Does high biodiversity reduce the risk of Lyme disease invasion?

High-resolution environmental and host-related factors impacting questing Ixodes scapularis at their northern range edge

The geographic range of tick populations has expanded in Canada due to climate warming and the associated poleward range shifts of their vertebrate hosts. Abiotic factors, such as temperature, precipitation, and snow, are known to directly affect tick abundance. Yet, biotic factors, such as the abundance and diversity of mammal hosts, may also alter tick abundance and consequent tick-borne disease risk. Here, we incorporated host surveillance data with high-resolution environmental data to evaluate the combined impact of abiotic and biotic factors on questing Ixodes scapularis abundance in Ontario and Quebec, Canada. High-resolution abiotic factors were derived from remote sensing satellites and meteorological towers, while biotic factors related to mammal hosts were derived from active surveillance data that we collected in the field. Generalized additive models were used to determine the relative importance of abiotic and biotic factors on questing I. scapularis abundance. Combinations of abiotic and biotic factors were identified as important drivers of abundances of questing I. scapularis. Positive and negative linear relationships were found for questing I. scapularis abundance with monthly mean precipitation and accumulated snow, but no effect was found for the relative abundance of white-footed mice. Positive relationships were also identified between questing I. scapularis abundance with monthly mean precipitation and mammal species richness. Therefore, future studies that assess I. scapularis should incorporate host surveillance data with high-resolution environmental factors to determine the key drivers impacting the abundance and geographic spread of tick populations and tick-borne pathogens.

Assessing the Human Health Benefits of Climate Mitigation, Pollution Prevention, and Biodiversity Preservation

Background

Since the Industrial Revolution, humanity has amassed great wealth and achieved unprecedented material prosperity. These advances have come, however, at great cost to the planet. They are guided by an economic model that focuses almost exclusively on short-term gain, while ignoring natural capital and human capital. They have relied on the combustion of vast quantities of fossil fuels, massive consumption of the earth's resources, and production and environmental release of enormous quantities of chemicals, pesticides, fertilizers, and plastics. They have caused climate change, pollution, and biodiversity loss, the "Triple Planetary Crisis". They are responsible for more than 9 million premature deaths per year and for widespread disease - impacts that fall disproportionately upon the poor and the vulnerable.

Goals

To map the human health impacts of climate change, pollution, and biodiversity loss. To outline a framework for assessing the health benefits of interventions against these threats.

Findings

Actions taken by national governments and international agencies to mitigate climate change, pollution, and biodiversity loss can improve health, prevent disease, save lives, and enhance human well-being. Yet assessment of health benefits is largely absent from evaluations of environmental remediation programs. This represents a lost opportunity to quantify the full benefits of environmental remediation and to educate policy makers and the public.

Recommendations

We recommend that national governments and international agencies implementing interventions against climate change, pollution, and biodiversity loss develop metrics and strategies for quantifying the health benefits of these interventions. We recommend that they deploy these tools in parallel with assessments of ecologic and economic benefits. Health metrics developed by the Global Burden of Disease (GBD) study may provide a useful starting point.Incorporation of health metrics into assessments of environmental restoration will require building transdisciplinary collaborations. Environmental scientists and engineers will need to work with health scientists to establish evaluation systems that link environmental and economic data with health data. Such systems will assist international agencies as well as national and local governments in prioritizing environmental interventions.

Leveraging machine learning approaches for predicting potential Lyme disease cases and incidence rates in the United States using Twitter

BACKGROUND

Lyme disease is one of the most commonly reported infectious diseases in the United States (US), accounting for more than [Formula: see text] of all vector-borne diseases in North America.

OBJECTIVE

In this paper, self-reported tweets on Twitter were analyzed in order to predict potential Lyme disease cases and accurately assess incidence rates in the US.

METHODS

The study was done in three stages: (1) Approximately 1.3 million tweets were collected and pre-processed to extract the most relevant Lyme disease tweets with geolocations. A subset of tweets were semi-automatically labelled as relevant or irrelevant to Lyme disease using a set of precise keywords, and the remaining portion were manually labelled, yielding a curated labelled dataset of 77, 500 tweets. (2) This labelled data set was used to train, validate, and test various combinations of NLP word embedding methods and prominent ML classification models, such as TF-IDF and logistic regression, Word2vec and XGboost, and BERTweet, among others, to identify potential Lyme disease tweets. (3) Lastly, the presence of spatio-temporal patterns in the US over a 10-year period were studied.

RESULTS

Preliminary results showed that BERTweet outperformed all tested NLP classifiers for identifying Lyme disease tweets, achieving the highest classification accuracy and F1-score of [Formula: see text]. There was also a consistent pattern indicating that the West and Northeast regions of the US had a higher tweet rate over time.

CONCLUSIONS

We focused on the less-studied problem of using Twitter data as a surveillance tool for Lyme disease in the US. Several crucial findings have emerged from the study. First, there is a fairly strong correlation between classified tweet counts and Lyme disease counts, with both following similar trends. Second, in 2015 and early 2016, the social media network like Twitter was essential in raising popular awareness of Lyme disease. Third, counties with a high incidence rate were not necessarily related with a high tweet rate, and vice versa. Fourth, BERTweet can be used as a reliable NLP classifier for detecting relevant Lyme disease tweets.

It's about time: small mammal communities and Lyme disease emergence

Theory predicts that biodiversity changes due to climate warming can mediate the rate of disease emergence. The mechanisms linking biodiversity-disease relationships have been described both theoretically and empirically but remain poorly understood. We investigated the relations between host diversity and abundance and Lyme disease risk in southern Quebec, a region where Lyme disease is rapidly emerging. We found that both the abundance of small mammal hosts and the relative abundance of the tick's natural host, the white-footed mouse (Peromyscus leucopus), influenced measures of disease risk in tick vectors (Borrelia burgdorferi infection abundance and prevalence in tick vectors). Our results suggest that the increase in Lyme disease risk is modulated by regional processes involving the abundance and composition of small mammal assemblages. However, the nature and strength of these relationships was dependent both on time and geographic area. The strong effect of P. leucopus abundance on disease risk we report here is of significant concern, as this competent host is predicted to increase in abundance and occurrence in the region, with the northern shift in the range of North American species under climate warming.

Integrated human behavior and tick risk maps to prioritize Lyme disease interventions using a 'One Health' approach

Lyme disease (LD) risk is emerging rapidly in Canada due to range expansion of its tick vectors, accelerated by climate change. The risk of contracting LD varies geographically due to variability in ecological characteristics that determine the hazard (the densities of infected host-seeking ticks) and vulnerability of the human population determined by their knowledge and adoption of preventive behaviors. Risk maps are commonly used to support public health decision-making on Lyme disease, but the ability of the human public to adopt preventive behaviors is rarely taken into account in their development, which represents a critical gap. The objective of this work was to improve LD risk mapping using an integrated social-behavioral and ecological approach to: (i) compute enhanced integrated risk maps for prioritization of interventions and (ii) develop a spatially-explicit assessment tool to examine the relative contribution of different risk factors. The study was carried out in the Estrie region located in southern Québec. The blacklegged tick, Ixodes scapularis, infected with the agent of LD is widespread in Estrie and as a result, regional LD incidence is the highest in the province. LD knowledge and behaviors in the population were measured in a cross-sectional health survey conducted in 2018 reaching 10,790 respondents in Estrie. These data were used to create an index for the social-behavioral component of risk in 2018. Local Empirical Bayes estimator technique were used to better quantify the spatial variance in the levels of adoption of LD preventive activities. For the ecological risk analysis, a tick abundance model was developed by integrating data from ongoing long-term tick surveillance programs from 2007 up to 2018. Social-behavioral and ecological components of the risk measures were combined to create vulnerability index maps and, with the addition of human population densities, prioritization index maps. Map predictions were validated by testing the association of high-risk areas with the current spatial distribution of human cases of LD and reported tick exposure. Our results demonstrated that social-behavioral and ecological components of LD risk have markedly different distributions within Estrie. The occurrence of human LD cases or reported tick exposure in a municipality was positively associated with tick density and the prioritization risk index (p < 0.001). This research is a second step towards a more comprehensive integrated LD risk assessment approach, examining social-behavioral risk factors that interact with ecological risk factors to influence the management of emerging tick-borne diseases, an approach that could be applied more widely to vector-borne and zoonotic diseases.

An ecological approach to predict areas with established populations of Ixodes scapularis in Quebec, Canada

Public health management of Lyme disease (LD) is a dynamic challenge in Canada. Climate warming is driving the northward expansion of suitable habitat for the tick vector, Ixodes scapularis. Information about tick population establishment is used to inform the risk of LD but is challenged by sampling biases from surveillance data. Misclassifying areas as having no established tick population underestimates the LD risk classification. We used a logistic regression model at the municipal level to predict the probability of I. scapularis population establishment based on passive tick surveillance data during the period of 2010-2017 in southern Quebec. We tested for the effect of abiotic and biotic factors hypothesized to influence tick biology and ecology. Additional variables controlled for sampling biases in the passive surveillance data. In our final selected model, tick population establishment was positively associated with annual cumulative degree-days > 0°C, precipitation and deer density, and negatively associated with coniferous and mixed forest types. Sampling biases from passive tick surveillance were controlled for using municipal population size and public health instructions on tick submissions. The model performed well as indicated by an area under the curve (AUC) of 0.92, sensitivity of 86% and specificity of 81%. Our model enables prediction of I. scapularis population establishment in areas which lack data from passive tick surveillance and may improve the sensitivity of LD risk categorization in these areas. A more sensitive system of LD risk classification is important for increasing awareness and use of protective measures employed against ticks, and decreasing the morbidity associated with LD.

No net effect of host density on tick-borne disease hazard due to opposing roles of vector amplification and pathogen dilution

To better understand vector-borne disease dynamics, knowledge of the ecological interactions between animal hosts, vectors, and pathogens is needed. The effects of hosts on disease hazard depends on their role in driving vector abundance and their ability to transmit pathogens. Theoretically, a host that cannot transmit a pathogen could dilute pathogen prevalence but increase disease hazard if it increases vector population size. In the case of Lyme disease, caused by Borrelia burgdorferi s.l. and vectored by Ixodid ticks, deer may have dual opposing effects on vectors and pathogen: deer drive tick population densities but do not transmit B. burgdorferi s.l. and could thus decrease or increase disease hazard. We aimed to test for the role of deer in shaping Lyme disease hazard by using a wide range of deer densities while taking transmission host abundance into account. We predicted that deer increase nymphal tick abundance while reducing pathogen prevalence. The resulting impact of deer on disease hazard will depend on the relative strengths of these opposing effects. We conducted a cross-sectional survey across 24 woodlands in Scotland between 2017 and 2019, estimating host (deer, rodents) abundance, questing Ixodes ricinus nymph density, and B. burgdorferi s.l. prevalence at each site. As predicted, deer density was positively associated with nymph density and negatively with nymphal infection prevalence. Overall, these two opposite effects canceled each other out: Lyme disease hazard did not vary with increasing deer density. This demonstrates that, across a wide range of deer and rodent densities, the role of deer in amplifying tick densities cancels their effect of reducing pathogen prevalence. We demonstrate how noncompetent host density has little effect on disease hazard even though they reduce pathogen prevalence, because of their role in increasing vector populations. These results have implications for informing disease mitigation strategies, especially through host management.

More than ticking boxes: Training Lyme disease education ambassadors to meet outreach and surveillance challenges in Québec, Canada

Lyme disease (LD) is an emerging public health threat in Canada, associated with the northward range expansion of the black-legged tick (Ixodes scapularis). To address this, public health authorities have been carrying out surveillance activities and awareness campaigns targeting vulnerable populations such as outdoor workers. Implementing these measures is time-consuming and resource-intensive, prompting the assessment of alternatives. Our goal was to evaluate the feasibility and implementation of a training-of-trainers-inspired approach in raising awareness about LD risk and prevention among workers and general population, as well as to evaluate its potential to contribute to provincial LD surveillance efforts. We trained a group of workers from publicly-accessible outdoor parks of the province of Québec to become "LD education ambassadors". Ambassadors were trained to raise tick and LD awareness, share information on preventive measures in their respective communities, and lead tick sampling activities using a standardised protocol similar to that used by Public Health authorities. Ambassador-led outreach activities, public reach, sampling activities and collected ticks were documented, as well as ambassadors' satisfaction with the training using forms and semi-structured interviews. In total, 18 ambassadors from 12 organizations were trained. Between June and September 2019, they led 28 independent outreach activities, reaching over 1 860 individuals (from occupational and general public settings) in seven public health units. Ambassadors led 28 tick samplings, together collecting 11 I. scapularis ticks. This study suggests that an adapted training-of-trainers is a feasible approach to raising tick and LD risk awareness among Québec outdoor workers and public. Trained ambassadors have the potential of reaching a large portion of the population visiting or working in outdoor parks while also providing much-needed outreach regarding risk and prevention. Pushing this concept further to include other types of workers and jurisdictions may contribute to national LD surveillance efforts.

Fine-scale determinants of the spatiotemporal distribution of Ixodes scapularis in Quebec (Canada)

The tick vector of Lyme disease, Ixodes scapularis, is currently expanding its geographical distribution northward into southern Canada driving emergence of Lyme disease in the region. Despite large-scale studies that attributed different factors such as climate change and changes in land use to the geographical expansion of the tick, a comprehensive understanding of local patterns of tick abundance is still lacking in that region. Using a newly endemic periurban nature park located in Quebec (Canada) as a model, we explored intra-habitat patterns in tick distribution and their relationship with biotic and abiotic factors. We verified the hypotheses that (1) there is spatial heterogeneity in tick densities at the scale of the park and (2) these patterns can be explained by host availability, habitat characteristics and microclimatic conditions. During tick activity season in three consecutive years, tick, deer, rodent and bird abundance, as well as habitat characteristics and microclimatic conditions, were estimated at thirty-two sites. Patterns of tick distribution and abundance were investigated by spatial analysis. Generalised additive mixed models were constructed for each developmental stage of the tick and the relative importance of significant drivers on tick abundance were derived from final models. We found fine-scale spatial heterogeneity in densities of all tick stages across the park, with interannual variability in the location of hotspots. For all stages, the local density was related to the density of the previous stage in the previous season, in keeping with the tick's life cycle. Adult tick density was highest where drainage was moderate (neither waterlogged nor dry). Microclimatic conditions influenced the densities of immature ticks, through the effects of weather at the time of tick sampling (ambient temperature and relative humidity) and of the seasonal microclimate at the site level (degree-days and number of tick adverse moisture events). Seasonal phenology patterns were generally consistent with expected curves for the region, with exceptions in some years that may be attributable to founder events. This study highlights fine scale patterns of tick population dynamics thus providing fundamental knowledge in Lyme disease ecology and information applicable to the development of well-targeted prevention and control strategies for public natural areas affected by this growing problem in southern Canada.

Development and validation of a behavioral index for adaptation to lyme disease

Background

Recent evidence suggests that climate change and other factors are leading to the emergence of Lyme disease in the province of Quebec, where it previously did not exist. As risk areas expand further north, the population can adopt specific preventive behaviors to limit chances of infection. The objectives of this study were to (1) create an index of Lyme disease prevention behaviors (LDPB), and (2) use the theory of planned behavior (TPB) to explain the decision-making process of people who choose to adopt LDPB.

Methods

A sample of 1959 adults living in a Lyme disease risk area completed a questionnaire by phone (n = 1003) or on the Web (n = 956). The questionnaire measured whether they did or did not adopt the LDPB proposed by public health officials. It also measured some TPB variables, including their attitude or perceived social norms regarding LDPB.

Results

Our findings led to the creation of a Lyme disease prevention index consisting of 10 behaviors, down from the 19 behaviors initially considered for inclusion in the index. Rates of adoption of each behavior varied tremendously, from 4.30 to 83.80%. All variables of the TPB model (attitude, social norms, and perceived control) were significantly associated with intention to adopt preventive behaviors. Intention itself was significantly associated with adoption of LDPB. Likewise, risk perception was positively correlated with the adoption of LDPB.

Conclusions

This study led to the creation of a Lyme disease prevention index that can be used by public health agencies, researchers, and professionals to monitor the evolution over time of individuals’ LDPB adoption rates. It also showed the usefulness of the TPB in understanding the adoption of LDPB and how intention to adopt such behaviors is formed.

Using Earth observation images to inform risk assessment and mapping of climate change-related infectious diseases

The number of human cases of several climate-related infectious diseases, including tick- and mosquito-borne diseases, has increased in Canada and other parts of the world since the end of the last century. Predicting and mapping the risks associated with these diseases using environmental and climatic determinants derived from satellite images is an emerging method that can support research, surveillance, prevention and control activities and help to better assess the impacts of climate change in Canada. Earth observation images can be used to systematically monitor changes in the Earth's surface and atmosphere at different scales of time and space. These images can inform estimation and monitoring of environmental and climatic determinants, and thus disease prediction and risk mapping. The current array of Earth observation satellites provides access to a large quantity and variety of data. These data have different characteristics in terms of spatial, temporal and thematic precision and resolution. The objectives of this overview are to describe how Earth observation images may inform risk assessment and mapping of tick-borne and mosquito-borne diseases in Canada, their potential benefits and limitations, the implications and next steps.

Factors Leading Municipal Authorities to Implement Preventive Interventions for Lyme Disease

The aim of this study is to document climate change adaptation interventions targeting Lyme disease at the municipal level in the province of Quebec (Canada). This exploratory study relies on the theory of planned behavior and certain constructs from the health belief model to identify the factors leading municipal authorities to implement preventive interventions for Lyme disease (PILD). Data were obtained from an online survey sent, during the summer of 2018, to municipal officers in 820 municipalities in Quebec, in all health regions where the population is at risk of contracting Lyme disease (response rate = 36%). The questionnaire was used to measure the implementation of PILD, the intention to implement these interventions, attitudes, perceived social pressure, perceived control (levers and barriers) over interventions, perceived effectiveness of preventive measures, risk, and perceived vulnerability. Results of structural equation analyses showed that attitudes were significantly associated with municipal authorities' intention to implement PILD, while the intention to implement PILD was a significant predictor of the implementation of PILD. Additional analyses showed that perceived barriers added a moderating effect in the intention-implementation relationship. The prediction of behaviors or practices that municipal authorities could implement to prevent Lyme disease will enable the evaluation over time of the evolution of Quebec municipalities' adaptation to Lyme disease. Moreover, the examination of the associations of specific psychosocial factors revealed important implications for the design of effective behavior-change interventions, which would allow health officials doing awareness work to create personalized interventions better suited to municipal officers and their specific contexts.

N Increased risk of tick-borne diseases with climate and environmental changes

Climate warming and other environmental changes have contributed to the expansion of the range of several tick species into higher latitudes in North America. As temperatures increase in Canada, the environment becomes more suitable for ticks and the season suitable for tick activity lengthens, so tick-borne diseases are likely to become more common in Canada. In addition to Lyme disease, four other tick-borne diseases (TBDs) have started to emerge and are likely to increase: Anaplasmosis; Babesiosis; Powassan virus; and Borrelia miyamotoi disease. Increased temperature increases the survival and activity period of ticks, increases the range of both reservoir and tick hosts (e.g. mice and deer) and increases the duration of the season when people may be exposed to ticks. Other ticks and TBDs may spread into Canada as the climate changes. The public health strategies to mitigate the impact of all TBDs include surveillance to detect current and emerging TBDs, and public health actions to prevent infections by modifying environmental and social-behavioral risk factors through increasing public awareness. Clinical care strategies include patient education, early detection, laboratory testing, and treatment.

N Increased risk of tick-borne diseases with climate and environmental changes

Climate warming and other environmental changes have contributed to the expansion of the range of several tick species into higher latitudes in North America. As temperatures increase in Canada, the environment becomes more suitable for ticks and the season suitable for tick activity lengthens, so tick-borne diseases are likely to become more common in Canada. In addition to Lyme disease, four other tick-borne diseases (TBDs) have started to emerge and are likely to increase: Anaplasmosis; Babesiosis; Powassan virus; and Borrelia miyamotoi disease. Increased temperature increases the survival and activity period of ticks, increases the range of both reservoir and tick hosts (e.g. mice and deer) and increases the duration of the season when people may be exposed to ticks. Other ticks and TBDs may spread into Canada as the climate changes. The public health strategies to mitigate the impact of all TBDs include surveillance to detect current and emerging TBDs, and public health actions to prevent infections by modifying environmental and social-behavioral risk factors through increasing public awareness. Clinical care strategies include patient education, early detection, laboratory testing, and treatment.

Detection of municipalities at-risk of Lyme disease using passive surveillance of Ixodes scapularis as an early signal: A province-specific indicator in Canada

Lyme disease, the most commonly reported vector-borne disease in North America, is caused by the spirochete Borrelia burgdorferi sensu stricto, which is transmitted by Ixodes scapularis in eastern Canada and Ixodes pacificus in western Canada. Recently, the northward range expansion of I. scapularis ticks, in south-eastern Canada, has resulted in a dramatic increase in the incidence of human Lyme disease. Detecting emerging areas of Lyme disease risk allows public health to target disease prevention efforts. We analysed passive tick surveillance data from Ontario and Manitoba to i) assess the relationship between the total numbers of I. scapularis submissions in passive surveillance from humans, and the number of human Lyme disease cases, and ii) develop province-specific acarological indicators of risk that can be used to generate surveillance-based risk maps. We also assessed associations between numbers of nymphal I. scapularis tick submissions only and Lyme disease case incidence. Using General Estimating Equation regression, the relationship between I. scapularis submissions (total numbers and numbers of nymphs only) in each census sub-division (CSD) and the number of reported Lyme disease cases was positively correlated and highly significant in the two provinces (P ≤ 0.001). The numbers of I. scapularis submissions over five years discriminated CSDs with ≥ 3 Lyme disease cases from those with < 3 cases with high accuracy when using total numbers of tick submission (Receiver Operating Characteristics area under the curve [AUC] = 0.89) and moderate accuracy (AUC = 0.78) when using nymphal tick submissions only. In Ontario the optimal cut-off point was a total 12 tick submissions from a CSD over five years (Sensitivity = 0.82, Specificity = 0.84), while in Manitoba the cut-off point was five ticks (Sensitivity = 0.71, Specificity = 0.79) suggesting regional variability of the risk of acquiring Lyme disease from an I. scapularis bite. The performances of the acarological indicators developed in this study for Ontario and Manitoba support the ability of passive tick surveillance to provide an early signal of the existence Lyme disease risk areas in regions where ticks and the pathogens they transmit are expanding their range.

Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces

INTRODUCTION

Natural environments and green spaces provide ecosystem services that enhance human health and well-being. They improve mental health, mitigate allergies and reduce all-cause, respiratory, cardiovascular and cancer mortality. The presence, accessibility, proximity and greenness of green spaces determine the magnitude of their positive health effects, but the role of biodiversity (including species and ecosystem diversity) within green spaces remains underexplored. This review describes mechanisms and evidence of effects of biodiversity in nature and green spaces on human health.

SOURCES OF DATA

We identified studies listed in PubMed and Web of Science using combinations of keywords including 'biodiversity', 'diversity', 'species richness', 'human health', 'mental health' and 'well-being' with no restrictions on the year of publication. Papers were considered for detailed evaluation if they were written in English and reported data on levels of biodiversity and health outcomes.

AREAS OF AGREEMENT

There is evidence for positive associations between species diversity and well-being (psychological and physical) and between ecosystem diversity and immune system regulation.

AREAS OF CONCERN

There is a very limited number of studies that relate measured biodiversity to human health. There is more evidence for self-reported psychological well-being than for well-defined clinical outcomes. High species diversity has been associated with both reduced and increased vector-borne disease risk.

GROWING POINTS

Biodiversity supports ecosystem services mitigating heat, noise and air pollution, which all mediate the positive health effects of green spaces, but direct and long-term health outcomes of species diversity have been insufficiently studied so far.

AREAS TIMELY FOR RESEARCH

Additional research and newly developed methods are needed to quantify short- and long-term health effects of exposure to perceived and objectively measured species diversity, including health effects of nature-based solutions and exposure to microbiota.

Integrated Social-Behavioral and Ecological Risk Maps to Prioritize Local Public Health Responses to Lyme Disease

BACKGROUND

The risk of contracting Lyme disease (LD) can vary spatially because of spatial heterogeneity in risk factors such as social-behavior and exposure to ecological risk factors. Integrating these risk factors to inform decision-making should therefore increase the effectiveness of mitigation interventions.

OBJECTIVES

The objective of this study was to develop an integrated social-behavioral and ecological risk-mapping approach to identify priority areas for LD interventions.

METHODS

The study was conducted in the Montérégie region of Southern Quebec, Canada, where LD is a newly endemic disease. Spatial variation in LD knowledge, risk perceptions, and behaviors in the population were measured using web survey data collected in 2012. These data were used as a proxy for the social-behavioral component of risk. Tick vector population densities were measured in the environment during field surveillance from 2007 to 2012 to provide an index of the ecological component of risk. Social-behavioral and ecological components of risk were combined with human population density to create integrated risk maps. Map predictions were validated by testing the association between high-risk areas and the current spatial distribution of human LD cases.

RESULTS

Social-behavioral and ecological components of LD risk had markedly different distributions within the study region, suggesting that both factors should be considered for locally adapted interventions. The occurrence of human LD cases in a municipality was positively associated with tick density (p<0.01) but was not significantly associated with social-behavioral risk.

CONCLUSION

This study is an applied demonstration of how integrated social-behavioral and ecological risk maps can be created to assist decision-making. Social survey data are a valuable but underutilized source of information for understanding regional variation in LD exposure, and integrating this information into risk maps provides a novel approach for prioritizing and adapting interventions to the local characteristics of target populations. https://doi.org/10.1289/EHP1943.

Multi-Scale Clustering of Lyme Disease Risk at the Expanding Leading Edge of the Range of Ixodes scapularis in Canada

Since its detection in Canada in the early 1990s, Ixodes scapularis, the primary tick vector of Lyme disease in eastern North America, has continued to expand northward. Estimates of the tick's broad-scale distribution are useful for tracking the extent of the Lyme disease risk zone; however, tick distribution may vary widely within this zone. Here, we investigated I. scapularis nymph distribution at three spatial scales across the Lyme disease emergence zone in southern Quebec, Canada. We collected ticks and compared the nymph densities among different woodlands and different plots and transects within the same woodland. Hot spot analysis highlighted significant nymph clustering at each spatial scale. In regression models, nymph abundance was associated with litter depth, humidity, and elevation, which contribute to a suitable habitat for ticks, but also with the distance from the trail and the type of trail, which could be linked to host distribution and human disturbance. Accounting for this heterogeneous nymph distribution at a fine spatial scale could help improve Lyme disease management strategies but also help people to understand the risk variation around them and to adopt appropriate behaviors, such as staying on the trail in infested parks to limit their exposure to the vector and associated pathogens.

Canine and human infection with Borrelia burgdorferi in the New York City metropolitan area

BACKGROUND

Autochthonous transmission of Borrelia burgdorferi, the primary agent of Lyme disease in dogs and people in North America, commonly occurs in the northeastern United States, including the New York City metropolitan area, a region with a large human and pet population and broadly diverse demographics and habitats.

METHODS

We evaluated results from a specific, C6-based serologic assay performed on 234,633 canine samples to compare evidence of past or current infection with B. burgdorferi (sensu stricto) in dogs to county-wide social and environmental factors, as well as to reported cases of Lyme disease in people.

RESULTS

The data revealed a wide range of county level percent positive canine test results (1.2-27.3%) and human case reports (0.5-438.7 case reports/100,000 people). Dogs from highly (> 50%) forested areas and counties with lower population density had the highest percent positive test results, at 21.1% and 17.9%, respectively. Canine percent positive tests correlated with population-adjusted human case reports (R2 = 0.48, P < 0.0001), as well as population density, development intensity, temperature, normalized difference vegetation index, and habitat type. Subsequent multiple regression allowed an accurate prediction of infection risk in dogs (R2 = 0.90) but was less accurate at predicting human case reports (R2 = 0.74).

CONCLUSION

In areas where Lyme disease is endemic, canine serology continues to provide insight into risk factors for transmission to both dogs and people although some differences in geographic patterns of canine infection and human disease reports are evident.

Lyme disease ecology in a changing world: consensus, uncertainty and critical gaps for improving control

Lyme disease is the most common tick-borne disease in temperate regions of North America, Europe and Asia, and the number of reported cases has increased in many regions as landscapes have been altered. Although there has been extensive work on the ecology and epidemiology of this disease in both Europe and North America, substantial uncertainty exists about fundamental aspects that determine spatial and temporal variation in both disease risk and human incidence, which hamper effective and efficient prevention and control. Here we describe areas of consensus that can be built on, identify areas of uncertainty and outline research needed to fill these gaps to facilitate predictive models of disease risk and the development of novel disease control strategies. Key areas of uncertainty include: (i) the precise influence of deer abundance on tick abundance, (ii) how tick populations are regulated, (iii) assembly of host communities and tick-feeding patterns across different habitats, (iv) reservoir competence of host species, and (v) pathogenicity for humans of different genotypes of Borrelia burgdorferi Filling these knowledge gaps will improve Lyme disease prevention and control and provide general insights into the drivers and dynamics of this emblematic multi-host-vector-borne zoonotic disease.This article is part of the themed issue 'Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.

Detecting and Attributing Health Burdens to Climate Change

BACKGROUND

Detection and attribution of health impacts caused by climate change uses formal methods to determine a) whether the occurrence of adverse health outcomes has changed, and b) the extent to which that change could be attributed to climate change. There have been limited efforts to undertake detection and attribution analyses in health.

OBJECTIVE

Our goal was to show a range of approaches for conducting detection and attribution analyses.

RESULTS

Case studies for heatwaves, Lyme disease in Canada, and Vibrio emergence in northern Europe highlight evidence that climate change is adversely affecting human health. Changes in rates and geographic distribution of adverse health outcomes were detected, and, in each instance, a proportion of the observed changes could, in our judgment, be attributed to changes in weather patterns associated with climate change.

CONCLUSIONS

The results of detection and attribution studies can inform evidence-based risk management to reduce current, and plan for future, changes in health risks associated with climate change. Gaining a better understanding of the size, timing, and distribution of the climate change burden of disease and injury requires reliable long-term data sets, more knowledge about the factors that confound and modify the effects of climate on health, and refinement of analytic techniques for detection and attribution. At the same time, significant advances are possible in the absence of complete data and statistical certainty: there is a place for well-informed judgments, based on understanding of underlying processes and matching of patterns of health, climate, and other determinants of human well-being. https://doi.org/10.1289/EHP1509.

Evaluating the submission of digital images as a method of surveillance for Ixodes scapularis ticks

Widespread access to the internet is offering new possibilities for data collection in surveillance. We explore, in this study, the possibility of using an electronic tool to monitor occurrence of the tick vector of Lyme disease, Ixodes scapularis. The study aimed to compare the capacity for ticks to be identified in web-based submissions of digital images/photographs, to the traditional specimen-based identification method used by the provincial public health laboratory in Quebec, Canada. Forty-one veterinary clinics participated in the study by submitting digital images of ticks collected from pets via a website for image-based identification by an entomologist. The tick specimens were then sent to the provincial public health laboratory to be identified by the 'gold standard' method using a microscope. Of the images submitted online, 74·3% (284/382) were considered of high-enough quality to allow identification. The laboratory identified 382 tick specimens from seven different species, with I. scapularis representing 76% of the total submissions. Of the 284 ticks suitable for image-based species identification, 276 (97·2%) were correctly identified (Kappa statistic of 0·92, Z = 15·46, P < 0·001). This study demonstrates that image-based tick identification may be an accurate and useful method of detecting ticks for surveillance when images are of suitable quality.

Effect of host diversity and species assemblage composition on bovine tuberculosis (bTB) risk in Ethiopian cattle

Current theories on diversity-disease relationships describe host species diversity and species identity as important factors influencing disease risk, either diluting or amplifying disease prevalence in a community. Whereas the simple term 'diversity' embodies a set of animal community characteristics, it is not clear how different measures of species diversity are correlated with disease risk. We therefore tested the effects of species richness, Pielou's evenness and Shannon's diversity on bovine tuberculosis (bTB) risk in cattle in the Afar Region and Awash National Park between November 2013 and April 2015. We also analysed the identity effect of a particular species and the effect of host habitat use overlap on bTB risk. We used the comparative intradermal tuberculin test to assess the number of bTB-infected cattle. Our results suggested a dilution effect through species evenness. We found that the identity effect of greater kudu - a maintenance host - confounded the dilution effect of species diversity on bTB risk. bTB infection was positively correlated with habitat use overlap between greater kudu and cattle. Different diversity indices have to be considered together for assessing diversity-disease relationships, for understanding the underlying causal mechanisms. We posit that unpacking diversity metrics is also relevant for formulating disease control strategies to manage cattle in ecosystems characterized by seasonally limited resources and intense wildlife-livestock interactions.

Infection resistance and tolerance in Peromyscus spp., natural reservoirs of microbes that are virulent for humans

The widely-distributed North American species Peromyscus leucopus and P. maniculatus of cricetine rodents are, between them, important natural reservoirs for several zoonotic diseases of humans: Lyme disease, human granulocytic anaplasmosis, babesiosis, erhlichiosis, hard tickborne relapsing fever, Powassan virus encephalitis, hantavirus pulmonary syndrome, and plague. While these infections are frequently disabling and sometimes fatal for humans, the peromyscines display little pathology and apparently suffer few consequences, even when prevalence of persistent infection in a population is high. While these Peromyscus spp. are unable to clear some of the infections, they appear to have partial resistance, which limits the burden of the pathogen. In addition, they display traits of infection tolerance, which reduces the damage of the infection. Research on these complementary resistance and tolerance phenomena in Peromyscus has relevance both for disease control measures targeting natural reservoirs and for understanding the mechanisms of the comparatively greater sickness of many humans with these and other infections.

The diversity-disease relationship: evidence for and criticisms of the dilution effect

The dilution effect, that high host species diversity can reduce disease risk, has attracted much attention in the context of global biodiversity decline and increasing disease emergence. Recent studies have criticized the generality of the dilution effect and argued that it only occurs under certain circumstances. Nevertheless, evidence for the existence of a dilution effect was reported in about 80% of the studies that addressed the diversity-disease relationship, and a recent meta-analysis found that the dilution effect is widespread. We here review supporting and critical studies, point out the causes underlying the current disputes. The dilution is expected to be strong when the competent host species tend to remain when species diversity declines, characterized as a negative relationship between species' reservoir competence and local extinction risk. We here conclude that most studies support a negative competence-extinction relationship. We then synthesize the current knowledge on how the diversity-disease relationship can be modified by particular species in community, by the scales of analyses, and by the disease risk measures. We also highlight the complex role of habitat fragmentation in the diversity-disease relationship from epidemiological, evolutionary and ecological perspectives, and construct a synthetic framework integrating these three perspectives. We suggest that future studies should test the diversity-disease relationship across different scales and consider the multiple effects of landscape fragmentation.

Linkages of Weather and Climate With Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae), Enzootic Transmission of Borrelia burgdorferi, and Lyme Disease in North America

Lyme disease has increased both in incidence and geographic extent in the United States and Canada over the past two decades. One of the underlying causes is changes during the same time period in the distribution and abundance of the primary vectors: Ixodes scapularis Say and Ixodes pacificus Cooley and Kohls in eastern and western North America, respectively. Aside from short periods of time when they are feeding on hosts, these ticks exist in the environment where temperature and relative humidity directly affect their development, survival, and host-seeking behavior. Other important factors that strongly influence tick abundance as well as the proportion of ticks infected with the Lyme disease spirochete, Borrelia burgdorferi, include the abundance of hosts for the ticks and the capacity of tick hosts to serve as B. burgdorferi reservoirs. Here, we explore the linkages between climate variation and: 1) duration of the seasonal period and the timing of peak activity; 2) geographic tick distributions and local abundance; 3) enzootic B. burgdorferi transmission cycles; and 4) Lyme disease cases. We conclude that meteorological variables are most influential in determining host-seeking phenology and development, but, while remaining important cofactors, additional variables become critical when exploring geographic distribution and local abundance of ticks, enzootic transmission of B. burgdorferi, and Lyme disease case occurrence. Finally, we review climate change-driven projections for future impact on vector ticks and Lyme disease and discuss knowledge gaps and research needs.

A Dynamic Population Model to Investigate Effects of Climate and Climate-Independent Factors on the Lifecycle of Amblyomma americanum (Acari: Ixodidae)

The lone star tick, Amblyomma americanum, is a disease vector of significance for human and animal health throughout much of the eastern United States. To model the potential effects of climate change on this tick, a better understanding is needed of the relative roles of temperature-dependent and temperature-independent (day-length-dependent behavioral or morphogenetic diapause) processes acting on the tick lifecycle. In this study, we explored the roles of these processes by simulating seasonal activity patterns using models with site-specific temperature and day-length-dependent processes. We first modeled the transitions from engorged larvae to feeding nymphs, engorged nymphs to feeding adults, and engorged adult females to feeding larvae. The simulated seasonal patterns were compared against field observations at three locations in United States. Simulations suggested that 1) during the larva-to-nymph transition, some larvae undergo no diapause while others undergo morphogenetic diapause of engorged larvae; 2) molted adults undergo behavioral diapause during the transition from nymph-to-adult; and 3) there is no diapause during the adult-to-larva transition. A model constructed to simulate the full lifecycle of A. americanum successfully predicted observed tick activity at the three U.S. study locations. Some differences between observed and simulated seasonality patterns were observed, however, identifying the need for research to refine some model parameters. In simulations run using temperature data for Montreal, deterministic die-out of A. americanum populations did not occur, suggesting the possibility that current climate in parts of southern Canada is suitable for survival and reproduction of this tick.

Evolutionary aspects of emerging Lyme disease in Canada

In North America, Lyme disease (LD) is a tick-borne zoonosis caused by the spirochete bacterium Borrelia burgdorferi sensu stricto, which is maintained by wildlife. Tick vectors and bacteria are currently spreading into Canada and causing increasing numbers of cases of LD in humans and raising a pressing need for public health responses. There is no vaccine, and LD prevention depends on knowing who is at risk and informing them how to protect themselves from infection. Recently, it was found in the United States that some strains of B. burgdorferi sensu stricto cause severe disease, whereas others cause mild, self-limiting disease. While many strains occurring in the United States also occur in Canada, strains in some parts of Canada are different from those in the United States. We therefore recognize a need to identify which strains specific to Canada can cause severe disease and to characterize their geographic distribution to determine which Canadians are particularly at risk. In this review, we summarize the history of emergence of LD in North America, our current knowledge of B. burgdorferi sensu stricto diversity, its intriguing origins in the ecology and evolution of the bacterium, and its importance for the epidemiology and clinical and laboratory diagnosis of LD. We propose methods for investigating associations between B. burgdorferi sensu stricto diversity, ecology, and pathogenicity and for developing predictive tools to guide public health interventions. We also highlight the emergence of B. burgdorferi sensu stricto in Canada as a unique opportunity for exploring the evolutionary aspects of tick-borne pathogen emergence.

The increasing risk of Lyme disease in Canada

There is an increasing risk of Lyme disease in Canada due to range expansion of the tick vector, Ixodes scapularis. The objectives of this article are to i) raise public awareness with the help of veterinarians on the emerging and expanding risk of Lyme disease across Canada, ii) review the key clinical features of Lyme disease in dogs, and iii) provide recommendations for veterinarians on the management of Lyme disease in dogs.

Different Ecological Niches for Ticks of Public Health Significance in Canada

Tick-borne diseases are a growing public health concern as their incidence and range have increased in recent decades. Lyme disease is an emerging infectious disease in Canada due to northward expansion of the geographic range of Ixodes scapularis, the principal tick vector for the Lyme disease agent Borrelia burgdorferi, into central and eastern Canada. In this study the geographical distributions of Ixodid ticks, including I. scapularis, and environmental factors associated with their occurrence were investigated in New Brunswick, Canada, where few I. scapularis populations have been found to date. Density of host-seeking ticks was evaluated by drag sampling of woodland habitats in a total of 159 sites. Ixodes scapularis ticks (n = 5) were found on four sites, Ixodes muris (n = 1) on one site and Haemaphysalis leporispalustris (n = 243) on 41 sites. One of four adult I. scapularis ticks collected was PCR-positive for B. burgdorferi. No environmental variables were significantly associated with the presence of I. scapularis although comparisons with surveillance data in neighbouring provinces (Québec and Nova Scotia) suggested that temperature conditions may be too cold for I. scapularis (< 2800 annual degree days above 0°C [DD > 0°C]) across much of New Brunswick. In contrast, the presence of H. leporispalustris, which is a competent vector of tularaemia, was significantly (P < 0.05) associated with specific ranges of mean DD > 0°C, mean annual precipitation, percentage of clay in site soil, elevation and season in a multivariable logistic regression model. With the exception of some localized areas, temperature conditions and deer density may be too low for the establishment of I. scapularis and Lyme disease risk areas in New Brunswick, while environmental conditions were suitable for H. leporispalustris at many sites. These findings indicate differing ecological niches for two tick species of public health significance.

Different populations of blacklegged tick nymphs exhibit differences in questing behavior that have implications for human lyme disease risk

Animal behavior can have profound effects on pathogen transmission and disease incidence. We studied the questing (= host-seeking) behavior of blacklegged tick (Ixodes scapularis) nymphs, which are the primary vectors of Lyme disease in the eastern United States. Lyme disease is common in northern but not in southern regions, and prior ecological studies have found that standard methods used to collect host-seeking nymphs in northern regions are unsuccessful in the south. This led us to hypothesize that there are behavior differences between northern and southern nymphs that alter how readily they are collected, and how likely they are to transmit the etiological agent of Lyme disease to humans. To examine this question, we compared the questing behavior of I. scapularis nymphs originating from one northern (Lyme disease endemic) and two southern (non-endemic) US regions at field sites in Wisconsin, Rhode Island, Tennessee, and Florida. Laboratory-raised uninfected nymphs were monitored in circular 0.2 m2 arenas containing wooden dowels (mimicking stems of understory vegetation) for 10 (2011) and 19 (2012) weeks. The probability of observing nymphs questing on these stems (2011), and on stems, on top of leaf litter, and on arena walls (2012) was much greater for northern than for southern origin ticks in both years and at all field sites (19.5 times greater in 2011; 3.6-11.6 times greater in 2012). Our findings suggest that southern origin I. scapularis nymphs rarely emerge from the leaf litter, and consequently are unlikely to contact passing humans. We propose that this difference in questing behavior accounts for observed geographic differences in the efficacy of the standard sampling techniques used to collect questing nymphs. These findings also support our hypothesis that very low Lyme disease incidence in southern states is, in part, a consequence of the type of host-seeking behavior exhibited by southern populations of the key Lyme disease vector.

Tree diversity and the role of non-host neighbour tree species in reducing fungal pathogen infestation

The degree to which plant pathogen infestation occurs in a host plant is expected to be strongly influenced by the level of species diversity among neighbouring host and non-host plant species. Since pathogen infestation can negatively affect host plant performance, it can mediate the effects of local biodiversity on ecosystem functioning.We tested the effects of tree diversity and the proportion of neighbouring host and non-host species with respect to the foliar fungal pathogens of Tilia cordata and Quercus petraea in the Kreinitz tree diversity experiment in Germany. We hypothesized that fungal pathogen richness increases while infestation decreases with increasing local tree diversity. In addition, we tested whether fungal pathogen richness and infestation are dependent on the proportion of host plant species present or on the proportion of particular non-host neighbouring tree species.Leaves of the two target species were sampled across three consecutive years with visible foliar fungal pathogens on the leaf surface being identified macro- and microscopically. Effects of diversity among neighbouring trees were analysed: (i) for total fungal species richness and fungal infestation on host trees and (ii) for infestation by individual fungal species.We detected four and five fungal species on T. cordata and Q. petraea, respectively. High local tree diversity reduced (i) total fungal species richness and infestation of T. cordata and fungal infestation of Q. petraea and (ii) infestation by three host-specialized fungal pathogen species. These effects were brought about by local tree diversity and were independent of host species proportion. In general, host species proportion had almost no effect on fungal species richness and infestation. Strong effects associated with the proportion of particular non-host neighbouring tree species on fungal species richness and infestation were, however, recorded.Synthesis. For the first time, we experimentally demonstrated that for two common forestry tree species, foliar fungal pathogen richness and infestation depend on local biodiversity. Thus, local tree diversity can have positive impacts on ecosystem functioning in managed forests by decreasing the level of fungal pathogen infestation.

Tick-borne pathogen - reversed and conventional discovery of disease

Molecular methods have increased the number of known microorganisms associated with ticks significantly. Some of these newly identified microorganisms are readily linked to human disease while others are yet unknown to cause human disease. The face of tick-borne disease discovery has changed with more diseases now being discovered in a “reversed way,” detecting disease cases only years after the tick-borne microorganism was first discovered. Compared to the conventional discovery of infectious diseases, reverse order discovery presents researchers with new challenges. Estimating public health risks of such agents is especially challenging, as case definitions and diagnostic procedures may initially be missing. We discuss the advantages and shortcomings of molecular methods, serology, and epidemiological studies that might be used to study some fundamental questions regarding newly identified tick-borne diseases. With increased tick-exposure and improved detection methods, more tick-borne microorganisms will be added to the list of pathogens causing disease in humans in the future.

Estimated effects of projected climate change on the basic reproductive number of the Lyme disease vector Ixodes scapularis

BACKGROUND

The extent to which climate change may affect human health by increasing risk from vector-borne diseases has been under considerable debate.

OBJECTIVES

We quantified potential effects of future climate change on the basic reproduction number (R0) of the tick vector of Lyme disease, Ixodes scapularis, and explored their importance for Lyme disease risk, and for vector-borne diseases in general.

METHODS

We applied observed temperature data for North America and projected temperatures using regional climate models to drive an I. scapularis population model to hindcast recent, and project future, effects of climate warming on R0. Modeled R0 increases were compared with R0 ranges for pathogens and parasites associated with variations in key ecological and epidemiological factors (obtained by literature review) to assess their epidemiological importance.

RESULTS

R0 for I. scapularis in North America increased during the years 1971-2010 in spatio-temporal patterns consistent with observations. Increased temperatures due to projected climate change increased R0 by factors (2-5 times in Canada and 1.5-2 times in the United States), comparable to observed ranges of R0 for pathogens and parasites due to variations in strains, geographic locations, epidemics, host and vector densities, and control efforts.

CONCLUSIONS

Climate warming may have co-driven the emergence of Lyme disease in northeastern North America, and in the future may drive substantial disease spread into new geographic regions and increase tick-borne disease risk where climate is currently suitable. Our findings highlight the potential for climate change to have profound effects on vectors and vector-borne diseases, and the need to refocus efforts to understand these effects.

The prevalence of Borrelia miyamotoi infection, and co-infections with other Borrelia spp. in Ixodes scapularis ticks collected in Canada

Background

Blacklegged ticks, Ixodes scapularis are vectors of the tick-borne pathogens Borrelia burgdorferi, Anaplasma phagocytophilum and Babesia microti. Recently, the I. scapularis-borne bacterium Borrelia miyamotoi has been linked to human illness in North America. The range of this tick is expanding in Canada which may increase the potential for human exposure to these agents.

Methods

In this study, 4938 I. scapularis ticks collected in 2012 were tested following a newly developed PCR-based testing protocol to determine the prevalence of infection with B. miyamotoi and other pathogens in I. scapularis in Canada.

Results

Borrelia miyamotoi was detected in blacklegged ticks from all provinces except Newfoundland, although the infection prevalence was low (<1%). There was significant variation among provinces in the prevalence of infection of ticks with B. burgdorferi and A. phagocytophilum, but not with B. miyamotoi.

Conclusions

Given the widespread distribution of B. miyamotoi, infection due to this agent should be considered in patients who have been exposed to blacklegged ticks in Canada.