abundance but trended towards more ticks in mown sections compared to controls. These results suggest that a single mowing intervention during early June is likely to be ineffective as a strategy to reduce the risk of human contacts with ticks on trails.

Improving Lyme disease testing with data driven test design in pediatrics

Diagnostic advances have not kept pace with the expansion of Lyme disease caused by Borrelia burgdorferi and transmitted by ticks. Lyme disease clinical manifestations can overlap with many other diagnoses making Lyme disease a critical part of many differential diagnoses in endemic areas. Current diagnostic blood tests rely on a 2-tiered algorithm for which the second step is either a time-consuming western blot or a whole cell lysate immunoassay. Neither of these second step tests allow for rapid results of this critical rule out test. We hypothesized that using western blot confirmation information, we could create computational models to propose recombinant second-tier tests that would allow for more rapid, automated, and specific testing algorithms. We propose here a framework for assessing retrospective data to determine putative recombinant assay components. A retrospective pediatric cohort of 2755 samples submitted for Lyme disease screening was assessed using support vector machine learning algorithms to optimize tier 1 diagnostic thresholds for the Vidas IgG II assay and determine optimal tier 2 components for both a positive and negative confirmation test. In cases where the tier 1 screen was negative, but clinical suspicion was high, we found that 1 protein (L58) could be used to reduce false-negative results. For second-tier testing of screen positive cases, we found that 6 proteins could be used to reduce false-positive results (L18, L39M, L39, L41, L45, and L58) with a final machine learning classifier or 2 proteins using a final rules-based approach (L41, L18). This led to an overall accuracy of 92.36% for the proposed algorithm without a final machine learning classifier and 92.12% with integration of the machine learning classifier in the final algorithm when compared to the IgG western blot as the gold-standard. Use of this framework across multiple assays and institutions will allow for a data-driven approach to assay development to provide laboratories and patients with the improvements in turnaround time needed for this testing.

Mark-release-recapture of ticks: A case study of estimating the abundance of Ixodes persulcatus (Acari, Ixodidae)

In this study, we tested the applicability of three common methods of absolute abundance estimation-Peterson, Bailey and Jolly-Seber-to Ixodes persulcatus ticks based on mark-release-recapture data. The ticks were collected by flagging during the seasonal activity peak of the ticks in the mid-taiga zone of Karelia (62.0697°N, 33.9614°E). In total, 108 females and 92 males of I. persulcatus were marked. The marked individuals were captured 161 times before the end of the study period with their proportion in the samples reaching 50%. Females were recaptured more often than males, 105 versus 56 times. Estimates of adult tick abundance ranged from 0.4 to 2 specimens per m² depending on the calculation method. The obtained estimates of absolute abundance varied unpredictably depending on the length of the intervals between capture sessions and showed no significant correlations with the number of ticks collected by flagging. The choice of the method of tick abundance estimation mainly depends on the study aims. The Petersen method may be useful for quick estimates of local tick abundance, whereas the Jolly-Seber method allows an estimation of the absolute abundance during the entire period of the tick activity. Individual marking of ticks may improve the accuracy of the estimates.

Inclusion of environmentally themed search terms improves Elastic net regression nowcasts of regional Lyme disease rates

Lyme disease is the most widely reported vector-borne disease in the United States. 95% of confirmed human cases are reported in the Northeast and upper Midwest (25,778 total confirmed cases from Northeast and upper Midwest / 27,203 total US confirmed cases). Human cases typically occur in the spring and summer months when an infected nymph Ixodid tick takes a blood meal. Current federal surveillance strategies report data on an annual basis, leading to nearly a year lag in national data reporting. These lags in reporting make it difficult for public health agencies to assess and plan for the current burden of Lyme disease. Implementation of a nowcasting model, using historical data to predict current trends, provides a means for public health agencies to evaluate current Lyme disease burden and make timely priority-based budgeting decisions. The objective of the study was to develop and compare the performance of nowcasting models using free data from Google Trends and Centers of Disease Control and Prevention surveillance reports. We developed two sets of elastic net models for five regions of the United States: 1. Using only monthly proportional hit data from the 21 disease symptoms and tick related terms, and 2. Using monthly proportional hit data from terms identified via Google correlate and the disease symptom and vector terms. Elastic net models using the full-term list were highly accurate (Root Mean Square Error: 0.74, Mean Absolute Error: 0.52, R2: 0.97) for four of the five regions of the United States and improved accuracy 1.33-fold while reducing error 0.5-fold compared to predictions from models using disease symptom and vector terms alone. Many of the terms included and found to be important for model performance were environmentally related. These models can be implemented to help local and state public health agencies accurately monitor Lyme disease burden during times of reporting lag from federal public health reporting agencies.

Distribution, Dynamics, and Diversity of Questing Ticks in the Lower Midwest

We investigated the spatiotemporal patterns of medically important tick species in southcentral Indiana in 2018 and 2019. In recent decades, both Amblyomma americanum (Acari: Ixodidae) (Linnaeus) and Ixodes scapularis (Acari: Ixodidae) (Say) have been expanding their ranges into the Midwest. We report updates to the status of A. americanum, I. scapularis, and Dermacentor variabilis (Acari: Ixodidae) (Say) across 13 counties in southern and south-central Indiana. We found more northerly establishment of A. americanum and more widespread establishment of I. scapularis than previously reported in the literature. We also provide the first report of Amblyomma maculatum (Acari: Ixodidae) (Koch) in Indiana. Using negative binomial regression, we observed significant spatial variation among sampling sites in A. americanum adults and nymphs, D. variabilis adults, and I. scapularis nymphs. Further, we found higher densities of A. americanum nymphs and I. scapularis adults in more forested areas as opposed to less forested, more developed areas. We did not find significant interannual variation in tick densities for any species. More southern sites featured higher densities of A. americanum adults and nymphs, D. variabilis adults, and I. scapularis nymphs than more northern sites. Seasonally, we observed the highest peaks in tick activity in the spring and early summer, but I. scapularis adults were most common in the early spring and fall. Average adult A. americanum and adult D. variabilis densities were positively correlated at our sites. Our results reflect the northward expansion of A. americanum in the Lower Midwest, as well as the increasing geographic prevalence of I. scapularis in the region.

Tick abundance and life-stage segregation on the American black bear (Ursus americanus)

Tick abundance and diagnosed cases of tick-borne diseases have been increasing in the United States. American black bear (Ursus americanus) populations have also been increasing in the eastern United States. As a competent host of several species of ticks and a mammal capable of traveling long distances, the role of black bears as hosts for ticks requires further evaluation. Ectoparasite surveys were conducted on black bears in Pennsylvania to evaluate tick presence, abundance, spatial distribution, and association with Sarcoptes scabiei, the etiological agent of sarcoptic mange, on bears to better understand their role in tick ecology and to improve on-host surveillance techniques. Tick burden was evaluated using standard area sampling (10.16 × 10.16 cm squares) on pre-designated body regions on black bears from June 2018–December 2019. In total, 278 unique individual black bears were evaluated, with all ticks identified as Ixodes scapularis (n = 1976; 76.7% adults, 23.3% immatures). Tick presence differed by body region on bears, with the highest percentage of tick observations located on bear ears and muzzle. Ticks also partitioned on black bears by life-stage, with immature ticks primarily recorded on the lower extremities of bears and adult ticks primarily recorded on the front-quarters of bears. This includes the first known record of I. scapularis larvae parasitizing black bears, and observations of all three mobile life-stages concurrently parasitizing bears. Tick abundance was also statistically significant dependent on season, with the highest abundance of ticks recorded in spring and lowest abundance in fall. Adult ticks were less likely to be present on bears with mange. These data reveal the important role black bears may serve in tick ecology and dispersal as all three mobile life-stages of I. scapularis were found parasitizing a mammal capable of traveling far distances in a region with high numbers of Lyme disease cases.

•

First record of Ixodes scapularis larvae parasitizing black bears.

•

All three I. scapularis mobile life-stages concurrently parasitizing black bears.

•

I. scapularis life-stage segregation on black bears.

•

Standardized tick survey findings can be used to improve on-host surveillance.

•

Bears with sarcoptic mange less likely to have adult ticks present.

Ecology of Powassan Virus in the United States

Zoonotic viruses threaten the lives of millions of people annually, exacerbated by climate change, human encroachment into wildlife habitats, and habitat destruction. The Powassan virus (POWV) is a rare tick-borne virus that can cause severe neurological damage and death, and the incidence of the associated disease (Powassan virus disease) is increasing in the eastern United States. The mechanisms by which POWV is maintained in nature and transmitted to humans are complex and only partly understood. This review provides an overview of what is known about the vector species, vector-host transmission dynamics, and environmental and human-driven factors that may be aiding the spread of both the vector and virus.

Relative Efficiency of Drag Fabrics for Collection of Blacklegged Tick (Acari: Ixodidae) Larvae, Nymphs, and Adults

The blacklegged tick (Ixodes scapularis Say) vectors several bacterial, protozoan, and viral human pathogens. The known distribution, abundance, and phenology of I. scapularis within its estimated range are incomplete. This gap in knowledge is problematic because these factors are important for determining acarological risk of exposure to infected ticks. Consequently, enhanced surveillance of I. scapularis is being promoted and supported in the United States. Although the most common method for collecting I. scapularis is by dragging a sturdy cloth along the ground, there are no published empirical data showing which drag fabric is most effective. We used a randomized block design to directly compare the relative efficiencies of canvas, corduroy, and flannel drags for the collection of larval, nymphal, and adult I. scapularis. Overall, flannel was the most effective fabric and canvas was the least effective. Significantly more adults were collected on flannel than on canvas or corduroy, and the same number of nymphs was collected on flannel and corduroy. Significantly more larvae were collected on flannel than on canvas, but one-third of larvae could not be removed from the former fabric by lint-rolling, and handpicking was difficult. Our findings support the use of flannel drags to maximize sampling effort for collection of I. scapularis, especially adults to determine the presence of ticks and tick-borne pathogens when density and infection prevalence are low, with the caveat that detection and removal of larvae are time-consuming.

Distribution and Density of Haemaphysalis longicornis (Acari: Ixodidae) on Public Lands in Pennsylvania, United States

Since the recent introduction of the Asian longhorned tick (Haemaphysalis longicornis Neumann) in the United States, quantitative surveillance information remains lacking, which hinders accurate estimates of population structure and entomological risk. We conducted statewide, active tick surveillance from May to August 2019 and report data on H. longicornis geographical distribution and population density in Pennsylvania. In total, 615 H. longicornis were collected from four counties. Across samples recovering H. longicornis, mean density of H. longicornis was 9.2/100 m2, comparably greater than Ixodes scapularis Say (8.5/100 m2). Density of H. longicornis was also significantly greater in August, largely driven by larvae, and greater in recreational habitat types (12.6/100 m2) and in Bucks County (11.7/100 m2), situated adjacent to the location of the first U.S. discovery of intense infestations. These data are among the first to document H. longicornis from statewide tick surveillance and provide initial measures of population density enabling more quantitative characterizations of distributional patterns.

Ticks infesting dogs and cats in North America: Biology, geographic distribution, and pathogen transmission

A diverse array of ixodid and argasid ticks infest dogs and cats in North America, resulting in skin lesions, blood loss, and disease. The ticks most commonly found on pets in this region are hard ticks of the genera Amblyomma, Dermacentor, Ixodes, and Rhipicephalus, as well as the more recently established Haemaphysalis longicornis. Soft tick genera, especially Otobius and Ornithodoros, are also reported from pets in some regions. In this review, we provide a summary of the complex and diverse life histories, distinct morphologies, and questing and feeding behaviors of the more common ticks of dogs and cats in North America with a focus on recent changes in geographic distribution. We also review pathogens of dogs and cats associated with the different tick species, some of which can cause serious, potentially fatal disease, and describe the zoonotic risk posed by ticks of pets. Understanding the natural history of ticks and the maintenance cycles responsible for providing an ongoing source of tick-borne infections is critical to effectively combatting the challenges ticks pose to the health of pets and people.

Lyme Carditis: A Reversible Cause of Acquired Third-Degree AV Block

Patient: Male, 36-year-old

Final Diagnosis: Lyme carditis

Symptoms: Fatigue • myalgia

Medication: —

Clinical Procedure: Transcutaneous pacemaker

Specialty: Cardiology

Increasing Burden of Lyme Carditis in United States Children's Hospitals

We sought to characterize the shifting epidemiology and resource utilization of Lyme disease and associated carditis in US children's hospitals. We hypothesized that the Lyme carditis burden has increased and that hospitalizations for Lyme carditis are costlier than those for Lyme disease without carditis. The PHIS database was queried for Lyme disease encounters between January 1, 2007 and December 31, 2013. Additional diagnostic codes consistent with carditis identified Lyme carditis cases. Demographic, clinical, and resource utilization data were analyzed. All costs were adjusted to 2014 US dollars. Lyme disease was identified in 3620 encounters with 189 (5%) associated with carditis. Lyme disease (360 cases in 2007 vs. 672 in 2013, p = 0.01) and Lyme carditis (17 cases in 2007 vs. 40 in 2013, p = 0.03) both significantly increased in frequency. This is primarily accounted for by their increase within the Midwest region. Carditis frequency among cases of Lyme disease was stable (p = 0.15). Encounters for Lyme carditis are dramatically costlier than those for Lyme disease without carditis [median $9104 (3741-19,003) vs. 922 (238-4987), p < 0.001] The increase in Lyme carditis cases in US children's hospitals is associated with an increased Lyme disease incidence, suggesting that there has not been a change in its virulence or cardiac tropism. The increasing number of serious cardiac events and costs associated with Lyme disease emphasize the need for prevention and early detection of disease and control of its spread.

Lyme Disease Risk of Exposure to Blacklegged Ticks (Acari: Ixodidae) Infected with Borrelia burgdorferi (Spirochaetales: Spirochaetaceae) in Pittsburgh Regional Parks

Lyme disease is the most commonly reported vector-borne illness and sixth most commonly reported notifiable infectious disease in the United States. The majority of cases occur in the Northeast and upper-Midwest, and the number and geographic distribution of cases is steadily increasing. The blacklegged tick (Ixodes scapularis Say) is the principal vector of the Lyme disease spirochete (Borrelia burgdorferi sensu stricto) in eastern North America. Although Lyme disease risk has been studied in residential and recreational settings across rural to urban landscapes including metropolitan areas, risk within U.S. cities has not been adequately evaluated despite the presence of natural and undeveloped public parkland where visitors could be exposed to B. burgdorferi-infected I. scapularis. We studied the occurrence of I. scapularis and infection prevalence of B. burgdorferi in four insular regional parks within the city of Pittsburgh to assess Lyme disease risk of exposure to infected adults and nymphs. We found that the density of I. scapularis adults (1.16 ± 0.21 ticks/100 m2) and nymphs (3.42 ± 0.45 ticks/100 m2), infection prevalence of B. burgdorferi in adults (51.9%) and nymphs (19.3%), and density of infected adults (0.60 ticks/100 m2) and nymphs (0.66 ticks/100 m2) are as high in these city parks as nonurban residential and recreational areas in the highly endemic coastal Northeast. These findings emphasize the need to reconsider, assess, and manage Lyme disease risk in greenspaces within cities, especially in high Lyme disease incidence states.

A 4-Yr Survey of the Range of Ticks and Tick-Borne Pathogens in the Lehigh Valley Region of Eastern Pennsylvania

Questing ticks were surveyed by dragging in forested habitats within the Lehigh Valley region of eastern Pennsylvania for four consecutive summers (2015-2018). A high level of inter-annual variation was found in the density of blacklegged tick nymphs, Ixodes scapularis Say, with a high density of host-seeking nymphs (DON) in summer 2015 and 2017 and a relatively low DON in summer 2016 and 2018. Very few American dog ticks (Dermacentor variabilis Say) and Ixodes cookei Packard were collected. Lone star ticks (Amblyomma americanum L.) and longhorned ticks (Haemaphysalis longicornis Neumann) were not represented among the 6,398 ticks collected. For tick-borne pathogen surveillance, DNA samples from 1,721 I. scapularis nymphs were prepared from specimens collected in summers 2015-2017 and screened using qPCR, high resolution melting analysis, and DNA sequencing when necessary. The overall 3-yr nymphal infection prevalence of Borrelia burgdorferi was 24.8%, Borrelia miyamotoi was 0.3%, Anaplasma phagocytophilum variant-ha was 0.8%, and Babesia microti was 2.8%. Prevalence of coinfection with B. burgdorferi and B. microti as well as B. burgdorferi and A. phagocytophilum variant-ha were significantly higher than would be expected by independent infection. B. burgdorferi nymphal infection prevalence is similar to what other studies have found in the Hudson Valley region of New York, but levels of B. microti and A. phagocytophilum variant-ha nymphal infection prevalence are relatively lower. This study reinforces the urgent need for continued tick and pathogen surveillance in the Lehigh Valley region.

Citizen science informs human-tick exposure in the Northeastern United States

BACKGROUND

Tick-borne disease is the result of spillover of pathogens into the human population. Traditionally, literature has focused on characterization of tick-borne disease pathogens and ticks in their sylvatic cycles. A limited amount of research has focused on human-tick exposure in this system, especially in the Northeastern United States. Human-tick interactions are crucial to consider when assessing the risk of tick-borne disease since a tick bite is required for spillover to occur.

METHODS

Citizen scientists collected ticks from the Northeastern US through a free nationwide program. Submitted ticks were identified to species, stage, and sex. Blacklegged ticks, Ixodes scapularis, were tested for the presence of Borrelia burgdorferi sensu lato (s.l.) and hard-tick relapsing fever Borrelia. Seasonality of exposure and the citizen science activity during tick exposure was recorded by the citizen scientist. A negative binomial model was fit to predict county level CDC Lyme disease cases in 2016 using citizen science Ixodes scapularis submissions, state, and county population as predictor variables.

RESULTS

A total of 3740 submissions, comprising 4261 ticks, were submitted from the Northeastern US and were reported to be parasitizing humans. Of the three species submitted, blacklegged ticks were the most prevalent followed by American dog ticks and lone star ticks. Submissions peaked in May with the majority of exposure occurring during every-day activities. The most common pathogen in blacklegged ticks was B. burgdorferi s.l. followed by hard-tick relapsing fever Borrelia. Negative binomial model performance was best in New England states followed by Middle Atlantic states.

CONCLUSIONS

Citizen science provides a low-cost and effective methodology for describing the seasonality and characteristics of human-tick exposure. In the Northeastern US, everyday activities were identified as a major mechanism for tick exposure, supporting the role of peri-domestic exposure in tick-borne disease. Citizen science provides a method for broad pathogen and tick surveillance, which is highly related to human disease, allowing for inferences to be made about the epidemiology of tick-borne disease.

A 117-year retrospective analysis of Pennsylvania tick community dynamics

Background

Tick-borne diseases have been increasing at the local, national, and global levels. Researchers studying ticks and tick-borne diseases need a thorough knowledge of the pathogens, vectors, and epidemiology of disease spread. Both active and passive surveillance approaches are typically used to estimate tick population size and risk of tick encounter. Our data consists of a composite of active and long-term passive surveillance, which has provided insight into spatial variability and temporal dynamics of ectoparasite communities and identified rarer tick species. We present a retrospective analysis on compiled data of ticks from Pennsylvania over the last 117 years.

Methods

We compiled data from ticks collected during tick surveillance research, and from citizen-based submissions. The majority of the specimens were submitted by citizens. However, a subset of the data was collected through active methods (flagging or dragging, or removal of ticks from wildlife). We analyzed all data from 1900–2017 for tick community composition, host associations, and spatio-temporal dynamics.

Results

In total there were 4491 submission lots consisting of 7132 tick specimens. Twenty-four different species were identified, with the large proportion of submissions represented by five tick species. We observed a shift in tick community composition in which the dominant species of tick (Ixodes cookei) was overtaken in abundance by Dermacentor variabilis in the early 1990s and then replaced in abundance by I. scapularis. We analyzed host data and identified overlaps in host range amongst tick species.

Conclusions

We highlight the importance of long-term passive tick surveillance in investigating the ecology of both common and rare tick species. Information on the geographical distribution, host-association, and seasonality of the tick community can help researchers and health-officials to identify high-risk areas.

Electronic supplementary material

The online version of this article (10.1186/s13071-019-3451-6) contains supplementary material, which is available to authorized users.

Tick bite and Lyme disease-related emergency department encounters in New Hampshire, 2010-2014

Lyme disease (LD) is a common tick-borne disease in New Hampshire (NH). While LD is a reportable condition and cases are counted for public health surveillance, many more people receive care for tick bites or diagnoses of LD than are reflected in surveillance data. NH's emergency department (ED) data system was queried for tick bite and LD-related encounters. Chief complaint text was queried for words related to LD or tick bites. International Classification of Diseases 9th Revision (ICD-9) codes were queried for the LD diagnosis code (088.81). Emergency department patient data were matched to reportable disease data to determine the proportion of ED patients reported to the health department as a suspected LD case. Data were analysed to calculate frequencies for key demographic and reporting characteristics. From 2010 to 2014, 13,615 tick bite or LD-related ED encounters were identified in NH, with most due to tick bites (76%). Of 3,256 patients with a LD-related ED encounter, 738 (23%) were reported to the health department as a suspected LD case. The geographic distribution of ED patients was similar to reported LD cases; however, the regions of the state that experienced higher rates of ED encounters were different than the regions that observed higher rates of reported LD cases. Seasonal distribution of ED encounters peaked earlier than reported LD cases with a second peak in the fall. While age and sex distribution was similar among ED patients and reported LD cases, the rates for children 5 years and younger and adults 65 years and older were greater for ED encounters. Patients frequently visit the ED to seek care for tick bites and suspected LD. Results of ED data analyses can be used to target education, in particular for ED providers and the public through timely distribution of evidence-based educational materials and training programmes.