Usability and Feasibility of a Smartphone App to Assess Human Behavioral Factors Associated with Tick Exposure (The Tick App): Quantitative and Qualitative Study

An effective internet-based system for surveillance and elimination of triatomine insects: AlertaChirimacha

Vector-borne diseases remain a significant public health threat in many regions of the world. Traditional vector surveillance and control methods have relied on active and passive surveillance programs, which are often costly and time-consuming. New internet-based vector surveillance systems have shown promise in removing some of the cost and labor burden from health authorities. We developed and evaluated the effectiveness of a new internet-based surveillance system, "AlertaChirimacha", for detecting Triatoma infestans (known locally by its Quechua name, Chirimacha), the Chagas disease vector, in the city of Arequipa, Peru. In the first 26 months post-implementation, AlertaChirimacha received 206 reports of residents suspecting or fearing triatomines in their homes or neighborhoods, of which we confirmed, through pictures or inspections, 11 (5.3%) to be Triatoma infestans. After microscopic examination, none of the specimens collected were infected with Trypanosoma cruzi. AlertaChirimacha received 57% more confirmed reports than the traditional surveillance system and detected 10% more infested houses than active and passive surveillance approaches combined. Through in-depth interviews we evaluate the reach, bilateral engagement, and response promptness and efficiency of AlertaChirimacha. Our study highlights the potential of internet-based vector surveillance systems, such as AlertaChirimacha, to improve vector surveillance and control efforts in resource-limited settings. This approach could decrease the cost and time horizon for the elimination of vector-mediated Chagas disease in the region.

Improving Surveillance of Human Tick-Borne Disease Risks: Spatial Analysis Using Multimodal Databases

BACKGROUND

The extent of tick-borne disease (TBD) risk in the United States is generally unknown. Active surveillance using entomological measures, such as presence and density of infected nymphal Ixodes scapularis ticks, have served as indicators for assessing human risk, but results have been inconsistent and passive surveillance via public health systems suggests TBDs are underreported.

OBJECTIVE

Research using various data sources and collection methods (eg, Google Trends, apps, and tick bite encounters [TBEs] reports) has shown promise for assessing human TBD risk. In that vein, and engaging a One Health perspective, this study used multimodal databases, geographically overlaying patient survey data on TBEs and concomitant reports of TBDs with data drawn from other sources, such as canine serological reports, to glean insights and to determine and assess the use of various indicators as proxies for human TBD risk.

METHODS

This study used a mixed methods research strategy, relying on triangulation techniques and drawing on multiple data sources to provide insights into various aspects of human disease risk from TBEs and TBDs in the United States. A web-based survey was conducted over a 15-month period beginning in December 2020 to collect data on TBEs. To maximize the value of the covariate data, related analyses included TBE reports that occurred in the United States between January 1, 2000, and March 31, 2021. TBEs among patients diagnosed with Lyme disease were analyzed at the county level and compared to I scapularis and I pacificus tick presence, human cases identified by the Centers for Disease Control and Prevention (CDC), and canine serological data. Spatial analyses employed multilayer thematic mapping and other techniques.

RESULTS

After cleaning, survey results showed a total of 249 (75.7%) TBEs spread across 148 respondents (61.9% of all respondents, 81.7% of TBE-positive respondents); 144 (4.7%) counties in 30 states (60%) remained eligible for analysis, with an average of 1.68 (SD 1.00) and median of 1 (IQR 1) TBEs per respondent. Analysis revealed significant spatial matching at the county level among patient survey reports of TBEs and disease risk indicators from the CDC and other official sources. Thematic mapping results included one-for-one county-level matching of reported TBEs with at least 1 designated source of human disease risk (ie, positive canine serological tests, CDC-reported Lyme disease, or known tick presence).

CONCLUSIONS

Use of triangulation methods to integrate patient data on TBE recall with established canine serological reports, tick presence, and official human TBD information offers more granular, county-level information regarding TBD risk to inform clinicians and public health officials. Such data may supplement public health sources to offer improved surveillance and provide bases for developing robust proxies for TBD risk among humans.

Perception of risk among children: Exploring the risk of TB-rickettsial disease based on the children's drawing pictures in a Mayan community of Yucatan

Background

It is important to work on designs of health promotion strategies that involve educational interventions about the risk factors associated to TB-rickettsiosis (Tick-Borne rickettsiosis). Children's drawings provide a window into their thoughts and feelings. The aim was to analyze children's risk perceptions regarding by the presence of ticks in a rural community in southeast Mexico.

Methods

The main framework used was a social cognitive perspective under the Health Belief Model. Study was carried out in rural elementary schools and included a drawing contest. A total of 224 children (8-12 years old) participated. Drawings were coded and classified; descriptive trend analysis was performed using counts and percentages. The qualitative data was analyzed by researcher experts in TB- rickettsiosis and using Atlas ti V.8.

Results

Results are presented in seven categories that consider environmental elements, actors, and cognitive aspects. The environmental context, 99.1% of the drawings represent sites outside the home (92% include vegetation with the presence of ticks in their immediate external environment). In the actors' category, 69.6% included people carrying out activities (prevention and risk). As for the cognitive aspects, 70% included domestic pets and 13.4% farmyards animals.

Conclusion

The children expressed their ideas about risk factors and preventive measures against TB-rickettsiosis with a self-care approach. They acquired knowledge about preventive strategies and clinical symptoms. It is necessary to evaluate what happens after an intervention and how they implement in their lives what they have learned.

Evaluating spatial and temporal patterns of tick exposure in the United States using community science data submitted through a smartphone application

Research initiatives that engage the public (i.e., community science or citizen science) increasingly provide insights into tick exposures in the United States. However, these data have important caveats, particularly with respect to reported travel history and tick identification. Here, we assessed whether a smartphone application, The Tick App, provides reliable and novel insights into tick exposures across three domains - travel history, broad spatial and temporal patterns of species-specific encounters, and tick identification. During 2019-2021, we received 11,424 tick encounter submissions from across the United States, with nearly all generated in the Midwest and Northeast regions. Encounters were predominantly with human hosts (71%); although one-fourth of ticks were found on animals. Half of the encounters (51%) consisted of self-reported peri‑domestic exposures, while 37% consisted of self-reported recreational exposures. Using phone-based location services, we detected differences in travel history outside of the users' county of residence along an urbanicity gradient. Approximately 75% of users from large metropolitan and rural counties had travel out-of-county in the four days prior to tick detection, whereas an estimated 50-60% of users from smaller metropolitan areas did. Furthermore, we generated tick encounter maps for Dermacentor variabilis and Ixodes scapularis that partially accounted for travel history and overall mirrored previously published species distributions. Finally, we evaluated whether a streamlined three-question sequence (on tick size, feeding status, and color) would inform a simple algorithm to optimize image-based tick identification. Visual aides of tick coloration and size engaged and guided users towards species and life stage classification moderately well, with 56% of one-time submitters correctly selecting photos of D. variabilis adults and 76% of frequent-submitters correctly selecting photos of D. variabilis adults. Together, these results indicate the importance of bolstering the use of smartphone applications to engage community scientists and complement other active and passive tick surveillance systems.

Passive collection of ticks in New Hampshire reveals species-specific patterns of distribution and activity

Ticks and tick-borne diseases are increasing in the United States, including New Hampshire (NH). We report on the findings of an ongoing free crowdsourcing program spanning four years within NH. The date of tick's submission was recorded along with species, sex, stage, location they were collected (translated into latitude and longitude), the activity the individual was doing when the tick was found, and host species. A total of 14,252 ticks belonging to subclass Acari, family Ixodidae and genera Ixodes, Dermacentor, Amblyomma, and Haemaphysalis was recorded from the period 2018-2021 throughout NH. A total of 2,787 Ixodes scapularis and 1,041 Dermacentor variabilis, were tested for the presence of Borrelia sp. (Spirochaetales: Spirochaetaceae), B. burgdorferi sensu lato, B. miyamotoi, B. mayonii, Babesia microti (Piroplasmida: Babesiidae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), Francisella tularensis (Thiotrichales: Francisellaceae), and Rickettsia rickettsii (Rickettsiales: Rickettsiaceae) by PCR. For the I. scapularis ticks tested, the pathogen prevalence was 37% B. burgdorferi s.l. 1% B. miyamotoi, 6% A. phagocytophilum, and 5% Ba. microti. Only one D. variabilis resulted positive to F. tularensis. We created state-wide maps informing the differences of ticks as detailed by administrative divisions. Dermacentor variabilis peaked in June and I. scapularis peaked in May and October. The most reported activity by people with tick encounters was while walking/hiking, and the least was biking. Using the reported distribution of both species of ticks, we modeled their climate suitability in the target territory. In NH, I. scapularis and D. variabilis have distinct patterns of emergence, abundance, and distribution. Tick prevention is important especially during April-August when both tick species are abundant and active.

A citizen science approach to investigate the distribution, abundance, and pathogen infection of vector ticks through active surveillance

Tick-borne disease poses a growing public health burden in the United States and understanding the patterns of presence and density of infected vector ticks is key to developing and implementing effective public health management strategies. Citizen science has emerged as a highly effective means to generate data sets on the geographical distribution of tick species. But to date, nearly all citizen science studies of ticks are 'passive surveillance' programs in which researchers accept reports of ticks, together with either physical specimens or digital images, found opportunistically on people, pets, and livestock from community members for species identification and in some cases also tick-borne pathogen detection. These studies are limited because data are not collected systematically, making comparisons among locations and over time challenging, and introducing considerable reporting bias. In this study, we engaged citizen scientists in 'active surveillance' of host-seeking ticks, training volunteers to actively collect ticks on their woodland properties in an emergent region of tick-borne disease in the state of Maine, USA. We developed volunteer recruitment strategies, materials to train volunteers in data collection methods, field data collection protocols based on techniques used by professional scientists, and a variety of incentives to promote volunteer retention and satisfaction with their experiences, and we communicated research findings to participants. A total of 125 volunteers in 2020 and 181 volunteers in 2021 collected 7,246 ticks in southern and coastal Maine, including the American dog tick (Dermacentor variabilis, 4,023 specimens), the blacklegged tick (Ixodes scapularis, 3,092 specimens), and the rabbit tick (Haemaphysalis leporispalustris, 102 specimens). We demonstrated the feasibility of citizen scientists collecting ticks using active surveillance methods and found that volunteers were motivated to participate largely by their interest in the scientific problem and a desire to learn about ticks on their properties.

Knowledge, attitudes, and practices for tick bite prevention and tick control among residents of Long Island, New York, USA

In the United States, tick-borne diseases (TBDs) are a major public health concern and a source of significant morbidity. To reduce tick-borne disease incidence, understanding factors associated with increased risk in humans for tick bites is necessary. These risk factors can include TBD knowledge, attitudes about prevention and care, and associated practices of individuals and their communities, including paying for preventive services. Our study focused on Long Island, New York, a region with high endemicity of ticks and TBDs. The purpose of our study was to identify gaps in the knowledge, attitudes, and practices regarding TBDs in residents of this region to inform priorities for TBD interventions. To this end, we performed a knowledge, attitudes, and practices (KAP) survey and collected 803 responses from Long Island residents. Our survey results demonstrated that Long Island residents had a low to moderate level of knowledge regarding ticks and TBDs. Still, residents expressed concern regarding TBDs, with increased levels of concern associated with increased likelihood of paying for tick control and for practicing tick bite prevention strategies. Individuals with pets were more likely to practice these tick bite prevention strategies. Residents with more frequent exposure to ticks, with a history of TBD in their household, and with higher general concern over ticks were also more likely to pay for tick control services. These findings highlight gaps in resident knowledge, differences in attitudes towards tick preventative behavior, and potential factors affecting motivation towards implementing tick control measures, which can inform future public health messaging regarding tick bite prevention.

Surveillance of Rocky Mountain wood ticks (Dermacentor andersoni) and American dog ticks (Dermacentor variabilis) in Colorado

Ticks pose an emerging threat of infectious pathogen transmission in the United States in part due to expanding suitable habitat ranges in the wake of climate change. Active and passive tick surveillance can inform maps of tick distributions to warn the public of their risk of exposure to ticks. In Colorado, widespread active surveillance programs have difficulty due to the state's diverse terrain. However, combining multiple citizen science techniques can create a more accurate representation of tick distribution than any passive surveillance dataset alone. Our study uses county-level tick distribution data from Northern Arizona University, the Colorado Department of Public Health and the Environment, and veterinary surveillance in addition to literature data to assess the distribution of the Rocky Mountain wood tick, Dermacentor andersoni, and the American dog tick, Dermacentor variabilis. We found that D. andersoni for the most part inhabits counties at higher elevations than D. variabilis in Colorado.

Outdoor Activity Associated with Higher Self-Reported Emotional Well-Being During COVID-19

Shifts in activity patterns during the COVID-19 pandemic might have impacted the benefits of outdoor activities for mental health. By leveraging an existing mobile application, we collected self-reported data on daily outdoor activities, emotional well-being, and the influence of COVID-19 on participant's outdoor activity levels during April-July 2020. Individuals reporting outdoor activities, in greenspaces or in their residence, had higher well-being scores and this effect increased with age. Self-reported impacts of COVID-19 on emotional well-being were associated with lower well-being scores. This work suggests that outdoor activities may have improved mental health during the COVID-19 pandemic.

All for One Health and One Health for All: Considerations for Successful Citizen Science Projects Conducting Vector Surveillance from Animal Hosts

Simple Summary

Vector-borne diseases are often zoonotic and so a One Health approach must be employed in order to investigate and control them. Therefore, surveillance of arthropod vectors and pathogens among animal populations should complement human disease surveillance. Since traditional surveillance methods to collect arthropod vectors and conduct pathogen testing from animals can be challenging, data collection can be supplemented with citizen science approaches, where the general public is actively involved in collecting animals and/or samples. In this review, we discuss considerations for researchers to create a successful vector surveillance program using citizen science approaches with different stakeholders who own, have interests in, or work with animals.

Abstract

Many vector-borne diseases that affect humans are zoonotic, often involving some animal host amplifying the pathogen and infecting an arthropod vector, followed by pathogen spillover into the human population via the bite of the infected vector. As urbanization, globalization, travel, and trade continue to increase, so does the risk posed by vector-borne diseases and spillover events. With the introduction of new vectors and potential pathogens as well as range expansions of native vectors, it is vital to conduct vector and vector-borne disease surveillance. Traditional surveillance methods can be time-consuming and labor-intensive, especially when surveillance involves sampling from animals. In order to monitor for potential vector-borne disease threats, researchers have turned to the public to help with data collection. To address vector-borne disease and animal conservation needs, we conducted a literature review of studies from the United States and Canada utilizing citizen science efforts to collect arthropods of public health and veterinary interest from animals. We identified common stakeholder groups, the types of surveillance that are common with each group, and the literature gaps on understudied vectors and populations. From this review, we synthesized considerations for future research projects involving citizen scientist collection of arthropods that affect humans and animals.

Riding the Wave: Reactive Vector-Borne Disease Policy Renders the United States Vulnerable to Outbreaks and Insecticide Resistance

Funding for vector-borne disease surveillance, management, and research is cyclical and reactive in the United States. The subsequent effects have yielded gross inequities nationally that unintentionally support recurrent outbreaks. This policy forum is comprised of four primary subsections that collectively identify specific areas for improvement and offer innovative solutions to address national inadequacies in vector borne disease policy and infrastructure.

Community engaged tick surveillance and tickMAP as a public health tool to track the emergence of ticks and tick-borne diseases in New York

A community engaged passive surveillance program was utilized to acquire ticks and associated information throughout New York state. Ticks were speciated and screened for several tick-borne pathogens. Of these ticks, only I. scapularis was commonly infected with pathogens of human relevance, including B. burgdorferi, B. miyamotoi, A. phagocytophilum, B. microti, and Powassan virus. In addition, the geographic and temporal distribution of tick species and pathogens was determined. This enabled the construction of a powerful visual analytical mapping tool, tickMAP to track the emergence of ticks and tick-borne pathogens in real-time. The public can use this tool to identify hot-spots of disease emergence, clinicians for supportive evidence during differential diagnosis, and researchers to better understand factors influencing the emergence of ticks and tick-borne diseases in New York. Overall, we have created a community-engaged tick surveillance program and an interactive visual analytical tickMAP that other regions could emulate to provide real-time tracking and an early warning for the emergence of tick-borne diseases.

Identification of public submitted tick images: A neural network approach

Ticks and tick-borne diseases represent a growing public health threat in North America and Europe. The number of ticks, their geographical distribution, and the incidence of tick-borne diseases, like Lyme disease, are all on the rise. Accurate, real-time tick-image identification through a smartphone app or similar platform could help mitigate this threat by informing users of the risks associated with encountered ticks and by providing researchers and public health agencies with additional data on tick activity and geographic range. Here we outline the requirements for such a system, present a model that meets those requirements, and discuss remaining challenges and frontiers in automated tick identification. We compiled a user-generated dataset of more than 12,000 images of the three most common tick species found on humans in the U.S.: Amblyomma americanum, Dermacentor variabilis, and Ixodes scapularis. We used image augmentation to further increase the size of our dataset to more than 90,000 images. Here we report the development and validation of a convolutional neural network which we call "TickIDNet," that scores an 87.8% identification accuracy across all three species, outperforming the accuracy of identifications done by a member of the general public or healthcare professionals. However, the model fails to match the performance of experts with formal entomological training. We find that image quality, particularly the size of the tick in the image (measured in pixels), plays a significant role in the network's ability to correctly identify an image: images where the tick is small are less likely to be correctly identified because of the small object detection problem in deep learning. TickIDNet's performance can be increased by using confidence thresholds to introduce an "unsure" class and building image submission pipelines that encourage better quality photos. Our findings suggest that deep learning represents a promising frontier for tick identification that should be further explored and deployed as part of the toolkit for addressing the public health consequences of tick-borne diseases.

Challenges in Participant Engagement and Retention using Mobile Health Apps: A Literature Review (Preprint)

Background

Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps.

Objective

This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention.

Methods

We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention.

Results

Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained.

Conclusions

Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention.

Crowdsourced Tick Image-Informed Updates to U.S. County Records of Three Medically Important Tick Species

Burgeoning cases of tick-borne disease present a significant public health problem in the United States. Passive tick surveillance gained traction as an effective way to collect epidemiologic data, and in particular, photograph-based tick surveillance can complement in-hand tick specimen identification to amass distribution data and related encounter demographics. We compared the Federal Information Processing Standards (FIPS) code of tick photos submitted to a free public identification service (TickSpotters) from 2014 to 2019 to published nationwide county reports for three tick species of medical concern: Ixodes scapularis Say (Ixodida: Ixodidae), Ixodes pacificus Cooley and Kohls (Ixodida: Ixodidae), and Amblyomma americanum Linneaus (Ixodida: Ixodidae). We tallied the number of TickSpotters submissions for each tick species according to "Reported" or "Established" criteria per county, and found that TickSpotters submissions represented more than half of the reported counties of documented occurrence, and potentially identified hundreds of new counties with the occurrence of these species. We detected the largest number of new county reports of I. scapularis presence in Michigan, North Carolina, and Texas. Tick image submissions revealed potentially nine new counties of occurrence for I. pacificus, and we documented the largest increase in new county reports of A. americanum in Kentucky, Illinois, Indiana, and Ohio. These findings demonstrate the utility of crowdsourced photograph-based tick surveillance as a complement to other tick surveillance strategies in documenting tick distributions on a nationwide scale, its potential for identifying new foci, and its ability to highlight at-risk localities that might benefit from tick-bite prevention education.

Tick-Borne Disease Prevention Behaviors Among Participants in a Tick Surveillance System Compared with a Sample Of Master Gardeners

Theory-based approaches to health communication and behavior are increasingly applied to interventions that address poor public tick-borne disease prevention knowledge and practices. We sought to understand the tick-borne disease prevention behaviors among participants in a crowdsourced passive tick surveillance system that employs theory-based messages about tick bite risk and prevention strategies. We administered an electronic survey to a randomly selected sample of passive surveillance system users and compared their responses to those from a nationwide sample of Master Gardeners (MG), a group with heighten tick exposure due to outdoor activity. Over 80% of TickSpotters respondents, and over 75% of MG respondents encountered a tick in the past year. Among both groups, tick checks were the most frequently practiced prevention behavior, with over 70% of people performing them most or all the time after outdoor activity. A greater proportion of MGs used skin repellents such as DEET or picaridin than TickSpotters users, but more than 70% of respondents from both groups reported that they never or only sometimes use permethrin-treatment on clothing, and nearly half of both groups reportedly used no peridomestic tick treatments. TickSpotters respondents overwhelmingly reported recording tick encounter information and saving specimens for identification and testing, while only a small percentage of MGs monitored their tick encounters. These findings suggest that while both TickSpotters and MG groups appear to be practicing some important tick bite prevention behaviors, there remain areas that could benefit from targeted theory-based interventional approaches.

An analysis of companion animal tick encounters as revealed by photograph-based crowdsourced data

Background

Community science is increasingly utilized to track important vectors of companion animal disease, providing a scalable, cost‐effective strategy for identifying new foci, changing phenology, and disease prevalence across wide geographies.

Objectives

We examined photographs of ticks found attached to predominately dogs and cats reported to a photograph‐based tick surveillance program to identify potential areas for improvements in tick prevention education and risk intervention.

Methods

We compared estimated days of tick attachment using a Kruskal–Wallis one‐way analysis of variance, and a Pearson's chi‐square analysis of variance on the number of submissions by host type submitted for each season.

Results

The blacklegged tick (Ixodes scapularis) was the most common species reported (39.8%). Tick photographs submitted were almost entirely adults (89.5%), and ticks found on companion animals exhibited an estimated median engorgement time of 2.5 days. Ixodes scapularis displayed the highest median engorgement of the top tick species found feeding on companion animals (χ² = 98.96, p < 0.001). Ticks were spotted year‐round; during spring and summer, ticks collected from pets represented 15.4 and 12.8% of all submissions, but increased to 28.5 and 35.2% during autumn and winter, respectively.

Conclusions

Crowdsourced data reveal that mostly adult ticks are detected on pets, and they are found at a point in the blood‐feeding process that puts pets at heightened risk for disease transmission. The increase in proportion of ticks found on pets during colder months may reveal a critical knowledge gap amongst pet owners regarding seasonal activity of I. scapularis, a vector of Lyme disease, providing an opportunity for prevention‐education.

Impact of Land Use Changes and Habitat Fragmentation on the Eco-epidemiology of Tick-Borne Diseases

The incidence of tick-borne diseases has increased in recent decades and accounts for the majority of vector-borne disease cases in temperate areas of Europe, North America, and Asia. This emergence has been attributed to multiple and interactive drivers including changes in climate, land use, abundance of key hosts, and people's behaviors affecting the probability of human exposure to infected ticks. In this forum paper, we focus on how land use changes have shaped the eco-epidemiology of Ixodes scapularis-borne pathogens, in particular the Lyme disease spirochete Borrelia burgdorferi sensu stricto in the eastern United States. We use this as a model system, addressing other tick-borne disease systems as needed to illustrate patterns or processes. We first examine how land use interacts with abiotic conditions (microclimate) and biotic factors (e.g., host community composition) to influence the enzootic hazard, measured as the density of host-seeking I. scapularis nymphs infected with B. burgdorferi s.s. We then review the evidence of how specific landscape configuration, in particular forest fragmentation, influences the enzootic hazard and disease risk across spatial scales and urbanization levels. We emphasize the need for a dynamic understanding of landscapes based on tick and pathogen host movement and habitat use in relation to human resource provisioning. We propose a coupled natural-human systems framework for tick-borne diseases that accounts for the multiple interactions, nonlinearities and feedbacks in the system and conclude with a call for standardization of methodology and terminology to help integrate studies conducted at multiple scales.

Using convolutional neural networks for tick image recognition - a preliminary exploration

Smartphone cameras and digital devices are increasingly used in the capture of tick images by the public as citizen scientists, and rapid advances in deep learning and computer vision has enabled brand new image recognition models to be trained. However, there is currently no web-based or mobile application that supports automated classification of tick images. The purpose of this study was to compare the accuracy of a deep learning model pre-trained with millions of annotated images in Imagenet, against a shallow custom-build convolutional neural network (CNN) model for the classification of common hard ticks present in anthropic areas from northeastern USA. We created a dataset of approximately 2000 images of four tick species (Ixodes scapularis, Dermacentor variabilis, Amblyomma americanum and Haemaphysalis sp.), two sexes (male, female) and two life stages (adult, nymph). We used these tick images to train two separate CNN models - ResNet-50 and a simple shallow custom-built. We evaluated our models' performance on an independent subset of tick images not seen during training. Compared to the ResNet-50 model, the small shallow custom-built model had higher training (99.7%) and validation (99.1%) accuracies. When tested with new tick image data, the shallow custom-built model yielded higher mean prediction accuracy (80%), greater confidence of true detection (88.7%) and lower mean response time (3.64 s). These results demonstrate that, with limited data size for model training, a simple shallow custom-built CNN model has great prospects for use in the classification of common hard ticks present in anthropic areas from northeastern USA.

Potential for online crowdsourced biological recording data to complement surveillance for arthropod vectors

Voluntary contributions by citizen scientists can gather large datasets covering wide geographical areas, and are increasingly utilized by researchers for multiple applications, including arthropod vector surveillance. Online platforms such as iNaturalist accumulate crowdsourced biological observations from around the world and these data could also be useful for monitoring vectors. The aim of this study was to explore the availability of observations of important vector taxa on the iNaturalist platform and examine the utility of these data to complement existing vector surveillance activities. Of ten vector taxa investigated, records were most numerous for mosquitoes (Culicidae; 23,018 records, 222 species) and ticks (Ixodida; 16,214 records, 87 species), with most data from 2019–2020. Case studies were performed to assess whether images associated with records were of sufficient quality to identify species and compare iNaturalist observations of vector species to the known situation at the state, national and regional level based on existing published data. Firstly, tick data collected at the national (United Kingdom) or state (Minnesota, USA) level were sufficient to determine seasonal occurrence and distribution patterns of important tick species, and were able to corroborate and complement known trends in tick distribution. Importantly, tick species with expanding distributions (Haemaphysalis punctata in the UK, and Amblyomma americanum in Minnesota) were also detected. Secondly, using iNaturalist data to monitor expanding tick species in Europe (Hyalomma spp.) and the USA (Haemaphysalis longicornis), and invasive Aedes mosquitoes in Europe, showed potential for tracking these species within their known range as well as identifying possible areas of expansion. Despite known limitations associated with crowdsourced data, this study shows that iNaturalist can be a valuable source of information on vector distribution and seasonality that could be used to supplement existing vector surveillance data, especially at a time when many surveillance programs may have been interrupted by COVID-19 restrictions.

Benefits and Drawbacks of Citizen Science to Complement Traditional Data Gathering Approaches for Medically Important Hard Ticks (Acari: Ixodidae) in the United States

Tick-borne diseases are increasing in North America. Knowledge of which tick species and associated human pathogens are present locally can inform the public and medical community about the acarological risk for tick bites and tick-borne infections. Citizen science (also called community-based monitoring, volunteer monitoring, or participatory science) is emerging as a potential approach to complement traditional tick record data gathering where all aspects of the work is done by researchers or public health professionals. One key question is how citizen science can best be used to generate high-quality data to fill knowledge gaps that are difficult to address using traditional data gathering approaches. Citizen science is particularly useful to generate information on human-tick encounters and may also contribute to geographical tick records to help define species distributions across large areas. Previous citizen science projects have utilized three distinct tick record data gathering methods including submission of: 1) physical tick specimens for identification by professional entomologists, 2) digital images of ticks for identification by professional entomologists, and 3) data where the tick species and life stage were identified by the citizen scientist. We explore the benefits and drawbacks of citizen science, relative to the traditional scientific approach, to generate data on tick records, with special emphasis on data quality for species identification and tick encounter locations. We recognize the value of citizen science to tick research but caution that the generated information must be interpreted cautiously with data quality limitations firmly in mind to avoid misleading conclusions.

Predicting the current and future distribution of the western black-legged tick, Ixodes pacificus, across the Western US using citizen science collections

In the twenty-first century, ticks and tick-borne diseases have expanded their ranges and impact across the US. With this spread, it has become vital to monitor vector and disease distributions, as these shifts have public health implications. Typically, tick-borne disease surveillance (e.g., Lyme disease) is passive and relies on case reports, while disease risk is calculated using active surveillance, where researchers collect ticks from the environment. Case reports provide the basis for estimating the number of cases; however, they provide minimal information on vector population or pathogen dynamics. Active surveillance monitors ticks and sylvatic pathogens at local scales, but it is resource-intensive. As a result, data are often sparse and aggregated across time and space to increase statistical power to model or identify range changes. Engaging public participation in surveillance efforts allows spatially and temporally diverse samples to be collected with minimal effort. These citizen-driven tick collections have the potential to provide a powerful tool for tracking vector and pathogen changes. We used MaxEnt species distribution models to predict the current and future distribution of Ixodes pacificus across the Western US through the use of a nationwide citizen science tick collection program. Here, we present niche models produced through citizen science tick collections over two years. Despite obvious limitations with citizen science collections, the models are consistent with previously-predicted species ranges in California that utilized more than thirty years of traditional surveillance data. Additionally, citizen science allows for an expanded understanding of I. pacificus distribution in Oregon and Washington. With the potential for rapid environmental changes instigated by a burgeoning human population and rapid climate change, the development of tools, concepts, and methodologies that provide rapid, current, and accurate assessment of important ecological qualities will be invaluable for monitoring and predicting disease across time and space.

Highlights in Medical Entomology, 2019: Familiar Foes and New Frontiers

The 2019 Entomological Society of America annual meeting was held in St. Louis, Missouri, just blocks away from the iconic Gateway Arch. Representing a 'gateway to the West', this inspired the theme of the Highlights in Medical Entomology to reflect on the accomplishments of the past year as we move into a 'new frontier' of vector biology research. Papers were selected broadly across arthropods that influence public health, focusing on topics ranging from West Nile virus transmission, ticks and tick-borne disease, to advances in genetics and 'big data' studies. This included current perspectives on West Nile virus ecology and epidemiology, which has now been endemic in the United States for 20 yr. Additional topics such as the advantages of citizen science and the importance of scientific communication were also discussed. Together, these papers demonstrate the achievements of the vector community while emphasizing the challenges that we collectively face to reduce the burden of vector-borne disease.

Context matters: Contrasting behavioral and residential risk factors for Lyme disease between high-incidence states in the Northeastern and Midwestern United States

The dynamics of zoonotic vector-borne diseases are determined by a complex set of parameters including human behavior that may vary with socio-ecological contexts. Lyme disease is the most common vector-borne disease in the United States. The Northeast and upper Midwest are the regions most affected - two areas with differing levels of urbanization and differing sociocultural settings. The probability of being infected with Lyme disease is related to the risk of encounters with Ixodes scapularis ticks infected with Borrelia burgdorferi sensu lato, which reflects both the environmental tick hazard and human behaviors. Herein, we compare behavioral and peridomestic risk factors perceived to influence the risk for human-tick encounters between two high-incidence states in the Northeast (New York and New Jersey) and one high-incidence state in the Midwest (Wisconsin). We used a smartphone application, The Tick App, as a novel survey tool, during spring and summer of 2018. Adaptive human behavior was identified in the relationship between outdoor activities and the use of methods to prevent tick bites. More frequent recreational outdoor activities and gardening (a peridomestic activity) were associated with a 1.4-2.3 times increased likelihood of using personal protective measures to prevent tick bites, when accounting for demographics and previous Lyme diagnosis. Most outdoor activities were more frequently reported by participants from the Midwest (n = 697), representing an older demographic, than the Northeast (n = 396). Participants from the Northeast were less likely to report use of personal protective measures to prevent tick bites, but a larger proportion of participants from the Northeast reported application of environmental pesticides targeting ticks or mosquitoes or other insects on their property (34 % of 279 versus 22 % of 616 participants) and interventions to reduce the presence of peridomestic deer compared to participants from the Midwest (e.g. 20 % of 278 versus 7% of 615 participants reported having a deer proof fence). Participants from the Midwest were more likely to kill rodents on their property (28 % versus 13 %). These differences illustrate the need for further assessment of personal behavior and tick exposure in these two Lyme disease-endemic regions to aid in targeted public health messaging to reduce tick-borne diseases.

Spatio-Temporal Dynamics of Tick-Borne Diseases in North-Central Wisconsin from 2000-2016

Lyme disease is a well-recognized public health problem in the USA, however, other tick-borne diseases also have major public health impacts. Yet, limited research has evaluated changes in the spatial and temporal patterns of non-Lyme tick-borne diseases within endemic regions. Using laboratory data from a large healthcare system in north-central Wisconsin from 2000-2016, we applied a Kulldorf's scan statistic to analyze spatial, temporal and seasonal clusters of laboratory-positive cases of human granulocytic anaplasmosis (HGA), babesiosis, and ehrlichiosis at the county level. Older males were identified as the subpopulation at greatest risk for non-Lyme tick-borne diseases and we observed a statistically significant spatial and temporal clustering of cases (p < 0.05). HGA risk shifted from west to east over time (2000-2016) with a relative risk (RR) ranging from 3.30 to 11.85, whereas babesiosis risk shifted from south to north and west over time (2004-2016) with an RR ranging from 4.33 to 4.81. Our study highlights the occurrence of non-Lyme tick-borne diseases, and identifies at-risk subpopulations and shifting spatial and temporal heterogeneities in disease risk. Our findings can be used by healthcare providers and public health practitioners to increase public awareness and improve case detection.