Behavioral risk factors associated with reported tick exposure in a Lyme disease high incidence region in Canada

Mismatched online public concern and tick-borne disease risk in China

Introduction

Ticks and tick-borne diseases are increasing public health concerns in China. This study examines public awareness and concern using data from the People Cloud, a national public opinion data platform.

Methods

We analyzed 358,862 posts related to ticks, tick bites, Lyme disease, and tick-borne encephalitis from October 2022 to November 2023. Temporal trends and geographic distribution were assessed to identify patterns of public interest.

Results

Public concern peaked in April, coinciding with tick season, with "ticks" being the most mentioned term, particularly on social media platforms, such as WeChat. High search activity was concentrated in southeastern and northern provinces, especially Zhejiang, Guangdong, and Jiangsu. Lyme disease posts were more dispersed, while tick-borne encephalitis posts clustered in southern areas.

Conclusion

Public interest in ticks follows seasonal and regional trends, reflecting tick activity but not always matching disease risk or tick distribution. Monitoring public opinion data can guide targeted health interventions and improve disease prevention efforts.

Exploratory actor mapping of social interactions within tick risk surveillance networks in France

Ticks are important zoonotic disease vectors for human and animal health worldwide. In Europe they are the principal vector of public health importance, responsible for Lyme disease, the most prevalent and widespread tick-borne disease (TBD). Tick presence and TBD incidence are increasing, questioning the effectiveness of existing surveillance systems. At the European level TBD burden is likely underestimated as surveillance differs amongst and within countries. France created its first national public health policy in 2016 to tackle TBDs, prompted by growing concern from the public, medical professionals and the scientific community for the lack of knowledge on tick-borne pathogen risk on the population. With global changes, France currently faces risk for TBD emergence (e.g. Crimean-Congo hemorrhagic fever) and re-emergence (e.g. tick-borne encephalitis), in addition to increasing Lyme disease cases. We conducted 13 semi-structured interviews with French tick risk surveillance actors to characterize how the national surveillance system functions. Qualitative descriptive analysis was conducted on interview transcripts to create actor maps and identify the barriers and levers for actor interactions. We identified four tick risk surveillance processes: surveillance-oriented research, risk evaluation, policy creation and policy application, to which interdisciplinary, intersectoral and multi-level actor interactions contribute. Actors express a pervasive need to reinforce intersectoral interactions between human, animal and environmental sectors for early risk detection, as well as multi-level interactions to accurately estimate risk and disseminate prevention information. Transdisciplinary, social-ecological system approaches may offer an adaptive framework for locally relevant surveillance activities in diverse social-ecological contexts.

Contrasting Perceptions, Knowledge, and Actions around Lyme Disease in an Urban Area of Emerging Lyme Disease and an Area of Endemic Lyme Disease in the Northeastern United States

Lyme disease transmission dynamics in the northeastern United States vary by context. Periurban regions, including Block Island, RI, have experienced decades of endemic transmission. In urban areas, including Staten Island, a borough in New York City, NY, Lyme disease is an emerging issue. Knowledge, attitudes, and practices around Lyme disease evolve as an area progresses from emergent to endemic. We conducted focus group discussions and household surveys within Staten Island, NY and Block Island, RI to compare knowledge, attitudes, and practices surrounding Lyme disease and other tick-borne diseases. Qualitative data were coded into themes, and survey data were used to provide more general context of the focus group discussions. Using item response theory, we developed an index of knowledge from relevant factors within the household survey. We identified a significant difference in knowledge scores between the two study areas. Additionally, we identified key differences across multiple domains. Participants from Block Island were more likely to report prior tick exposure and Lyme disease in themselves or household members and were more likely to express concerns about the environmental impact of mitigation strategies. Individuals on Staten Island were more likely to assign responsibility of prevention and control to local, state, and federal government than to take personal prevention measures. Prevention of Lyme disease and other tick-borne diseases must be tailored to the community context and monitored over time as perceptions and priorities may evolve as transmission dynamics transition from emergent to endemic.

Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015-2022

We investigated differences in risk factors and preventive behaviors by age and sex among persons with reported Lyme disease in Ontario, Canada, during 2015-2022. Incidence rates peaked among children 5-9 and adults 50-79 years of age. Median age was higher for female than male case-patients (54 vs. 51 years). Male case-patients reported more activity in wooded and tall grass areas than did female case-patients; fewer male case-patients reported sharing living space with outdoor-exposed companion animals. As age increased, more case-patients reported activity in blacklegged tick habitats, exposure to ticks, and wearing adequate clothing, but fewer reported sharing living space with outdoor-exposed companion animals. Adoption of preventive behaviors was relatively low and did not differ by sex. Male case-patients, children 5-9 years of age and their parents or caregivers, and adults >59 years of age represent populations that would benefit from tailored public health messaging on Lyme disease prevention.

Borrelia burgdorferi sensu lato prevalence in Ixodes scapularis from Canada: A thirty-year summary and meta-analysis (1990-2020)

Borrelia burgdorferi sensu lato (Bb) are a complex of bacteria genospecies that can cause Lyme disease (LD) in humans after the bite of an infected Ixodes spp. vector tick. In Canada, incidence of LD is increasing in part due to the rapid geographic expansion of Ixodes scapularis across the southcentral and eastern provinces. To better understand temporal and spatial (provincial) prevalence of Bb infection of I. scapularis and how tick surveillance is utilized in Canada to assess LD risk, a literature review was conducted. Tick surveillance studies published between January 1975 to November 2023, that measured the prevalence of Bb in I. scapularis via "passive surveillance" from the public citizenry or "active surveillance" by drag or flag sampling of host-seeking ticks in Canada were included for review. Meta-analyses were conducted via random effects modeling. Forty-seven articles, yielding 26 passive and 28 active surveillance studies, met inclusion criteria. Mean durations of collection for I. scapularis were 2.1 years in active surveillance studies (1999-2020) and 5.5 years by passive surveillance studies (1990-2020). Collectively, data were extracted on 99,528 I. scapularis nymphs and adults collected between 1990-2020 across nine provinces, including Newfoundland & Labrador (33 ticks) and Alberta (208 ticks). More studies were conducted in Ontario (36) than any other province. Across nine provinces, the prevalence of Bb infection in I. scapularis collected by passive surveillance was 14.6% with the highest prevalence in Nova Scotia at 20.5% (minimum studies >1). Among host-seeking I. scapularis collected via active surveillance, Bb infection prevalence was 10.5% in nymphs, 31.9% in adults, and 23.8% across both life stages. Host-seeking I. scapularis nymphs and adults from Ontario had the highest Bb prevalence at 13.6% and 34.8%, respectively. Between 2007-2019, Bb infection prevalence in host-seeking I. scapularis was positively associated over time (p<0.001) which is concurrent with a ∼25-fold increase in the number of annually reported LD cases in Canada over the same period. The prevalence of Bb-infection in I. scapularis has rapidly increased over three decades as reported by tick surveillance studies in Canada which coincides with increasing human incidence for LD. The wide-ranging distribution and variable prevalence of Bb-infected I. scapularis ticks across provinces demonstrates the growing need for long-term standardized tick surveillance to monitor the changing trends in I. scapularis populations and best define LD risk areas in Canada.

Effects of climate change and human activities on vector-borne diseases

Vector-borne diseases are transmitted by haematophagous arthropods (for example, mosquitoes, ticks and sandflies) to humans and wild and domestic animals, with the largest burden on global public health disproportionately affecting people in tropical and subtropical areas. Because vectors are ectothermic, climate and weather alterations (for example, temperature, rainfall and humidity) can affect their reproduction, survival, geographic distribution and, consequently, ability to transmit pathogens. However, the effects of climate change on vector-borne diseases can be multifaceted and complex, sometimes with ambiguous consequences. In this Review, we discuss the potential effects of climate change, weather and other anthropogenic factors, including land use, human mobility and behaviour, as possible contributors to the redistribution of vectors and spread of vector-borne diseases worldwide.

Infectious risks associated with outdoor sports activities

In France, outdoor sports and activities account for 36% of sports engagement, making outdoor venues the most popular settings for sports participation. Discussing the links between sports and health almost always highlights the beneficial impact of engaging in sports. However, due to a lack of specific notifications, infectious risks are not subject to epidemiological monitoring, and need to be better understood. Since the practice of outdoor sports has become part and parcel of many individuals' daily routines, it is essential to more accurately characterize the knowledge we have gained about the risks associated with exposure. However, directly associating the practice of a sport with an elevated risk of infectious diseases is a challenging endeavor. Sociological factors based on risk awareness and adoption of protective behaviors in response to the risk are crucial to the orientation of prevention efforts. This review deals with several (bacteriological, viral, parasitic, and mycological) infectious risks related to outdoor activities practiced in a natural field via contamination routes such as tick-bite, enteric pathogen, skin, and aerosol transmission. We have also detailed a number of preventive measures taking into account the outdoor setting (e.g., vaccination).

Behavioral and cognitive factors influencing tick-borne disease risk in northeast China: Implications for prevention and control strategies

The growth in ecotourism and nature-based recreational activities in China has resulted in an increased frequency of visits to green spaces, thereby elevating exposure to ticks and the subsequent risk of tick-borne diseases. This study comprehensively investigate individual behavioral and cognitive factors associated with the risk of contracting tick-borne diseases to facilitate the development of effective prevention and control strategies, supporting public health initiatives in high-prevalence regions. We conducted an extensive questionnaire survey among 3000 residents from three northeastern provinces in China (Heilongjiang, Jilin, and Liaoning), where tick-borne diseases exhibit relatively high prevalence. The survey focused on gathering information regarding participants' tick bite history, perception of tick-borne disease risks, and outdoor activity patterns. Using structural equations analysis, we explored the pathways and strengths of the associations between these factors. Our findings revealed an average self-reported tick bite rate of 14% among the participants. Notably, tick-borne encephalitis exhibited the highest self-reported prevalence of infection (4%) among tick-borne diseases, while both Lyme disease and Severe fever with thrombocytopenia syndrome had a prevalence of 2%. The average rate of tick bites among respondents' pets was 14%, with bites predominantly located on the ears, back, and abdomen. The strongest correlation was observed between tick bite rate and subsequent infections, emphasizing its role as the primary contributing factors to infectious status. Moreover, our results indicated that the causal structure of tick-borne disease infections varied across different cities, underscoring the significance of considering the ecological environment and regional knowledge on ticks. This study provides valuable insights into the current landscape of tick-borne disease infections in northeast China and identifies potential behavioral and cognitive factors, an aspect that has not been previously investigated. Our findings enable predictions on the future impact of knowledge dissemination efforts and improved urban facilities on mitigating tick bites and reducing tick-borne disease infections.

The risk of contact between visitors and Borrelia burgdorferi-infected ticks is associated with fine-scale landscape features in a southeastern Canadian nature park

BACKGROUND

Infectious diseases are emerging across temperate regions of the world, and, for some, links have been made between landscapes and emergence dynamics. For tick-borne diseases, public parks may be important exposure sites for people living in urbanized areas of North America and Europe. In most cases, we know more about the ecological processes that determine the hazard posed by ticks as disease vectors than we do about how human population exposure varies in urban natural parks.

METHODS

In this study, infrared counters were used to monitor visitor use of a public natural park in southern Quebec, Canada. A risk index representing the probability of encounters between humans and infected vectors was constructed. This was done by combining the intensity of visitor trail use and the density of infected nymphs obtained from field surveillance. Patterns of risk were examined using spatial cluster analysis. Digital forest data and park infrastructure data were then integrated using spatially explicit models to test whether encounter risk levels and its components vary with forest fragmentation indicators and proximity to park infrastructure.

RESULTS

Results suggest that, even at a very fine scales, certain landscape features and infrastructure can be predictors of risk levels. Both visitors and Borrelia burgdorferi-infected ticks concentrated in areas where forest cover was dominant, so there was a positive association between forest cover and the risk index. However, there were no associations between indicators of forest fragmentation and risk levels. Some high-risk clusters contributed disproportionately to the risk distribution in the park relative to their size. There were also two high-risk periods, one in early summer coinciding with peak nymphal activity, and one in early fall when park visitation was highest.

CONCLUSIONS

Here, we demonstrate the importance of integrating indicators of human behaviour visitation with tick distribution data to characterize risk patterns for tick-borne diseases in public natural areas. Indeed, understanding the environmental determinants of human-tick interactions will allow organisations to deploy more effective risk reduction interventions targeted at key locations and times, and improve the management of public health risks associated with tick-borne diseases in public spaces.

Knowledge, protective behaviours, and perception of Lyme disease in an area of emerging risk: results from a cross-sectional survey of adults in Ottawa, Ontario

BACKGROUND

The number of Lyme disease risk areas in Canada is growing. In regions with emerging tick populations, it is important to emphasize peridomestic risk and the importance of protective behaviours in local public health communication. This study aims to identify characteristics associated with high levels of Lyme disease knowledge and adoption of protective behaviours among residents in the Ottawa, Ontario region.

METHODS

A geographically stratified web survey was conducted in November 2020 (n = 2018) to determine knowledge, attitudes, and practices regarding Lyme disease among adult residents. Responses were used to calculate: (i) composite scores for knowledge and adoption of protective practices; and (ii) an exposure risk index based on reported activity in woodlands during the spring-to-fall tick exposure risk period.

RESULTS

60% of respondents had a high knowledge of Lyme disease, yet only 14% indicated they often use five or more measures to protect themselves. Factors strongly associated with a high level of Lyme disease knowledge included being 55 or older (Odds Ratio (OR) = 2.04), living on a property with a yard (OR = 3.22), having a high exposure index (OR = 1.59), and knowing someone previously infected with Lyme disease (OR = 2.05). Strong associations with the adoption of a high number of protective behaviours were observed with membership in a non-Indigenous racialized group (OR = 1.70), living on a property with a yard (OR = 2.37), previous infection with Lyme disease (OR = 2.13), prior tick bite exposure (OR = 1.62), and primarily occupational activity in wooded areas (OR = 2.31).

CONCLUSIONS

This study highlights the dynamics between Lyme disease knowledge, patterns of exposure risk awareness, and vigilance of personal protection in a Canadian region with emerging Lyme disease risk. Notably, this study identified gaps between perceived local risk and protective behaviours, presenting opportunities for targeted enhanced communication efforts in areas of Lyme disease emergence.

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

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

Self-reported tick exposure as an indicator of Lyme disease risk in an endemic region of Quebec, Canada

BACKGROUND

Lyme disease (LD) and other tick-borne diseases are emerging across Canada. Spatial and temporal LD risk is typically estimated using acarological surveillance and reported human cases, the former not considering human behavior leading to tick exposure and the latter occurring after infection.

OBJECTIVES

The primary objective was to explore, at the census subdivision level (CSD), the associations of self-reported tick exposure, alternative risk indicators (predicted tick density, eTick submissions, public health risk level), and ecological variables (Ixodes scapularis habitat suitability index and cumulative degree days > 0 °C) with incidence proportion of LD. A secondary objective was to explore which of these predictor variables were associated with self-reported tick exposure at the CSD level.

METHODS

Self-reported tick exposure was measured in a cross-sectional populational health survey conducted in 2018, among 10,790 respondents living in 116 CSDs of the Estrie region, Quebec, Canada. The number of reported LD cases per CSD in 2018 was obtained from the public health department. Generalized linear mixed-effets models accounting for spatial autocorrelation were built to fulfill the objectives.

RESULTS

Self-reported tick exposure ranged from 0.0 % to 61.5 % (median 8.9 %) and reported LD incidence rates ranged from 0 to 324 cases per 100,000 person-years, per CSD. A positive association was found between self-reported tick exposure and LD incidence proportion (ß = 0.08, CI = 0.04,0.11, p < 0.0001). The best-fit model included public health risk level (AIC: 144.2), followed by predicted tick density, ecological variables, self-reported tick exposure and eTick submissions (AIC: 158.4, 158.4, 160.4 and 170.1 respectively). Predicted tick density was the only significant predictor of self-reported tick exposure (ß = 0.83, CI = 0.16,1.50, p = 0.02).

DISCUSSION

This proof-of-concept study explores self-reported tick exposure as a potential indicator of LD risk using populational survey data. This approach may offer a low-cost and simple tool for evaluating LD risk and deserves further evaluation.

Tick bite risk factors and prevention measures in an area with emerging Powassan virus disease

Background

In the United States (U.S.), Powassan virus is primarily transmitted to humans by the black-legged tick (Ixodes scapularis). Rarely, infections can present as severe neuroinvasive disease. In 2019, four neuroinvasive disease cases were reported in Sussex County, New Jersey, U.S. We administered a survey to county residents to better understand tick bite risk factors and the performance of personal prevention measures.

Methods

A survey was administered in October 2019 to adult residents of randomly selected households. Questions focused on tick bite prevention and risk factors. Crude and adjusted odds ratios (ORs) and 95% confidence intervals were calculated for various outcomes.

Results

Of 274 participants, 25% were previously diagnosed with a tick-borne disease, and 42% reported finding an attached tick in 2019. Yardwork and gardening (OR = 7.38) and spending >50 hours outdoors per week (OR = 8.15) were associated with finding an attached tick. Finding an attached tick was inversely associated with the number of prevention measures used, indicating that a layered approach could reduce the risk of tick bites. Those who performed post-outdoor activity prevention measures (e.g., tick checks) were less likely to have a tick attached compared to finding a crawling tick.

Conclusion

Compliance with prevention recommendations was low, despite a high prevalence of reported tick bites and significant outdoor exposures. Older adults and persons who spend significant time outdoors or engage in yardwork or gardening were at the highest risk of tick bites. Additional research is needed to further understand the barriers to tick bite prevention.

Collaborative Modeling of the Tick-Borne Disease Social-Ecological System: A Conceptual Framework

Hard-bodied ticks have become a major concern in temperate regions because they transmit a variety of pathogens of medical significance. Ticks and pathogens interact with hosts in a complex social-ecological system (SES) that influences human exposure to tick-borne diseases (TBD). We argue that addressing the urgent public health threat posed by TBD requires an understanding of the integrated processes in the forest ecosystem that influence tick density and infection prevalence, transmission among ticks, animal hosts, and ultimately disease prevalence in humans. We argue that collaborative modeling of the human-tick SES is required to understand the system dynamics as well as move science toward policy action. Recent studies in human health have shown the importance of stakeholder participation in understanding the factors that contribute to human exposure to zoonotic diseases. We discuss how collaborative modeling can be applied to understand the impacts of forest management practices on ticks and TBD. We discuss the potential of collaborative modeling for encouraging participation of diverse stakeholders in discussing the implications of managing forest ticks in the absence of large-scale control policy.

Risky business: human-related data is lacking from Lyme disease risk models

Used as a communicative tool for risk management, risk maps provide a service to the public, conveying information that can raise risk awareness and encourage mitigation. Several studies have utilized risk maps to determine risks associated with the distribution of Borrelia burgdorferi, the causal agent of Lyme disease in North America and Europe, as this zoonotic disease can lead to severe symptoms. This literature review focused on the use of risk maps to model distributions of B. burgdorferi and its vector, the blacklegged tick (Ixodes scapularis), in North America to compare variables used to predict these spatial models. Data were compiled from the existing literature to determine which ecological, environmental, and anthropic (i.e., human focused) variables past research has considered influential to the risk level for Lyme disease. The frequency of these variables was examined and analyzed via a non-metric multidimensional scaling analysis to compare different map elements that may categorize the risk models performed. Environmental variables were found to be the most frequently used in risk spatial models, particularly temperature. It was found that there was a significantly dissimilar distribution of variables used within map elements across studies: Map Type, Map Distributions, and Map Scale. Within these map elements, few anthropic variables were considered, particularly in studies that modeled future risk, despite the objective of these models directly or indirectly focusing on public health intervention. Without including human-related factors considering these variables within risk map models, it is difficult to determine how reliable these risk maps truly are. Future researchers may be persuaded to improve disease risk models by taking this into consideration.

Molecular characterization of Amblyomma geoemydae using CO1 mitochondrial gene to validate phenotypic taxonomical evaluation

Animal ectoparasites are linked to the spread of serious medical and veterinary important pathogens. Our research intends to close the knowledge gap concerning the numerous ectoparasites that inhabit animals in Wayanad. Ectoparasites in animals brought to the veterinary dispensaries in Wayanad were retrieved and identified morphologically and molecularly. Using a high-quality stereomicroscope, the taxonomic features of the four following species were examined and identified: Haemaphysalis bispinosa, Rhipicephalus annulatus, R. microplus, and Amblyomma geoemydae. The important disease vector A. geoemydae was reported for the first time in Kerala. The important phenotypic characters of the highlighted species A. geoemydae are the edge of the basis capituli is circular without cornua, and the hypostomal dental formula is 2/2. The taxonomically identified four species were subjected to CO1 gene sequence analysis. The evolutionary relationship was inspected through the neighbour-joining method, and the phylogenetic tree was built through the Maximum Likelihood method. The present study has also estimated the diversity index of R. microplus, R. annulatus, H. bispinosa, and A. geoemydae. Among them, R. microplus 0.36638 have reported with the maximum diversity index score. The significance of the study is the presence of Lyme disease vector A. geoemydae, in the Wayanad District of Kerala, and it is the first report of the species from where an outbreak of Lyme disease occurred in 2013.

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.

Fluralaner Baits Reduce the Infestation of Peromyscus spp. Mice (Rodentia: Cricetidae) by Ixodes scapularis (Acari: Ixodidae) Larvae and Nymphs in a Natural Environment

The development of interventions that reduce Lyme disease incidence remains a challenge. Reservoir-targeted approaches aiming to reduce tick densities or tick infection prevalence with Borrelia burgdorferi have emerged as promising ways to reduce the density of infected ticks. Acaricides of the isoxazoline family offer high potential for reducing infestation of ticks on small mammals as they have high efficacy at killing feeding ticks for a long period. Fluralaner baits were recently demonstrated as effective, in the laboratory, at killing Ixodes scapularis larvae infesting Peromyscus mice, the main reservoir for B. burgdorferi in northeastern North America. Here, effectiveness of this approach for reducing the infestation of small mammals by immature stages of I. scapularis was tested in a natural environment. Two densities of fluralaner baits (2.1 baits/1,000 m2 and 4.4 baits/1,000 m2) were used during three years in forest plots. The number of I. scapularis larvae and nymphs per mouse from treated and control plots were compared. Fluralaner baiting reduced the number of larvae per mouse by 68% (CI95: 51-79%) at 2.1 baits/1,000 m2 and by 86% (CI95: 77-92%) at 4.4 baits/1,000 m2. The number of nymphs per mouse was reduced by 72% (CI95: 22-90%) at 4.4 baits/1,000 m2 but was not significantly reduced at 2.1 baits/1,000 m2. Reduction of Peromyscus mouse infestation by immature stages of I. scapularis supports the hypothesis that an approach targeting reservoirs of B. burgdorferi with isoxazolines has the potential to reduce tick-borne disease risk by decreasing the density of infected ticks in the environment.